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Medicaid unwinding complicates care decisions for some assisted living providers

Senior woman placing bandage over cracked piggy bank
Senior woman placing bandage over cracked piggy bank
(Credit: Malte Mueller / Getty Images)

As states navigate the Medicaid redetermination process, some assisted living providers that accept Medicaid for their low-income residents have experienced payment disruptions. This situation leaves them struggling with whether to go into debt to cover residents’ care or issue eviction notices.

A recent report by KFF highlights the plight of Montana providers, many of whom reported inconsistent Medicaid payments even for residents who haven’t lost coverage. Payment delays have led some assisted living providers that rely on Medicaid payments for their residents to take out high-interest loans or consider evicting those residents as they scramble to cover costs.

Residents served by Medicaid waivers also encountered limited in-person help, long waits on hold for the state’s call center, and months-long waits for those who reapplied for Medicaid after losing coverage. 

More than 19.2 million low-income people have lost health insurance in the past year due to Medicaid unwinding, according to KFF. And most (70%) of those disenrolled lost coverage due to procedural issues, including missing paperwork or administrative inefficiencies, rather than actual ineligibility.

Sixty-one percent of assisted living communities are Medicaid-certified, and 18% of assisted living residents rely on Medicaid to pay for daily services.

Disenrollment rates vary widely across states, ranging from 57% in Utah to 12% in Maine, according to KFF. Those differences are largely influenced by renewal policies and system capacity.

The Centers for Medicare & Medicaid Services granted states a range of emergency waivers to modify their Medicaid programs during the COVID-19 public health emergency, particularly their home- and community-based services programs. The continuity of those flexibilities for community-based organizations, however, depends on individual state decisions.

CMS recently finalized a rule, proposed in 2022, that addresses the Medicaid unwinding process by streamlining the Medicaid enrollment process. Among the changes: older adults and those with disabilities no longer will be required to attend in-person interviews, and states cannot conduct renewals more frequently than every 12 months.

CMS said that the rule would remove red tape and enrollment barriers and simplify applications, verifications, enrollment and renewals for healthcare coverage through Medicaid and the Children’s Health Insurance Program.

Source: McKnights Seniorliving

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