The Governor has a Medicaid system improvement bill on his desk

If you or any of your colleagues, friends, or family members are in support of improving the system for Medicaid eligibility determinations, you should call the Governor’s Office  of new jersey’s Governor Murphy at 609.292.6000 and request that the Governor sign A4569/S499 into law. pass on this information to people you know who are interested in this issue.

According to BillTrack50, in its Bill Summary, This bill “requires the Commissioner of Human Services to develop an information technology platform for the intake, processing, and tracking of applications for benefits under the Medicaid and NJ FamilyCare programs.” Among other things, “The goals of the system will be: to simplify the applications and eligibility determination processes for both applicants and eligibility determination staff; to standardize application of eligibility policy across the various agencies responsible for eligibility determination; to allow for real-time tracking of the status of applications.”

At our Firm, we prepare and file Medicaid applications for the MLTSS long-term care Medicaid programs in nursing homes, assisted living and community care settings. It’s an incredibly complex process, since five years of transaction records are required, substantial evidence can be required for certain things, it can be challenging to explain transactions that occurred several years prior, and there seem to be many unwritten procedures and policies which vary a bit county by county. There are many legal pitfalls that can occur for an individual client that need particularized attention. Applications are regularly turned down due to insufficient evidence or failure to submit everything that is required. Applicants with alzheimers and other cognitive deterioration may not be able to recall or retrieve the necessary information.

Simplifying the application process would be great. This bill is a step ahead for monitoring and uniformity.

  • Implementation of the bill would bring accountability and uniformity to the Medicaid application system, in-line with the Governor’s goal to create a Fairer NJ. You can’t drive improvement to this process, if you can’t monitor.
  • Federal Government will pay 90% of IT development work and 75% for operations.
  • Bill has unanimous support in both houses
  • Bill is based on the report by the NJHCQI (Health Care Quality Institute), “Medicaid 2.0: Blueprint for the Future” with additional input/amendments/improvements by NJ NAELA (the New Jersey chapter of the National Academy of Elder Law Attorneys)
  • If you have personal or professional experience which reinforces the need for the implementation of this bill, you should feel free to share it with the Governor’s office.

Call us for legal advice on how to achieve Medicaid eligibility for someone who needs long-term care ……….. 732-382-6070

Applying for NJ MLTSS? Here are the acronyms you need to know

You probably know by now that NJ Medicaid’s Home and Community Based Services are now being administered NJ FamilyCare and that the State’s Comprehensive Medicaid Waiver has created a whole new landscape that is centered around managed care. http://www.state.nj.us/humanservices/dmahs/home/mltss.html When applying for these services you will encounter a lot of code words. For example, when your low-income or low-asset loved one is being discharged from the hospital, you might be told  that “as soon as he’s eligible financially for MLTSS, you need to contact the ADRC, request a referral to OCCO for a PAS, then file an application at the CWA and then if they meet LOC, you’ll  receive a PoC that includes HBSC and PCA, but you could choose the PPP instead, and you’ll have to sign off on the PoP and select an MCO.”  Aagh!  So  I thought I’d help out by listing them here:

DHS – NJ Department of Human Services

DAS – Division of Aging Services

DMAHS – Division of Medical Assistance and Health Services (administers NJ Family Care)

ADRC – Aging & Disabiality Resource Connection – or AAA – Area Agency on Aging  ( a county-based portal of entry for people seeking referrals for governmental programs)

DDS – Division of Disability Services (makes clinical determinations)

CWA – County Welfare Agency, sometimes called a Board or Division of Social Services (this is where the Medicaid application is filed and processed)

OCCO – Office of Community Choice Options (sends out the person to perform the clinical PAS, and decides whether to issue the PAS)

PAS – Pre-Admission Screening (required to establish clinical eligibility for Medicaid services)

LOC – Level of Care ( as in “she does not meet the level of care to receive services”)

HCBS – Home and Community Based Services (its an umbrella for many waiver services)

LTC – Long Term Care (nursing home care)

TBI – Traumatic Brain Injury Program ( a waiver program)

GO – Global Options (an older HCBS program waiver program under secn. 1915(c))

MFP – Money follows the Person, ( a federal mandate for funds to follow a person who is leaving a nursing home and going back to the community with services)

MCO – Managed Care Organization (all new Medicaid  recipients must select an MCO to manage their care)

PoC – Plan of Care (must be developed by the Care Manager from the MCO before services are started)

There are a variety of types of services that can be incorporated into a PoC. These include HBSC – Home-Based Supportive Care (non-medical, such as help with chores); PCA – Personal Care Assistant; PERS – personal Emergency Response System (phone button or necklace); PDN  – Private Duty Nursing (required for specific medical needs, up to 16 hours per day);

PPP – Personal Preference Program (Medicaid recipient becomes the employer and controls the terms and conditions of employment of their caregiving team)

IDT – Interdisciplinary Team review (done to assess costs and risks of the PoC)

ACT – Annual Cost Threshold (all services in the PoC are measured in comparison to this per-person capitation rate)

 

Next time … thoughts on the level-of-care assessment process.

Call us for legal advice on Medicaid eligibility …  732-382-6070