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Medicaid

Welcome to Medicaid!!!

Betty Dumas-Beasley, Chief, Medicaid Eligibility UnitEna Lightbourne, Program coordinatorPam Cooper, Policy Consultant

What’s new, changed or may come…………..

Haitian Family Reunification Parole Program (HFRP)

Implemented by U.S. Citizenship and Immigration Services (USCIS).

An Immigration petition that offers a Principal Beneficiary and Derivative Beneficiaries (spouses and unmarried children under 21) the opportunity to be reunited with family in the United States.

The program is intended to expedite family reunification, by increasing avenues for legal migration from Haiti, and help Haiti continue to recover from the devastation and damage suffered in the January 12, 2010 earthquake.

Only U.S. petitioners who receive invitations from the National Visa Center (NVC) will be eligible to apply.

Approved beneficiaries will enter the US as parolees.

Medicaid Eligibility

Once paroled into the United States, the parolee will meet the definition of Cuban/Haitian entrants under section 501(e)(1) of the Refugee Education and Assistance Act of 1980, and will be a “Qualified Alien”.

Follow sections MA-2504 and MA-3330 Alien Requirements to determine Medicaid eligibility.

Non-Emergency Medicaid Transportation

(NEMT) The North Carolina Medicaid program provides non-emergency

medical transportation services to and from medical appointments for Medicaid beneficiaries.

Currently, NEMT is arranged and provided by the local county departments of social services. Each county contracts with vendors to provide transportation. The County DSS pays the vendors for the cost of the trip and seeks reimbursement from DMA.

The Affordable Care Act (ACA) requires that “professionals providing services under the state plan (Medicaid) or waiver of the plan to be enrolled as participating providers.” This provision applies to NEMT vendors.

Once enrolled, the NEMT vendor will be allowed to bill for services through NCTracks just like any other Medicaid provider.

NEMT Continued…..

Since NEMT vendors will be able to bill through NCTracks, there must be a way to verify the following:

The vendor is contracted with the County DSS

A billed trip was authorized by the county

The trip occurred

The cost of the trip

Essentially, we would need to create a “prior approval” process.

“Prior Approval” ProcessProposal #1

The transportation coordinator will enter travel information into NCFAST.

This information will include :

MID of individual transported.

Date and time of trip.

Name of vendor.

Destination address.

Medicaid provider name.

NCFAST will send a daily file containing this information to NCTracks. The information will be compared to the NEMT provider’s claim in NCTracks. NCFAST data must match provider claim data in NCTracks, completing a “prior approval” process. This will allow NCTracks to pay the claim.

“Prior Approval” ProcessProposal #2

The transportation coordinator will enter travel information directly into NCTracks.

Data must match provider claim data in NCTracks, completing a “prior approval” process.

This will allow NcTracks to pay the claim.

Keep in Mind…….

Although NEMT vendors will be enrolled Medicaid providers, they will still be required to contract with the local county department of social services.

The County DSS is still responsible for assessments and arranging transportation.

More information is forthcoming.

Eastern Band of Cherokee Indians (EBCI)

N.C. General Assembly approved legislation allowing the EBCI to establish and operate as a separate social services entity. The EBCI will be responsible for determining Medicaid eligibility and case maintenance. They will take on this role for people living on tribal lands.

The EBCI is a sovereign nation; however for system functionality purposes they will be considered “County 10X.”

The Qualla Boundary lies within the counties of Jackson, Swain, Graham, Cherokee, and Haywood.

EBCI Functions and ResponsibilitiesResponsible for intake and processing for Medicaid applications face to face, by mail or electronically.

Subject to all eligibility determination rules and regulations.

Responsible for completing annual reviews.

The EBCI will utilized NCFAST and electronic verifications to determine eligibility.

Subject to program integrity guidelines and procedures.

NEMT compliance

Subject to case audit review requirements:

Alexander Audit

Perm/MEQC

Single Audit

Quality Assurance

Monitoring and Oversight

Hearings Process

A Beneficiary has the right to appeal an action if he/she disagrees with the decision. A local hearing must be held at the EBCI DSS office for all appeals except those involving a disability. Appeals involving disability are held at the state level.

A Beneficiary has the right to a state appeal if he/she disagrees with the local appeal decision, or if the appeal involves a determination of a disability.

EBCI and the state will maintain the hearing process for any cases appealed regarding actions taken by the EBCI.

Resources

EBCI will be included in Listserv messages

Access to state Medicaid manuals for guidance and reviews

Access to Dear County Director Letter and State Administrative letters and other state communications

EBCI will be present on the DSS Director Board

EBCI will be invited to join the Economic Benefits sub-committee, which reviews draft policy for comments

Receive webinar policy training periodically as a county DSS office

More information forthcoming

Asset Verification System (AVS) Clarifications

AVS is an automated system that obtains electronic financial information for individuals applying or subject to redetermination for Aged, Blind and Disabled Medicaid.

Here are some clarifications on how the AVS system works:

AVS is not a verification in the sense a caseworker should expect a response from known banks for the purpose of verification.

The AVS system is designed to identify undisclosed accounts, not validate/verify what is already known.

All financial institutions in North Carolina are eligible to receive requests.

Asset Verification System (AVS) Clarifications (cont.’)

The caseworker should proceed with the manual verification process for all known accounts and not to wait to receive a response. 

If the caseworker gets a response prior to receiving verification from the client or the bank, use it to confirm the information received. Move forward with processing the application/recertification.

Title IV-E Adoption IV-E children that move to North Carolina from another state.

NC covers IV-E children up to age 18, however many states cover them up to age 21. Changes to regulations require states/NC to cover all IV-E children through the age stated in the IV-E agreement in the originating state.

Policy is forthcoming. In the interim call DMA/MEU @ 919-855-4000

Proposed bill

NC G.S. 108-A-55.55(b) Verification of State Residency for Medical Assistance.

A document issued by the Mexican consular or other foreign consulate verifying the applicant’s intent to live in North Carolina permanently or for an indefinite period of time or that the applicant is residing in North Carolina to seek employment or with a job commitment from state residency verification.

REVIEW

Proposed billSenate Bill 14

NC State Auditor Language back in bill; that state auditors will be auditing the counties to ensure they are implementing policy accurately and timely.

County Recertification