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Department of Human Services

Dec 20
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Medicaid and Federal Funding

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How is Medicaid funded and what are the funding rules?

States are not required to accept federal funding for Medicaid; however, if they chose to participate in the Medicaid program, they are required to comply with federal statutory and regulatory requirements. Camacho v. Texas Workforce Com’n., [326 F.Supp. 2d 794 (W.D.Tx. 2008)].

States must submit their proposed Medicaid plans for approval from the Centers for Medicare and Medicaid Services (CMS). CMS does not automatically approve state Med

icaid plans and has the final say in approving or denying a proposed amendment to a state Medicaid plan. For instance, in Md. Dept. of Health and Mental Hygiene v. CMS, [592 F.3d 424, 427 (4th Cir. 2008)], the CMS rejected Maryland’s proposed amendments to its state Medicaid plan because those amendments would have unreasonably limited the deductibility of medical expenses incurred by Medicaid enrollees after being determined eligible for Medicaid in contravention of federal requirements.

The CMS may approve a state’s waiver application through a section 1115 waiver application. The 2017 National Academy Elder Law Attorneys Summit highlighted a current trend of CMS allowing a state to forgo the three months of retroactive Medicaid coverage. Recently, Arkansas and Maine have submitted 1115 demonstration waiver applications doing away with the three months of retroactivity and Iowa is also seeking to forgo this option. It is anticipated that CMS will continue to relax the three month retroactive coverage in future state demonstration waiver applications.

Understanding how the funding for the Medicaid program works is a step in understanding the rules to qualifying for Medicaid and where those rules originate. The State of Rhode Island has the Department of Human Services as overseeing the administration of the Medicaid program. Applications for Medicaid are submitted to DHS where they review and advise as to the applicants approval for the program.

Jan 17
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Many Rhode Island Nursing Homes Awaiting Payment from State

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Troubled launch of the State’s new UHIP computer system at center of issue

Since the launch of the Rhode Island’s trouble social services system, UHIP, many nursing homes have gone without payment for Medicaid patients. Owed for months of care, many administrators are concerned they won’t be able to go without payment for much longer.

Debra Griffin is the administrator at Hattie Ide Chaffee Nursing Home and Rehabilitation in East Providence. She also chairs the state nursing home association. Griffin says the system for getting paid for these patients was inefficient before but it’s worse now.

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RI DHS Executives

“We haven’t received an approval since September. And that was for someone back to last April,” says Griffin.

Griffin says firing Department of Human Services workers who understood long- term care Medicaid applications before the launch of the new system was a mistake.

“Long- term applications are not run of the mill,” said Griffin. “You have to have a level of knowledge and expertise in the approval process.”

Governor Gina Raimondo acknowledges letting workers go before the launch of the system that was a mistake. The Governor has just accepted the resignations of two top officials involved in the launch. But Griffin says that the governor’s latest actions to fix the problem may not be enough to solve nursing homes’ financial woes.

Griffin says the state owes her home more than $200,000, and most nursing homes in the state are still awaiting payment.

The original Article was written by Kristen Gourlay for RINPR and can be found HERE.

Matt Leonard

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