We all know that the Deficit Reduction Act (DRA) changed the Medicaid look-back period from three years to five years. So why hasn’t your facility felt the impact? The reason is that the increased look-back is being phased in – starting now, February 2009.
Here’s how it works: The increased look-back is being phased in so that February of 2006 will always be a part of the documentation requirements of any Medicaid application submitted after the passage of the DRA. A Medicaid application filed between February 2006 and the present necessarily included February 2006 in its three-year look-back. However, beginning in February 2009, that won’t be the case. Therefore, a Medicaid application must contain three years plus one month of financial records for every month post-February 2009 you are applying.
For example, if you are filing a Medicaid application in March 2009, you must submit three years plus one month of financial records. If you are filing in April 2009, you must submit three years plus two months of financial records and so on. In February 2011, we will be at the full five years.
What will this mean to your facility? To begin with, facilities will face longer periods of carrying residents Medicaid-pending as application processing time will likely be increased. You can also expect more denials of benefits as families are unable to produce three-plus years of financial records and/or explain financial transactions during such increased period of time. That will translate into increased reconsideration applications (and possible loss of originally requested pick-up date, depending on the county) and increased Fair Hearings. In either scenario, your facility will be faced with greater delays in reimbursement.
So what should you do to protect your facility? First, get your designated representative to sign: 1) an authorization for you to gather financial records on the resident’s behalf; 2) a fair hearing authorization that survives incapacity or death; 3) a Medicaid obligations understanding or, alternatively, a waiver of Medicaid filing; 4) an authorization to pursue a hardship waiver; 5) an authorization for the Department of Social Services to release information to your facility regarding the resident’s Medicaid application, including asset and income information; and 6) an authorization for the facility to act on behalf of the resident in the Medicaid Application and recertification process.
Put your facility in the driver’s seat. Don’t rely on well-intentioned family members to get a Medicaid application completed. Take charge of the application yourself so that you can control what gets submitted and when. That is your best defense in these challenging times.