What Can Happen, and What Can You Do?

If you lose Medicaid coverage, you may be responsible for paying the full cost of your long-term care services. This situation can be financially challenging, as long-term care expenses can be significant. Finding an alternative payment source is an immediate concern, even if you plan to reenroll for Medicaid coverage. The application process takes some time to complete.

Tap Into Existing Resources

For the short term, you may need to seek family help. If you previously did Medicaid planning, you may tap into personal savings or sell assets. If you qualify, you may need to explore other government programs providing financial assistance for long-term care, such as veterans benefits. Medicare policies traditionally don’t cover long-term care, but they do cover some skilled nursing home care in specific situations for a limited time.

Negotiate with the Care Facility

If you can’t cover the full cost of your long-term care, you may need to negotiate with the care facility, nursing home, or in-home services to find a solution. Some facilities may be willing to work out payment plans to avoid resident churn or make other arrangements to help you continue care. It’s in your best interest to seek the counsel of a disability or elder law attorney specializing in long-term care to negotiate a solution.

Care Facility Discharge

When a short-term fix isn’t available, or negotiations to alter payment obligations fail, the loss of Medicaid coverage may result in discharge from the facility or denied in-home or community-based care services. However, a facility is legally obligated to provide notice before discharging a resident. During this time, the facility and your elder law attorney can work with you or your family to arrange a safe and suitable transition to another living arrangement.

Disenrollment Numbers

The number of Medicaid cutoffs for previously existing beneficiaries has surpassed one million, with the expectation to increase between 14 to 18 million. So far, Medicaid-dependent facilities, nursing homes, and at-home and community-based services are not widely affected. Still, the law of large numbers indicates disenrollment can significantly impact some beneficiaries requiring long-term care.

Many Medicaid beneficiaries who have been released due to procedural issues or technicalities anticipate being reenrolled. However, according to Medicaid, states have up to “twelve months to return to normal eligibility and enrollment operations.” The permitted time frame creates havoc for many Americans who rely on Medicaid benefits. However, it’s catastrophic for beneficiaries receiving Medicaid for long-term care as costs in a facility may range from about $4,000 – $8,000 per month, depending on the location.

If You or a Loved One Are in Long-Term Care

Understand that the unwinding of Medicaid continuous enrollment happens by state. Some long-term care beneficiaries may be unaware that continuous enrollment has stopped. Beneficiaries or their loved ones may neglect to return Medicaid paperwork or omit required documents consistent with current Medicaid qualifiers.

Some long-term care providers raise concerns that staff shortages in state agencies that handle reenrollment will create delays in processing required patient paperwork. The twelve-month grace period Medicaid provides to the states creates a slow reenrollment process that affects providers who continue to care for residents without reimbursement.

Consult a Disability or Elder Law Attorney

If you have been cut off from Medicaid and need to reenroll, an attorney can guide you through the general steps to ensure your benefits begin again as soon as possible. Your lawyer can help you confirm the reason for the discontinuation of benefits. It may be a failure to provide required documentation since the end of continuous enrollment or changes in eligibility requirements.

Once you understand why it has happened, your attorney can gather the necessary documentation for the reenrollment process. Documents may include:

• Proof of income
• Identification documents
• Proof of residency
• Social Security number
• Other documents your state’s Medicaid office requests

Your disability or elder law attorney can ensure all relevant financial documents and medical records are included to support your application. They may contact the state’s Medicaid office and advise them that you have been receiving long-term care benefits in an effort to flag your application for expedited processing.

Because short-term loss of benefits can make maintaining residency in a long-term care facility difficult, your attorney can strategize a short-term solution that addresses your unique situation.

Appeals and Advocacy

If your Medicaid reenrollment application is denied or you face challenges during the reenrollment process, an elder law or disability attorney specializing in long-term care can help you through the appeals process. They can gather additional information, advocate on your behalf, and represent you in administrative hearings or appeals.

If you are in long-term care and lose Medicaid benefits, specific consequences will depend on individual circumstances and your state’s regulations. Pay close attention to your Medicaid status. Disenrollment may continue to affect long-term care beneficiaries for some time due to the end of the requirement in FFCRA legislation requiring continuous enrollment.

Consult with one of our experienced elder law or disability attorneys specializing in Medicaid and long-term care issues. They understand the laws and regulations and help you reenroll in Medicaid, securing the necessary coverage to continue your long-term care benefits.

We hope you found this article helpful. Contact our office at (740) 947-7277 and schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.

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Early January of 2023, the Department of Health and Human Services (HHS) released a Medicaid federal policy guide covering key dates for the end of the continuous enrollment provision no longer linked to the end of the public health emergency. In fact, the expiration has already occurred. As of April 2023, states may terminate Medicaid coverage and request a beneficiary redetermination.

Previous Spike in Medicaid Enrollment

Medicaid enrollment increased substantially during the pandemic. Now that continuous enrollment is ending, millions of Americans are at risk of losing their existing Medicaid coverage. Medicaid disenrollments happen at the state level, but states must comply with the federal rules to conduct renewals. Each state’s process may vary slightly.

The Kaiser Family Foundation (KFF), a non-profit focusing on national health issues, estimates between 5.3 to 14.2 million people will lose Medicaid coverage. HHS estimates as many as 15 million people may be disenrolled, including 6.8 million who may remain eligible but need to re-enroll.

Those who temporarily lose Medicaid coverage and re-enroll quickly are called “churn.” Churn may account for those individuals who experience short-term changes in circumstances or income that temporarily render them ineligible or face barriers in maintaining coverage because of the redetermination process that the end of the continuous enrollment provision brings.

Eligibility Checks

The federal government required states to develop plans to resume routine operations during the unwinding of the continuous enrollment process. Each state has renewal priorities and estimates for the time needed to complete the redetermination process and apply updated standards to reduce inappropriate coverage loss.

Streamlining renewal processes can help the continuity of coverage under the Affordable Care Act (ACA). Medicaid agency services can check eligibility through available data sources like the state wage databases before sending renewal forms or document requests to an enrollee. These electronic data checks can verify ongoing eligibility. However, of the 42 participating states, only 11 report completing 50 percent or more redeterminations using this process. The renewal process will be lengthy and cumbersome for most beneficiaries.

Medicaid Redetermination Process

Individuals who don’t renew automatically must go through the Medicaid redetermination process to continue receiving coverage. Absent the FFCRA provision for ongoing enrollment, the process will return to its annual renewal basis to ensure individuals receiving Medicaid benefits are still eligible.

The Medicaid agency will request that beneficiaries provide updated income, assets, and household information. They may also require the beneficiary to provide documentation such as pay stubs, tax returns, and bank statements to verify eligibility.

If the agency determines a beneficiary is no longer eligible for Medicaid, they may send a notice of termination and allow the individual to appeal the decision. If the beneficiary disagrees with the appeal decision, they can request a fair hearing to have their case reviewed by an impartial hearing officer.

Medicaid beneficiaries must respond promptly to any request for information from the Medicaid agency and keep their contact information current to receive important notices about their eligibility for benefits.

An Elder Law Attorney Helps with Redetermination Approval

An elder law attorney with disability experience can help during the Medicaid redetermination process in several ways, including:

• Assisting a beneficiary in preparing and submitting the necessary documentation and information to the Medicaid agency to support their continued eligibility for benefits. Preparation may include obtaining medical records, documenting changes in income or household composition, and responding to additional requests for information from the Medicaid agency.
• Helping a beneficiary understand their rights and options if their Medicaid benefits are terminated or reduced due to the redetermination process. Options may include appealing the decision, requesting a fair hearing, and advocating for the beneficiary’s rights and interests throughout the process. The attorney may represent and speak for them at an agency hearing.
• Assisting a beneficiary in navigating the complex rules and regulations of the Medicaid program, including any changes in eligibility criteria or program requirements. These changes may impact their ability to receive benefits, particularly since the end of the ongoing provision prompted requirements to change. Keeping current with program rules and regulations and any changes is particularly important for individuals with disabilities or chronic health conditions who may require ongoing medical care and support.

The prediction for millions of individuals to lose their Medicaid coverage, some temporarily and others more permanently, as the system returns to pre-pandemic annual eligibility reviews may be a costly disruption for some. For others, losing Medicaid coverage may be catastrophic to their health.

Medicaid is a joint federal and state program, and while the federal government has general rules which all state Medicaid programs must follow, each state runs its program. All states can now terminate Medicaid coverage and request a beneficiary redetermination process putting many at risk.

Contact one of our elder law attorneys at (740) 947-7277 to represent you if you are a Medicaid beneficiary facing the redetermination process. We protect your rights and access to vital healthcare services needed to maintain health and wellbeing.

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