Federal officials on Wednesday issued a new final rule that helps seniors better navigate the Medicaid enrollment process, and that’s likely very good news for long-term care providers.
While envisioning positive effects for providers, LTC consultant Melissa Brown, chief operating officer of Gravity Healthcare Consulting, also noted that some serious concerns cropped up in the new rule’s release.
The measure will streamline and modernize the processes used to ensure eligible seniors are able to access Medicaid. This promises to reduce procedural headaches for those seniors, and for long-term care providers who rely on timely reimbursements to keep their finances steady, Brown pointed out.
Key changes for seniors include increasing the amount of time beneficiaries have to provide states with information, prohibiting states from requiring renewals more than once a year and eliminating the requirement of in-person renewal interviews for older and disabled adults.
Hundreds of thousands of Medicaid beneficiaries lost coverage following the COVID-19 pandemic during the “unwinding” process — many due to procedural reasons rather than ineligibility. Some long-term care providers have complained that delayed Medicaid payments during the renewal process have hurt their revenues and taken up valuable time as care workers attempt to help residents handle calls and paperwork.
“This will improve access for beneficiaries and reduce critical waiting periods that can limit access at times when it is often most vital,” Brown told McKnight’s Long-Term Care News Wednesday. “The bottom line is this is good news for beneficiaries and it makes a lot of common sense to modernize and streamline these processes. For far too long, the most vulnerable have borne the burden of these archaic practices, and these changes should actually make an impact on improving access to Medicaid, and the associated healthcare it covers.”
Highlights and concerns
Following the upfront costs of implementing the new rules, CMS estimates that Medicaid beneficiaries will save more than 21 million hours annually and states will save $66 million annually from the enrollment and renewal process.
Brown said the in-person interview changes are particularly meaningful.
“Because of lack of transportation and medical challenges with getting to the interviews, older adults have lost their benefits needlessly, and this discriminatory practice will now be discontinued,” she explained. “In 2020, there were 2,688,386 non-MAGI beneficiaries that this could have impacted.”
She acknowledged that the new policies could open up a higher likelihood of future fraud causes, however, noting that states should be extra alert for bad actors trying to take advantage of newly accessible practices.
She also raised concerns that if high CMS estimates are accurate, the additional Medicaid beneficiaries could cause a drain on another key funding source for long-term care providers.
“It concerns me about whether there will be enough Medicare funding if Medicaid starts to cost so much more,” she told McKnight’s. “The fraud aspect is also concerning. Generally, it’s good news, but definitely has the potential for unintended consequences that would not be beneficial for seniors and the senior living industry.”
