PHE Ending and the effect on Dual Enrollees

[kgmom219]

This is way outside my box, but I want to get in front of it for the whopping 3 people I have, plus to help some other agents.

If you are active in the Dual Market, can you please tell me what happens when someone loses their Medicaid eligibility to their Dual Plan?

1. Tell me what state you are in.
2. Do you help people stay enrolled in Medicaid? Are you reaching out to the clients about the PHE and re-determination?
3. Do the clients automatically get enrolled into a "regular" MAPD with the same carrier?
4. Do carriers tell you when someone loses their Medicaid?

TIA!

 

[Tkruger]

This is way outside my box, but I want to get in front of it for the whopping 3 people I have, plus to help some other agents.

If you are active in the Dual Market, can you please tell me what happens when someone loses their Medicaid eligibility to their Dual Plan?

1. Tell me what state you are in.
2. Do you help people stay enrolled in Medicaid? Are you reaching out to the clients about the PHE and re-determination?
3. Do the clients automatically get enrolled into a "regular" MAPD with the same carrier?
4. Do carriers tell you when someone loses their Medicaid?

TIA!

Fl, TX, WV, GA, TN and so on.....
Yes, many of the carriers will reach out to you and let you know they are loosing their eligibility. I reach out when I am notified.
No, that is on the consumer. During AEP I came across a large number of people who should not of had it in the first place.
Number 3 I've seen dropped back to a PDP I've not seen auto enroll into a non DSNP plan.
See 1

 

[kgmom219]

Fl, TX, WV, GA, TN and so on.....
Yes, many of the carriers will reach out to you and let you know they are loosing their eligibility. I reach out when I am notified.
No, that is on the consumer. During AEP I came across a large number of people who should not of had it in the first place.
Number 3 I've seen dropped back to a PDP I've not seen auto enroll into a non DSNP plan.
See 1

Thank you!

Just to confirm: the carriers MAY tell you but they are not required to tell you they were notified that the client lost Medicaid? Can you tell me who does and who does not?

 

[Tkruger]

UHC has sent me notifications and if you look in your back office Humana will state the reason for EOM term. Not seen it with other carriers. I will only write a DSNP plan if the consumer is not a HOPPER. IF they are I try to educate why this is a bad idea and tell them that I cannot help them. Then I go for the referral request.

 

[StephanieCJ]

1. Louisiana
2. I tell them if they ever get something saying there have been changes in any way to their Medicaid to give me a call. If they give me a call or the carrier notifies me, I help.
3. No. They stay enrolled in the current plan for 6 months but are responsible for the things Medicaid was covering but now isn't.
4. Some do and some don't, depends on the carrier. I've had UHC and Humana both reach out to me about it (I don't have a ton of DSNP clients, so it has only happened maybe 3 times in 6 years).

 

[Tkruger]

3. No. They stay enrolled in the current plan for 6 months but are responsible for the things Medicaid was covering but now isn't.

That is partially correct. Generally, carriers will give them a grace period to re cert for Medicaid, they are 100% responsible for the costs not covered by Medicaid could also end up with a 3 month part B claw back from the state. When the grace period ends the carrier is required to drop them back to a PDP only.

Those who qualified during the PHE and would not have normally qualified and who don't change plans wind up with a very rude awaking about gaming the system.

Over the last 7 years I personally have fielded dozens of calls about the part B claw back, you talk about angry folks...No Ms. Smith you won't get the $ 510.30 (old numbers) out of your $ 1300 check back.

 

[kgmom219]

That is partially correct. Generally, carriers will give them a grace period to re cert for Medicaid, they are 100% responsible for the costs not covered by Medicaid could also end up with a 3 month part B claw back from the state. When the grace period ends the carrier is required to drop them back to a PDP only.

Those who qualified during the PHE and would not have normally qualified and who don't change plans wind up with a very rude awaking about gaming the system.

Over the last 7 years I personally have fielded dozens of calls about the part B claw back, you talk about angry folks...No Ms. Smith you won't get the $ 510.30 (old numbers) out of your $ 1300 check back.

So is the grace period a CMS requirement? A state requirement?

Same question on the PDP enrollment? CMS or state?

 

[Tkruger]

It's always been my understanding that this is carrier specific. UHC is quicker than Humana and so on. Not MAPD or PDP specific.

 

[EricWB]

1. Tell me what state you are in. AZ, CA, CO, FL, ID, TN, TX & WA
2. Do you help people stay enrolled in Medicaid? Yes.
Are you reaching out to the clients about the PHE and re-determination? No, the State's Medicaid Agencies and the Insurance Carrier's already have notifications and communications planned to inform Dual Eligible individuals of pending redeterminations and terminations. I "coach" all of my Dual enrollees to never disregard any letters from their State Medicaid program and to call Me immediately if they receive anything.
3. Do the clients automatically get enrolled into a "regular" MAPD with the same carrier? No they will not. Although, Carriers will be active in retaining their ineligible D-SNP members. (Hopefully they'll honor their AOR Pledge to us.) As previously stated, most carriers will give a grace period for up to 6 mos to give the enrollees chance to re-qualify, although with loss of State Cost Share protection, they would be responsible for all Part A & Part B cost shares (ie: 20% Part B) and if their income is above LIS for Extra Help, they may not be auto-enrolled into a PDP.
4. Do carriers tell you when someone loses their Medicaid? Some may notify their brokers, but they are not required to do so. Keep and eye on your BOB reports.

 

[StephanieCJ]

So is the grace period a CMS requirement? A state requirement?

Same question on the PDP enrollment? CMS or state?

I honestly couldn't tell you. I haven't run into it much because I have them trained to call me if they receive anything related to the coverage changing, ending, or renewing through either Medicare or Medicaid so I don't know that I've ever had a lapse issue.