When the pandemic hit, there were so many policy changes to long-term services and supports. This included availability, financing, and more. The public health emergency also helped ensure that less people were dis-enrolled from Medicaid, including those receiving Medicaid Long Term Services and Supports. Now that the public health emergency is over, some of these changes will unwind and transition back to pre-pandemic policies and operations. What does this mean for you and your loved one?
States haven’t been able to dis-enroll individuals from Medicaid, which means that the process for checking eligibility has been halted. This process, called redeterminations will resume starting in April, and to top it off, this redetermination will continue annually. The process may begin in April, but states have until June 1st of 2024 to complete the dis-enrollment process for anyone ineligible to continue receiving long term support services. This may become a concern, because individuals can lose coverage over simple procedural issues, such as either not receiving or failing to complete required paperwork in a timely manner.
Our suggestion: while it can be somewhat rare for someone receiving long term services and supports to become ineligible once they are enrolled, it is important to double check and make sure that all of your paperwork is in order.
Before the pandemic, Medicare required that beneficiaries be admitted to a hospital on an inpatient basis for at least three days before they would pay for a post-acute nursing home stay. During the pandemic, this three-day stay was waived, allowing individuals to be admitted to nursing homes for assistance after shorter inpatient stays, observation stays, or even in some cases directly from home. Now that the pandemic is over, the three-day stay will be reinstated, meaning that post-acute stays that don’t have the required inpatient hospital stay won’t be paid for.
Our suggestion: patients and families can ask to confirm the status of their hospital stay, for example, is this inpatient care, or observation? If the hospital believes that a post-acute nursing home stay might be helpful, then the family can advocate for inpatient status for at least 3 days.
States have the option to make amendments to their home and community-based service programs. Almost every state made at least one of these emergency amendments during the pandemic, either adding or revising services, increasing reimbursement rates, or allowing family caregivers to get paid while providing care. Since the end of the public health emergency will bring an end to emergency amendments, states have the opportunity to make these amendments permanent.
Our suggestion: if you have found that providing care during the pandemic has made things easier for you, you may consider asking your respective state agency to consider making these policies permanent parts of the home and community-based service programs. This is done by a state agency taking action and submitting amendment applications and other documents to CMS. Do research to know whether the supports you are receiving are permanent or temporary, and make sure you prepare if your support is ending.
If your loved one may need support from one of our caregivers at Homewatch CareGivers of Charlotte, don’t hesitate to contact us to help you determine the services your loved one may be eligible for. We can help you navigate the upcoming changes that are happening. Reach out today to learn more!