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DHMH, Office of Eligibility Services Deb Ruppert , Executive Director

PROJECT SUMMARY: Expediting the LTC/HCBS Waiver Eligibility Process for SSI Recipients and Community-Eligible Individuals. DHMH, Office of Eligibility Services Deb Ruppert , Executive Director. Overview. LTC/HCBS Waiver Expediting Project Goal :

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DHMH, Office of Eligibility Services Deb Ruppert , Executive Director

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  1. PROJECT SUMMARY:Expediting the LTC/HCBS Waiver Eligibility Process for SSI Recipients and Community-Eligible Individuals DHMH, Office of Eligibility Services Deb Ruppert, Executive Director

  2. Overview LTC/HCBS Waiver Expediting Project Goal: • Expedite the LTC/HCBS waiver financial eligibility process for SSI recipients and community-eligible individuals through the implementation of application/redetermination form, policy, and procedural modifications. Survey Objective: • Identify innovative state examples of application/redetermination formats, policies, and procedures to expedite the Medicaid financial eligibility determination process for SSI recipients and community-eligible individuals, who need LTC/HCBS waiver services.

  3. Survey Scope and Approach OES conducted in-depth, multi-state research of Medicaid LTC/HCBS waiver eligibility policies: • Phone interviews with state eligibility policy staff • Searches of state eligibility manuals and regulations • Document/data collection review and analysis 14 states surveyed: • AL, FL, GA, LA, ME, MN, MO, NJ, NY, OH, PA, RI, VA, WV  Survey research questions included: • Does the state require SSI recipients/community-eligible individuals to complete a LTC/HCBS application? • Does the state use a “streamlined” LTC/HCBS waiver application for these groups? • Does the state have policies/procedures that expedite the LTC/HCBS waiver financial eligibility process for SSI recipients/community-eligible individuals?

  4. Survey Findings: Long Term Care SSI Recipients: • 4 of 14 states do not use or require SSI recipients to complete a Medicaid LTC application • 5 of 14 states use a streamlined LTC application for SSI recipients • 8 of 14 states have policies and/or procedures that expedite SSI recipients’ applications for LTC Community-Eligible Individuals: • 1 of 14 states did not use or require community-eligible individuals to complete a LTC Application • 3 of 14 states used a streamlined LTC application for community-eligible individuals • 7 of 14 states have policies and/or procedures that expedite community-eligible individuals’ applications for LTC *some states are reflected in more than one category above

  5. Expedited LTC Policies and Procedures Types of expedited LTC policies and procedures identified among the surveyed states: • No eligibility determination for LTC for SSI recipients • Use streamlined application/redetermination • Exempt from LTC application/redetermination • Caseworker/provider completion of application/referral form • SSI status enables payment to NH vendor to be automatically authorized (do not need to reside in a nursing facility (NF) for 30 days before payments to the NF can be made) • Exempt from annual or semi-annual renewal/redeterminations (e.g. “administrative renewal”) • Partial renewal completed by caseworker telephonically

  6. Survey Findings: HCBS Waivers SSI Recipients: • 7 of 14 states do not require SSI recipients to complete a HCBS Waiver application • 4 of 14 states use a streamlined HCBS waiver application for SSI recipients • 10 of 14 states have policies and/or procedures that expedite SSI recipients’ applications for HCBS Community-Eligible Individuals: • 5 of 14 states do not require community-eligible individuals to complete a HCBS waiver application • 3 of 14 states use a streamlined HCBS waiver application for community-eligible individuals • 9 of 14 states have policies and/or procedures that expedite community-eligible individuals’ applications for HCBS Waiver Services *some states are reflected in more than one category above

  7. Expedited HCBS Waiver Policies and Procedures Types of expedited HCBS Waiver policies and procedures identified among the surveyed states: • Exempt from application/redetermination • Use streamlined application/redetermination • Expedited services; provider assists individual with completing a LTC application; state pays costs of HCBS while LTC application is being determined • No transfer of asset penalty • Partial renewal completed by caseworker telephonically

  8. Next Steps • OES Eligibility Policy staff will perform an in-depth review of the expedited LTC/HCBS Waiver policies and procedures identified in the state survey • Based on this research, OES will recommend one or more strategies to expedite the eligibility process for SSI recipients and community-eligible individuals

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