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In Long-Term Care Facilities, Medicaid Disenrollments May Affect Patients

On May 11, 2023, the Covid Public Health Emergency (PHE) was formally ended by the federal government. The conclusion of the PHE also ended a requirement of the Families First Coronavirus Response Act (FFCRA) that kept people continuously enrolled in Medicaid programs through the end of the PHE. The end of continuous enrollment has seen many beneficiaries dropped from their Medicaid status, affecting payment for long-term care services. What happens to residents receiving long-term care services at home, in assisted living, or nursing home facilities if Medicaid beneficiaries experience disenrollment?

What Can Happen, and What Can You Do?

If you lose Medicaid coverage, you may be responsible for paying the full cost of your long-term care services. This situation can be financially challenging, as long-term care expenses can be significant. Finding an alternative payment source is an immediate concern, even if you plan to reenroll for Medicaid coverage. The application process takes some time to complete.

Tap Into Existing Resources

For the short term, you may need to seek family help. If you previously did Medicaid planning, you may tap into personal savings or sell assets. If you qualify, you may need to explore other government programs providing financial assistance for long-term care, such as veterans benefits. Medicare policies traditionally don’t cover long-term care, but they do cover some skilled nursing home care in specific situations for a limited time.

Negotiate with the Care Facility

If you can’t cover the full cost of your long-term care, you may need to negotiate with the care facility, nursing home, or in-home services to find a solution. Some facilities may be willing to work out payment plans to avoid resident churn or make other arrangements to help you continue care. It’s in your best interest to seek the counsel of a disability or elder law attorney specializing in long-term care to negotiate a solution.

Care Facility Discharge

When a short-term fix isn’t available, or negotiations to alter payment obligations fail, the loss of Medicaid coverage may result in discharge from the facility or denied in-home or community-based care services. However, a facility is legally obligated to provide notice before discharging a resident. During this time, the facility and your elder law attorney can work with you or your family to arrange a safe and suitable transition to another living arrangement.

Disenrollment Numbers

The number of Medicaid cutoffs for previously existing beneficiaries has surpassed one million, with the expectation to increase between 14 to 18 million. So far, Medicaid-dependent facilities, nursing homes, and at-home and community-based services are not widely affected. Still, the law of large numbers indicates disenrollment can significantly impact some beneficiaries requiring long-term care.

Many Medicaid beneficiaries who have been released due to procedural issues or technicalities anticipate being reenrolled. However, according to Medicaid, states have up to “twelve months to return to normal eligibility and enrollment operations.” The permitted time frame creates havoc for many Americans who rely on Medicaid benefits. However, it’s catastrophic for beneficiaries receiving Medicaid for long-term care as costs in a facility may range from about $4,000 – $8,000 per month, depending on the location.

If You or a Loved One Are in Long-Term Care

Understand that the unwinding of Medicaid continuous enrollment happens by state. Some long-term care beneficiaries may be unaware that continuous enrollment has stopped. Beneficiaries or their loved ones may neglect to return Medicaid paperwork or omit required documents consistent with current Medicaid qualifiers.

Some long-term care providers raise concerns that staff shortages in state agencies that handle reenrollment will create delays in processing required patient paperwork. The twelve-month grace period Medicaid provides to the states creates a slow reenrollment process that affects providers who continue to care for residents without reimbursement.

Consult a Disability or Elder Law Attorney

If you have been cut off from Medicaid and need to reenroll, an attorney can guide you through the general steps to ensure your benefits begin again as soon as possible. Your lawyer can help you confirm the reason for the discontinuation of benefits. It may be a failure to provide required documentation since the end of continuous enrollment or changes in eligibility requirements.

Once you understand why it has happened, your attorney can gather the necessary documentation for the reenrollment process. Documents may include:

  • Proof of income
  • Identification documents
  • Proof of residency
  • Social Security number
  • Other documents your state’s Medicaid office requests

Your disability or elder law attorney can ensure all relevant financial documents and medical records are included to support your application. They may contact the state’s Medicaid office and advise them that you have been receiving long-term care benefits in an effort to flag your application for expedited processing.

Because short-term loss of benefits can make maintaining residency in a long-term care facility difficult, your attorney can strategize a short-term solution that addresses your unique situation.

Appeals and Advocacy

If your Medicaid reenrollment application is denied or you face challenges during the reenrollment process, an elder law or disability attorney specializing in long-term care can help you through the appeals process. They can gather additional information, advocate on your behalf, and represent you in administrative hearings or appeals.

If you are in long-term care and lose Medicaid benefits, specific consequences will depend on individual circumstances and your state’s regulations. Pay close attention to your Medicaid status. Disenrollment may continue to affect long-term care beneficiaries for some time due to the end of the requirement in FFCRA legislation requiring continuous enrollment.

Consult with one of our experienced elder law or disability attorneys specializing in Medicaid and long-term care issues. They understand the laws and regulations and help you reenroll in Medicaid, securing the necessary coverage to continue your long-term care benefits. If you have questions or would like to discuss a personal legal matter, please contact our office at 732-972-1600. We look forward to the opportunity to work with you.

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