Tuesday, December 20, 2016

The Medicaid Application Process with the Waivers

There is no black and white process for obtaining Medicaid with the waiver, each case is handled differently.  We suggest you work with your BDDS contact or case manager to make sure that your case is handled correctly. However, here is general information on what to expect from the Medicaid process once targeted for the waiver.

If you already have Medicaid at the time of targeting, they should change your category to Traditional, if eligible.

Why do I get a letter asking me to choose a managed care plan for Medicaid when I have the waiver? Shouldn’t I be on Traditional Medicaid without a managed care plan?

Response from State:
Any client that is receiving Medicare will not be assigned, or asked to choose, a Managed Care Entity (MCE).  The members that are not receiving Medicare are referred to Hoosier Care Connect and must select an MCE.  The letters sent, requesting clients to select an MCE, are sent from Hoosier Care Connect and not the state.  This is all determined by DFR during the eligibility process.

All non-HIP adult Medicaid (except Pregnancy) is considered Traditional.  The category of Medicaid (Medicaid for the Aged, or Disabled etc.) puts them directly into Hoosier Care Connect if they are not receiving Medicare.  It is only if they are receiving Medicare, or if Division of Aging or BDDS goes in and changes their Level of Care, they would go into the non-Hoosier Care Connect category.  If they are not on Hoosier Care Connect, then they would not have an MCE.  DFR does not make this determination (unless they are on Medicare), it is Aging or BDDS, who go in and change their Level of Care, which would change their coverage.  Aging or BDDS can determine at any time, that their Level of Care needs changed, which could be why some families are changed after their initial approval. 

Guidance from FV: You need to make sure that you get an approved cost comparison budget (CCB) for case management from BDDS BEFORE applying for Medicaid. If you do that first, BDDS should change your level of care so that you get Traditional Medicaid without managed care.
If you run into issues with Medicaid and the type of plan they’re assigning you to, contact BDDS.
If you are still assigned to a managed care plan, you will be moved to Traditional Medicaid without a managed care plan at some point.

Why does the DFR ask for family income and assets for Medicaid when I have the waiver? Shouldn’t SB 30 mean I don’t have to provide it for a child under age 18?

Response from the State:
If families apply for Medicaid prior to the Cost Comparison Budget (CCB) confirmation by the DDRS Waiver Unit, then our system does not recognize the waiver as being approved and they will be placed into the regular Medicaid processing criteria, which would require parent’s income/assets.  If families wait for the CCB to be confirmed, then our system would recognize the waiver, and we would not request the parent’s income/assets.  DFR receives a nightly batch file from DDRS that sends CCB to confirmation to the DFR Eligibility System.  For the families that could potentially be eligible for retro coverage prior to the waiver starting, we will have to request parent’s income/assets in order to determine eligibility.  If they do not wish to have coverage for those months, then they could simply not return the requested income/assets and we would just deny those retro months, but still approve the ongoing months corresponding to the waiver start date.  

Guidance from FV: Be sure you have an approved CCB with BDDS before applying for Medicaid. If the DFR still requests family income/assets, explain that you have the waiver. If they don’t understand that, and you don’t want retroactive coverage, tell them that.
You can refuse to provide the family income/assets as the response above states. However, many families who do that end up in an appeal process. Ultimately, it’s your decision whether or not to provide family income/assets. SB 30 will disregard any family income/asset info for a child under age 18 and it should not affect eligibility.
You DO have to provide income/assets for the eligible child.

Feel free to contact Family Voices Indiana is you have questions. 844 F2F INFO or info@fvindiana.org

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