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Summary: The LTSS 60-Day Extension Project, CPPM-9472, went into effect on Jan. 1, 2025. This means that an LTSS member who receives a termination will get an additional 60 days in which to resolve their case to retain coverage (exceptions listed below). Here are some tips and reminders related to this project. Please review these tips and share them with your teams as appropriate.
Details: To allow time for LTSS system stabilization, an HDT was applied to all LTSS, PACE, and Buy-in cases in March 2024, putting them in a pending status to prevent the case from closing because of system action. Users still had the ability to remove the HDT to apply updates to the case. They were instructed to reapply for the HDT. If an LTC, PACE, or Buy-In case was terminated, they were reinstated, and the HDT was reapplied.
To ensure that every member has the HDT removed and is appropriately determined, on the 5th of every month, the HDT will be removed for that renewal month due. For example, a member’s renewal is due in June 2025. On the 5th of June 2025, the HDT will be removed systematically. Members who have not returned their renewal packet by this date will receive the 60-day extension upon removal of the HDT. The following are the termination reasons that are an exception to receiving a 60-day notice:
- Death
- No longer a Colorado resident
- Withdrawal from the program
- Incarceration
- Over Income (Being implemented March 8)
- Over Resources (Being implemented March 8)
The reinstatement and HDT process stopped with the initiation of the 60-day extension project. HDTs are no longer being applied to new cases. Users should not reapply HDTs when they are removed to run the case. If a termination results, users should allow this to happen as the case will fall into the 60-day extension process. NOTE: This includes cases that are being worked for COLA. Again, users can remove the Pend HDT from the case and terminate members prior to their renewal month. For example, users are clearing COLA and have some members who are ineligible when EDBC is run. To clear the COLA "flag," they must authorize the case, which will terminate the member. Users do not need to wait until the member's renewal is due to remove the HDT. The termination can happen at any time, and the member will receive the 60-day extension.
Members may receive more than one 60-day extension. However, they cannot receive consecutive extensions. For example, if a member received an extension in January 2025, if their case is not resolved by March 2025, they cannot receive another 60-day extension at that time. However, if they do reestablish eligibility, and something happens later in the year that doesn’t fall into the exception reasons, the member may receive another 60-day extension.
Tips:
A Cognos report accompanies this project, which details all members. The report is called MA LTC and Buy-In Eligibility Extension. This report is refreshed weekly and includes all members in your county who received and are in the 60-day extension period. Once the extension expires, the member will drop off the report. This report includes the following details:
- Case ID
- State ID
- DOB
- Name
- Case Information
- Status
- Combo
- Contact information
- County
- Primary/Secondary Aid Code
- Renewal Due Date
- Renewal Status
- Initial and Extended Termination Date and Month
- Termination Reason
Action: Counties and Eligibility Sites should use this report to support their members. The report can be sorted to prioritize work and outreach to members. It is recommended that termination reasons Failed to Provide Verification and Failure to Complete the Renewal Process should be a focus. Check to see if renewal packets or verifications have been received and need to be processed. Reach out to members and authorized representatives to facilitate the submission of required documentation. Coordinate with Case Management Agencies and Nursing Facilities to ensure members do not experience a gap in coverage.
Other Outreach Efforts: The Department is conducting outreach to members receiving a 60-day extension. An automated message will go through an auto-dialer process. A text and/or email will be sent to the members as well. Lists will be shared with NFs, PACE, ICFs, and CMAs to enlist their help in maintaining coverage.
Contact: Questions regarding this communication may be directed to the HCPF Medicaid eligibility inbox.
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