Notes from Medicaid Advisory Committee July 15, 2013

From the Center on Law and Poverty

 

Notes from MAC Meeting July 15, 2013

 

Centennial Care Updates:

 

·         Centennial Care Waiver was approved today.
·         HSD plans to do public education and outreach regarding centennial care. This will include 200+ meetings targeted at various groups.
·         Current Medicaid enrollees will get an orange envelope in the mail with information about how their coverage is changing.
·         Open enrollment will begin October 15, 2013 for Centennial Care. Applications will be evaluated using the current eligibility rules and using the new eligibility rules. Individuals who will be eligible under the expansion will have their applications held for approval January 1, 2014. Even though the ASPEN system won’t be rolled out in every county, applications under the new eligibility rules will be processed through ASPEN. The 60 day income verification rule will not be a problem for people to be considered eligible Jan 1, 2014 but supplying income information in Oct.
·         Molina will be taking over for Lovelace in one month. They have almost identical provider networks. There are 1400 people who will need to switch. First course of action will be to try to contract with these people’s providers who are currently out of network.
·         Centennial Care will have consumer directed care. It was thought that this would be eliminated, but the disability community spoke out against it and this option will remain for individuals who wish to coordinate long term care services for themselves rather than delegate that to a company.
·         “reasonable promptness” requirement for long term care services has been waived. This is because there will continue to be a limited number of recipients in Centennial care who are not eligible for Medicaid under the expansion or as an SSI recipient who need long term care services (139-250% FPL) the waiver allowed the state to increase the number of slots (formerly waiver slots)] but continue to be a limit.
·         SCI and Family Planning Medicaid Enrollees that are eligible for Medicaid under the Expansion will be automatically converted to Centennial Care (40,000 ppl). 2/3 of SCI recipients are eligible with the expansion. No additional paperwork should be necessary. Notices will go out to these individuals in September.
·         Retroactive coverage was not included in the waiver. CMS has committed themselves to revisit this at the request of HSD in the future. However, this should not happen for “at least a year” because CMS wants to see how easy it is for people to enroll in the expansion.
·         The MAGI conversion has been sent to CMS and HSD is waiting for approval.

 

Medicaid Behavioral Health Audit

·         After an audit of providers on 7/24 74% of claims had errors. When excluding human error and controlling for other factors, 25% of claims has serious problems. That represents 14% of payments made by HSD to providers for mental health.
·         They have referred these cases to DOJ who has found credible allegations of fraud, triggering an investigation. As a result, HSD cannot pay these providers anymore unless they file for a waiver.
·         Providers have filed for an injunction in state court. Hearing is WED. 7/16/13
·         Many of these providers will have to decrease services or potentially close due to the loss of revenue.
·         Companies from Arizona will step in to coordinate services and ensure that individuals can still access care.

 

ACA Activity Update

·         New eligibility regulations for Medicaid will be out in the fall for comment.
·         New eligibility regulations will require a state plan amendment.
·         Conversion for MAGI will be out soon.
·         New Benefits package will be out at the end of august for comment.
·         New Benefits package will be a hybrid of SCI and Medicaid. Are still considering dental benefits.
·         There will be exemptions for certain individuals who are medically fragile or pregnant to be able to get a different benefits package.
·         Presumptive eligibility curriculum is being developed that includes a curriculum to train hospital workers to do PE/MOSAA for adults.
·         There will be a tribal consultation on August 29
·         CHIPRA grants will be used for technology only (not outreach) to make sure that PEMIOSAA is easier for workers to use and that it is easier for ISD. There will be special kiosks in ISD offices.
·         Looking at how to enroll SNAP eligible kids in Medicaid automatically.
·         When asked about outreach to vulnerable and underserved populations – starting with the targeted meetings and expressed interest in working with advocacy and community groups on outreach strategist to disseminate information.
·         Kathy Slater-Huff is taking on a new position as director of the MAD Communication & Education Bureau. She will be a point person for outreach and education. This position was created in May/June.
·         Regarding Exchange doing Medicaid outreach and workers being trained in Medicaid programs, had no information. Stated that IT would interface to ensure there was no wrong door.

Sovereign Hager

Staff Attorney

New Mexico Center on Law and Poverty