Major new Medicaid rule exempts nursing home residents
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A major new Medicaid regulation gives states "unprecedented flexibility" in configuring their Medicaid programs. Exempted from the rule are nursing home residents, Medicare beneficiaries and medically frail individuals who have freedom of choice in participating in coverage offerings.
The rule, which was issued by the Centers for Medicare & Medicaid Services Wednesday, allows states to place Medicaid beneficiaries in alternative benefit packages called "benchmark plans." These plans are models states can use in designing their programs. They could carry benefits of a standard Blue Cross/Blue Shield provider plan under the Federal Employees Health Benefit Plan, or state employee coverage, as two examples.
The final rule incorporates some comments that the American Health Care Association made following the release of the proposed rule last February, according to Janice Zalen, senior director of special programs for the American Health Care Association. It states more explicitly that enrollment in a benchmark plan is optional for exempt individuals and they may opt out at any time, she said. AHCA was concerned that two states, which received approval to offer benchmark benefits, did not properly inform elderly people that inclusion was optional.
"I'm glad to see that CMS is strengthening the requirement," Zalen noted.
The rule, which implements provisions of the Deficit Reduction Act of 2005, is the latest in a series of regulations expanding states' control over their Medicaid programs. Mary Kahn, a spokeswoman from CMS, said that the regulation issued Wednesday will allow for state expansion of home- and community-based services.