Medicaid Redetermination PITA

[AgentGeneral]

Anyone having issues with clients getting their medicaid redeterminations done ?

I am. Not many but a few. Clients are getting letters now that theyre no longer qualified for medicaid or dual plan.

Humana is sending out letters.

It's not a big deal. I think I have it covered. Basically a few people I've sent right into DHS and had them figure it out. Too often they get their "proofs" letter indicating they have 10 days to send in proofs but they receive the letter with 2 days to spare causing them to get cut off. So they have to go in and sort it out.

The ones who no longer qualify I'll just move them to a regular PPO.

My understanding is that they have 6 months or so to sort it out on the Humana DSNPs? Is this correct? And obviously it would open up a SEP if theyre booted off medicaid.

Wonder how DonP is doing with all the DSNPs ? Don, how's it going? Is the redetermination going ok in your neck of the woods? I think he did quite a few of them anyway...

 

[straightnochaser]

Anyone having issues with clients getting their medicaid redeterminations done ?

I am. Not many but a few. Clients are getting letters now that theyre no longer qualified for medicaid or dual plan.

Humana is sending out letters.

It's not a big deal. I think I have it covered. Basically a few people I've sent right into DHS and had them figure it out. Too often they get their "proofs" letter indicating they have 10 days to send in proofs but they receive the letter with 2 days to spare causing them to get cut off. So they have to go in and sort it out.

The ones who no longer qualify I'll just move them to a regular PPO.

My understanding is that they have 6 months or so to sort it out on the Humana DSNPs? Is this correct? And obviously it would open up a SEP if theyre booted off medicaid.

Wonder how DonP is doing with all the DSNPs ? Don, how's it going? Is the redetermination going ok in your neck of the woods? I think he did quite a few of them anyway...

They have up-to 6 months to sort it out depending on carrier (i think uhc gives 4 months) but they will be responsible for cost-share if they stay on the dsnp whilst medicaid is inactive.. could get pricey

 

[DonP]

Anyone having issues with clients getting their medicaid redeterminations done ?

I am. Not many but a few. Clients are getting letters now that theyre no longer qualified for medicaid or dual plan.

Humana is sending out letters.

It's not a big deal. I think I have it covered. Basically a few people I've sent right into DHS and had them figure it out. Too often they get their "proofs" letter indicating they have 10 days to send in proofs but they receive the letter with 2 days to spare causing them to get cut off. So they have to go in and sort it out.

The ones who no longer qualify I'll just move them to a regular PPO.

My understanding is that they have 6 months or so to sort it out on the Humana DSNPs? Is this correct? And obviously it would open up a SEP if theyre booted off medicaid.

Wonder how DonP is doing with all the DSNPs ? Don, how's it going? Is the redetermination going ok in your neck of the woods? I think he did quite a few of them anyway...

Yes I have a lot of DSNPs and lis.I’ve gotten about 15 calls were people have lost Medicaid or lis . There could be many more but I have no way to know . Supposedly it will show up as pending term the month before it goes inactive . We’ll see if that’s correct. The deeming period ( the time the plan stays active while they reapply for Medicaid is 5-6 months I’m noticing ). Look at the positive . If they get disenrolled and you see it and quickly out them into a new plan the rolling month you get full Tru up comp .

 

[kgmom219]

Its a friggin disaster and the scale of the disaster is based on what state you are in.

 

[AgentGeneral]

Yes I have a lot of DSNPs and lis.I’ve gotten about 15 calls were people have lost Medicaid or lis . There could be many more but I have no way to know . Supposedly it will show up as pending term the month before it goes inactive . We’ll see if that’s correct. The deeming period ( the time the plan stays active while they reapply for Medicaid is 5-6 months I’m noticing ). Look at the positive . If they get disenrolled and you see it and quickly out them into a new plan the rolling month you get full Tru up comp .

Im finding out on some before by doing another eligibility check. Friggin mess in+ Michigan.

Thankfully, it's 30% of book, couldn't imagine having a boat load. So far had to switch 30ish.

I never wanted more of these, it just happens bc then all their friends and family call. It was ok though, had quite a few appts where the fam and friends all checked out QMB+, and easy enough by having them all go to brothers or aunts or whatever to do 2/3 at a time. Just know that these will be a pain and have to group them up when possible. So this was a positive (I guess/hope until next year they add another 25 to card or some small enticement and change plan #).

Its a friggin disaster and the scale of the disaster is based on what state you are in.

Michigan (and Fla soon). Disastrous. We have spend down plans and those are not qualified QMB+, and even if theyre are other Dsnps, they are only "ok". Supposedly Humana has another one coming that sounds great on paper, but zero so far show up as eligible-last I heard they were trying to get the state eligibility updated to show up on the vantage site properly.

The spend downs have a piece that acts like a deductible, ranging from $100-$1800 (I saw one with $2000) PER MONTH. So in many ways having an MAPD is helpful.

edit: Checked today, Humana eligibility starting to show SLMB qualified for a decent DSNP in Mi, 120 month healthy bennies card still copays though. Interesting for the spend down folks.

 

[wehotex]

They have up-to 6 months to sort it out depending on carrier (i think uhc gives 4 months) but they will be responsible for cost-share if they stay on the dsnp whilst medicaid is inactive.. could get pricey

But, is it 6 months from the time that their Medicaid actually ends or 6 months from the date that the carrier “discovers” that the member no longer has full Medicaid?
In Texas, partial Duals are not detected in the online Medicaid system which means that they have to submit the PITA once a year Award Letter. Some of them have the most recent 2021-dated Award Letter that they received that UHC will not accept as proof because it’s more than 1-year old. I have no choice but to put them into a regular plan while they wait for an Award letter to come without a timeline.

 

[DonP]

But, is it 6 months from the time that their Medicaid actually ends or 6 months from the date that the carrier “discovers” that the member no longer has full Medicaid?
In Texas, partial Duals are not detected in the online Medicaid system which means that they have to submit the PITA once a year Award Letter. Some of them have the most recent 2021-dated Award Letter that they received that UHC will not accept as proof because it’s more than 1-year old. I have no choice but to put them into a regular plan while they wait for an Award letter to come without a timeline.

It’s 6 months from Medicaid term date . But the time client gets carrier term letter it’s 5 months to plan term I’ve noticed . States that don’t show partial Medicaid are pia . Few if any have their award letter . I’m assuming member can call state and get one mailed ?

 

[wehotex]

It’s 6 months from Medicaid term date . But the time client gets carrier term letter it’s 5 months to plan term I’ve noticed . States that don’t show partial Medicaid are pia . Few if any have their award letter . I’m assuming member can call state and get one mailed ?

Yes they can. I’ve conference called on some telephone requests. The holds have been 50 minutes/70 minutes at times, some of them dropped calls when we are talking. It does suck at times when I realize that many don’t try to help themselves, giving up way too easily. They didn’t work so much in their working lives so I guess it carries over? Middle class ppl are certainly more deserving.

 

[Lin Guini]

Best way to help clients on Medicare apply for Medicaid? Sorry new to Medicaid.

 

[straightnochaser]

Best way to help clients on Medicare apply for Medicaid? Sorry new to Medicaid.

Refer them to health and human services unless they also don't have LIS.. You can start the application for MSP in the LIS app..