|
Summary: As HCPF continues to work towards LTSS Stabilization and protecting vulnerable members from losing coverage inappropriately, we are implementing a workaround to also protect coverage for LTSS and Buy-In (WAwD and CBwD) members who lost coverage as of Sept. 30, 2024.
Details: HCPF implemented a system workaround to reinstate and keep impacted individuals covered until an appropriate resolution is found for their case. The week of Sept. 23, all LTSS and Buy-In (WAwD and CBwD) members who had a termination date of Sept. 30, 2024, will be reinstated as of Oct. 1, 2024. A new Notice of Action letter indicating an approval effective as of Oct. 1, 2024, will be sent to those members who were impacted. Impacted member reports will be shared with county directors.
Additional details:
- Impacted LTSS or Buy-In members include HCBS, NF, PACE, WAwD (with or without HCBS), and CBwD.
- NOTE: If the member is active in a secondary program for Medicare Savings (QMB or SLMB), this program will be reinstated as well.
- Termination effective Sept. 3, 2024, was for various reasons (not meeting financial criteria, LOC criteria, disability criteria, missing verifications, etc.).
- The system workaround was applied through an override record on the Medical Assistance Eligibility Determination Override screen.
-
The following comment was entered on this record: To maintain services to this vulnerable population, the Department has reinstated eligibility for LTSS and Buy-In members with an end date of Sept. 30, 2024.
Action: If an LTSS or Buy-In (WAwD and CBwD) member reaches out to you because they received a termination notice effective Sept. 30, 2024, please share this information with them, as those not receiving their communications electronically may be delayed in receiving communication via USPS mail. We have also shared this message with case managers, consumer advocates, and others who may hear from members receiving LTSS services who were originally notified that coverage was terminated on Sept. 30, 2024.
Please continue to work on these cases if there is work that is outstanding and data to be entered. (Outstanding verifications and/or information reported, Renewals, etc.)
The override record will continue to apply for the case until an Effective End Date is entered by HCPF. Additional information and guidance will be provided as soon as it is available.
If there is a need to modify the override record, please submit a Help Desk Ticket. This may be done for the following reasons only: member has died, moved out of state, voluntary withdrawal, Level of Care updated, and newly eligible for Medicare (MSP eligible).
NOTE: For nursing facility cases that require a 5615, if the case was previously terminated and the termination 5615 was sent to the facility prior to the reinstatement, a new approval 5615 will need to be completed for the member that was reinstated. If a member terminates due to one of the exemption reasons listed above, a termination 5615 can be sent reflecting the reason.
We want to acknowledge how challenging the past year has been for your staff and communities and realize that this message is coming at a time of great difficulty. Please know that we are dedicating resources to alleviating the pressures this will have on the county workload as much as possible.
Thank you sincerely for your continued partnership, so we can help members stay connected to needed services.
Contact: Questions regarding this communication may be directed to HCPF Medicaid Eligiblity.
| 
