PHE Ending and the effect on Dual Enrollees

[DonP]

The above answers are correct but I’ll add a few things . Humana seems proactive in notifying you of loss of dual . United could give 2 craps . But United very proactive in helping medicaid people reapply.What happens when somebody loses medicaid they almost always keep lis which is federal . You have a 6 month grace on the dsnp but are responsible for all copays and coins like a regular mapd. Thats why you see 2 set of sob’s in dsnp enrollment books . You’ll see a premium of like $35 in enrollment books. If somebody has lis after losing Medicaid then they pay no premium to stay on the plan for 6 months . I have a large book of duals . Few of mine will lose their medicaid but they’ll all have to recertify so it will be a tough few months as I’ll have to help many .

 

[goillini52]

Important Update: Medicare Members to Be Impacted by Medicaid Redetermination


Attention Valued Partner,

Starting in April, states will have the ability to resume the Medicaid Redetermination process after three years of being paused due to the COVID pandemic. States can begin to initiate the redetermination process as early as February 1, 2023, and disenrollments can be effective as early as April 1 if adequate notice is given to the enrollee. Each state will set the date for when redetermination will start.

Approximately 15 million individuals will be at risk of losing Medicaid coverage. Anyone who is no longer eligible for Medicaid will be disenrolled. Wellcare members set to be disenrolled from their Medicaid plans will need your help to obtain new coverage and maintain continuity of coverage.

Let’s ensure our members don’t experience a gap in coverage.

• Wellcare D-SNP beneficiaries who no longer qualify for Medicaid will be disenrolled after the deeming period and will need other coverage options. Wellcare implements a six-month deeming period for D-SNP (Tennessee is the exception at three months).
• For individuals no longer eligible, brokers should discuss non-dual Medicare plan options. For those eligible for Medicare, they will have a 60-day window during which they can transition to Medicare without any late enrollment penalties.
• Secondarily, members losing Medicaid eligibility may explore Ambetter Health Marketplace plan options. The window to enroll in a marketplace plan will start 60 days before their Medicaid coverage ends and will continue for 60 days after it ends.
• Current members under Wellcare D-SNP will be supported by our Wellcare partner, Centauri, to help members reapply for Medicaid and the Medicare Savings Program.

 

[kgmom219]

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.

So I’m hearing the ability for carriers to “pre-warn” clients on the PHE ending is state specific.

Love how you manage it prior to an issue!!! “Pay attention and call me”

 

[kgmom219]

Important Update: Medicare Members to Be Impacted by Medicaid Redetermination


Attention Valued Partner,

Starting in April, states will have the ability to resume the Medicaid Redetermination process after three years of being paused due to the COVID pandemic. States can begin to initiate the redetermination process as early as February 1, 2023, and disenrollments can be effective as early as April 1 if adequate notice is given to the enrollee. Each state will set the date for when redetermination will start.

Approximately 15 million individuals will be at risk of losing Medicaid coverage. Anyone who is no longer eligible for Medicaid will be disenrolled. Wellcare members set to be disenrolled from their Medicaid plans will need your help to obtain new coverage and maintain continuity of coverage.

Let’s ensure our members don’t experience a gap in coverage.

• 
  
  
  • Wellcare D-SNP beneficiaries who no longer qualify for Medicaid will be disenrolled after the deeming period and will need other coverage options. Wellcare implements a six-month deeming period for D-SNP (Tennessee is the exception at three months).
  • For individuals no longer eligible, brokers should discuss non-dual Medicare plan options. For those eligible for Medicare, they will have a 60-day window during which they can transition to Medicare without any late enrollment penalties.
  • Secondarily, members losing Medicaid eligibility may explore Ambetter Health Marketplace plan options. The window to enroll in a marketplace plan will start 60 days before their Medicaid coverage ends and will continue for 60 days after it ends.
  • Current members under Wellcare D-SNP will be supported by our Wellcare partner, Centauri, to help members reapply for Medicaid and the Medicare Savings Program.

WellCare is the first carrier to jump on this??? I’ve got nothing from UHC or Humana.

Anybody else have anything?

 

[goillini52]

WellCare is the first carrier to jump on this??? I’ve got nothing from UHC or Humana.

Anybody else have anything?

1st one I've seen.

 

[pogo]

There's a 50-state "Unwinding the PHE" tracker at https://ccf.georgetown.edu/2022/09/06/state-unwinding-tracker/

And links to available state documents at

 

[yorkriver1]

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!

Virginia: (the only state where I have DSNP clients and not more than about 10)
Yes, I help people apply/re-apply. I have taken courses offered by my state specific to both types of Medicaid. Expansion--not means (assets) tested, higher income allowed--and Aged Blind and Disabled--means tested and lower income level to qualify, a gap in the system. Means tested=money and other assets above certain limits.
It occurs to me that asking the Medicaid client to find out from their local office what is the renewal month of their Medicaid will help, depending on how the state is operating their process to requalify Medicaid recipients.
Here in Virginia the Medicaid renewal letters that used to go out every year based on their renewal month will now be serialized over the next year or so by the previously established renewal month. For those new to Medicaid during the PHE, probably their original start date for Medicaid would be the renewal month.
So, if their renewal month is, say, October, they will get a letter to reapply ahead of that month.
As a member of my county's Social Services Community Board, I can find these things out easier. The local Social Services office for each client should also be able to help the client with the answer for their timing for being re-evaluated within the next few weeks.

 

[kgmom219]

Virginia: (the only state where I have DSNP clients and not more than about 10)
Yes, I help people apply/re-apply. I have taken courses offered by my state specific to both types of Medicaid. Expansion--not means (assets) tested, higher income allowed--and Aged Blind and Disabled--means tested and lower income level to qualify, a gap in the system. Means tested=money and other assets above certain limits.
It occurs to me that asking the Medicaid client to find out from their local office what is the renewal month of their Medicaid will help, depending on how the state is operating their process to requalify Medicaid recipients.
Here in Virginia the Medicaid renewal letters that used to go out every year based on their renewal month will now be serialized over the next year or so by the previously established renewal month. For those new to Medicaid during the PHE, probably their original start date for Medicaid would be the renewal month.
So, if their renewal month is, say, October, they will get a letter to reapply ahead of that month.
As a member of my county's Social Services Community Board, I can find these things out easier. The local Social Services office for each client should also be able to help the client with the answer for their timing for being re-evaluated within the next few weeks.

Love this. Both your involvement and the information.

Now if only every state had a local office. TX for example is at 2+ hour wait if they call and local offices are few and far between.

 

[yorkriver1]

I got started in Medicaid related situations and renewals in 2013 when the first ACA plans were offered, because of the children's health program, Medicaid for kids is common in ACA households. They always reported to me about getting Medicaid renewal letters and the ACA renewal process was handy for some to do their kids Medicaid renewal since the ACA app sorts that out and sends it to the Medicaid office.
Now that ACA carriers have upped the commish, I am keeping/expanding my book of ACA clients and they feed into Medicare as they age in.
Virginia adopted expansion Medicaid and expects about 500,000 to lose benefits.