Medicaid 'Spend Down' and Medicare Part D: Published on 2008-09-29 17:06:46: Category: Medicaid, LIS and Extra Help: People with Medicare who are also eligible for. Information partners can use on: Medicaid Spend Down. THE SPEND-DOWN PROCESS 1. How does spend-down work? 3.7.1 MNP Spend Down Processing. This process enables TMHP MNC to expedite the conclusion of the case and inform DSHS when the spend down. Don’t lose your house to the nursing home! Learn attorney secrets for protecting assets while qualifying for Medicaid! What is spenddown in. To qualify for Medicaid, you may have to first spend down some of your assets. Spend down is a MO HealthNet program in which you have an amount that you must pay or reach each month before you can have MO HealthNet coverage. The Medically Needy 'Spenddown' Program: Medicaid for Adults 65 and Older or Disabled Who Don't Get SSI Authored By: Columbia Legal Services. DSHS proposes sweeping medicaid changes. New waiver would allow state to reduce benefits, impose premiums and cost- sharing, and deny coverage to people with disabilities, low- income families, and elderly citizens. Washington State. This waiver will result in dramatic changes in the state. The state plans to submit its final proposal by October 3. What is a Medicaid Demonstration Waiver? Medicaid is a health care program for people in financial need and is funded jointly by the federal and state governments. To receive federal funds, the state must comply with federal Medicaid laws. These laws include important protections relating to health care benefits, co- payments and premiums, and guaranteed enrollment. However, a state may be permitted to use different rules for its Medicaid program through a . The changes would be made primarily through the legislative budget negotiation process and/or by DSHS. Under the proposal, the following existing federal protections would be removed: Enrollment Guarantee. Under the waiver, DSHS would have unilateral power to impose waiting lists for certain clients, even if they cannot afford to purchase other health insurance. DSHS has stated that these clients would receive benefits at least the same as the state. However, in its proposal, DSHS does not make a commitment to maintain even this level of coverage. In fact, the proposal allows for changes in the Basic Health package. Moreover, the Basic Health package does not now cover medical equipment or supplies, complications resulting from excluded services, emergency facility services for non- emergency situations, dental care, custodial care, complete mental health services, and other services. For example, under this package, a child could be denied necessary asthma equipment and supplies. A state may charge no more than a $2. Furthermore, women receiving pregnancy- related care, children, nursing home residents, and others may not be charged any cost- sharing, and no Medicaid client may be denied services if he or she cannot afford the co- payment. Under the waiver, DSHS plans to charge cost- sharing for all clients, with select services exempted for certain client groups. The DSHS proposal does not state the amount of cost- sharing it would charge, but indicates that it could reach 5% of a family. States may collect limited premiums from very select groups of clients. Under the waiver, DSHS could charge premiums for all clients above 1. In its proposal, DSHS states that it would charge . However, DSHS does state that combined premiums and cost- sharing could be as high as 5% of a family. Therefore, a member of a three- person family with income of only $1. Some of these could be done without a waiver; others (such as removing the requirement of a signature on the application) require a waiver. Will Washington be able to cover more people under this waiver? The waiver proposal also requests using Washington. The proposal does not address the leading single driver of Medicaid spending increases - the cost of prescription drugs - even though several states are exploring ways of reducing such costs. Furthermore, many questions remain as to how cost- savings, if any, would be achieved. No cost- benefit analysis has been cited by DSHS and none has been made public. Such an analysis, which must take into account costs to clients and long- term costs (such as increased use of emergency rooms), is essential for understanding the potential outcome of the DSHS proposal. For example, the collection of premiums and co- payments requires a costly and sophisticated administrative structure that DSHS does not now have. Recently, the state decided to impose Medicaid premiums on clients coming off welfare and admitted that the cost savings would come primarily from clients dropping coverage because they could no longer afford it, rather than from premiums. How will decisions about Medicaid changes be made if the waiver is approved? Many of the decisions about how to change Medicaid would occur during legislative budget negotiations and would not necessarily be raised or discussed in public hearings. DSHS would have discretion to impose enrollment caps and waiting lists if it ran out of funds. There is no additional public process mentioned in the waiver memo. There is also no indication of which changes will be considered when, because the purpose of the waiver is to give the state flexibility to make the changes however and whenever it chooses. How can Washington residents express their concern about this waiver? Advocates have expressed concern about the lack of real public process for the waiver. DSHS is presenting information on the waiver in its Community Conversations meetings in various cities and towns, but has not widely publicized these meetings. Meetings have already been held in several locations, but for meetings in Spokane and Colville potential participants were provided less than one week advance notice. In September, Community Conversations meetings will be held in Wenatchee, Yakima, Pasco, Seattle and Bellingham. There will also be a Title XIX Medicaid Advisory Committee meeting on September 2. Sea. Tac. Concerned individuals should also contact Governor Locke, their legislators, and Secretary Braddock (of DSHS) to express their concerns. Let them know that Washington should: pursue the Family Expansion Waiver. Pine Street, Suite 3. Seattle, WA, 9. 81.
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