Emphasis In Long-term Care

Medical Assistance Renewal Requirements have Returned: What should Long Term Care Providers do to Prepare?

On Behalf of | Apr 18, 2023 | Long-Term Care Facilities |

During the COVID-19 pandemic, Medical Assistance (MA) recipients were not required to complete the annual renewal application.  The federal government officially ended the continuous coverage requirement for Medicaid effective March 31, 2023.  As a result, the Pennsylvania Department of Human Services (DHS) reinstated MA renewal requirements and eligibility processing as of April 1, 2023.

What is the process?

DHS will be mailing notices to MA eligible residents in advance of the anniversary date of initial MA eligibility.  The renewal can be completed online (COMPASS) or over the phone.  DHS will also mail the renewal packet to the resident within 30-60 days of the notice. The renewal packet will contain the required completion date.  Current income, resources, and any transfers since the last approval/renewal must be verified.  If the application is not completed by the deadline or is missing information, MA benefits will be terminated.  Benefits may also be terminated if, for example, the application is completed correctly but the MA recipient is no longer financially eligible for MA.

What can a nursing home do to prepare?

The following are some suggestions:

  1. Educate your employees on the process, timelines, deadlines, and reasons why the renewal requirement had stopped and why it is now back in place. DHS has instructions, webinars, FAQs, etc. on their website.  Sample notices to the residents are also provided.  See: Medical Assistance & CHIP Renewals (pa.gov). There is a specific training webinar for long term care renewals: Videos & Webinars (pa.gov)
  2. Identify the MA eligibility anniversary date for each MA recipient within your facility.
  3. Providers can verify upcoming renewal dates by registering as a COMPASS Community Partner. COMPASS HHS CP Landing Page (state.pa.us). There is also a webinar on partner topic: Videos & Webinars (pa.gov).
  4. Identify residents that may need assistance in completing the application and contact any family members or other appropriate persons (e.g., a Power of Attorney) that may be able to assist.
  5. Identify residents that may need a guardian appointed due to the lack of an individual available to assist.
  6. Communicate with the resident and/or other appropriate persons regarding the renewal requirements and provide available resources to assist with the application.
  7. Encourage the resident and/or other appropriate persons to sign up for DHS text and email notifications. OIM-Texting-Opt-in-Flyer.pdf (pa.gov).
  8. Be prepared to assist residents, family members, and/or other appropriate persons with the process. Many residents may never have gone through a renewal.

What if a resident does not have the ability to complete the MA renewal application?

A resident may have difficulty in completing the application.  If the resident has no one with the ability to assist and/or access financial information needed to complete the application, the resident may want to have their own Power of Attorney appointed.  If the resident is not competent to make such an appointment, the family may need to have a guardian appointed to access the financial information.  The nursing home may also file a petition to have a guardian appointed by the court if, for example, the family is unable to do so.

What if the resident’s MA is terminated?

If terminated due to failure to submit the renewal or required verifications by the due date, DHS will mail notice to the resident providing appeal instructions and also notifying the resident they can still submit their renewal or verifications to DHS within 90 days with no lapse in coverage.  If the application is rejected for other financial reasons, DHS will also provide notice with appeal rights to the resident.

The appeal deadline for a MA denial is thirty days from the date of the notice.  However, if the appeal is filed within 15 days, benefits will continue to be paid during the appeal period.  An appeal can be filed by the resident and the nursing facility may also have the right to file an appeal. Filing the appeal should provide the opportunity to preserve the MA eligibility retroactivity date, thereby reducing a chance of a gap in MA coverage.  The appeal may also provide additional time to take the steps necessary to prove eligibility.