Now that we know that expanded Medicaid is kicking off in a big way this month, with expanded eligibility and full integration of all the waiver populations and nursing home residents in the new Managed Long Term Services and Supports program, we need to start thinking about how this will affect clients’ particular interactions with Medicaid, the managed care organization (MCO) and providers. We know that the MCOs will be looking to keep costs down for each individual — depending on the person, they may think that the best and most cost-effective setting is at home, at an assisted living facility, or in a nursing home. Hopefully, the family will agree with their opinion! But that might not always be the case, and the place where that may come to a head is the Interdisciplinary Team meeting, or IDT.
This meeting, or series of meetings, are where the MCO, the family, state representatives and case managers will come together to see how much money can be spent on an individual in a particular setting, whether that setting is appropriate, and whether a family may accept the risk of keeping someone in a community setting if the MCO determines that it may be safer or more cost effective to have the recipient in an institutional setting. Documents may be presented to the Medicaid recipient or his or her representative for signing that may be confusing or not what the recipient wants. It would be a good idea to have your attorney with you at these IDT meetings. Call on us for support!
We represent clients in Medicaid and MLTSS applications, hearings and appeals. Call for appointment … 732-382-6070