HONOLULU- The Department of Human Services (DHS) wants to reassure beneficiaries who continue to meet financial and clinical eligibility criteria that they will continue to receive long-term care services regardless of the end date stated in a recently received notice.
The DHS sent notices during the period of May 16-30, 2014 to approximately 4,500 medical assistance beneficiaries who receive long-term care services in a facility, their own home, or a community-based setting. The notices were generated as a result of adding new long-term care functionality to the DHS eligibility system.
There have been no changes to eligibility criteria for aged, blind or disabled individuals, or for long-term care services. To receive long-term care services, a beneficiary must meet financial and clinical requirements. The clinical requirement is a certain minimum level of functional impairment, considered as institutional level of care (LOC). LOC is communicated through the DHS Form 1147, and can be approved for a maximum 12-month period. This has been and continues to be the requirement.
All approved DHS Form 1147s have an end date. Typically, the long-term care provider renews the DHS Form 1147. Beneficiaries have largely not been responsible for this process, and end date information was previously not conveyed to them. Because the recent notices included the end date,
beneficiaries may be concerned about losing or having lost long-term care coverage as of the noted end date.
Again, the DHS assures beneficiaries who continue to meet financial and clinical eligibility criteria that they will continue to receive long-term care services. Long-term care services will not end until after a beneficiary is notified by his or her health plan, or the individual loses Medicaid eligibility altogether.
The DHS is working with health plans and long-term care providers to reassure beneficiaries, and their families, that they will not lose coverage. Additionally, the DHS will be mailing a letter to beneficiaries to provide clarification.
The DHS is in the process of replacing its eligibility system to meet federal requirements, enhance our ability to serve beneficiaries, and improve program integrity. The replacement of its legacy 25 year-old system is a substantial endeavor that would typically take three to five years, and DHS is on track to complete in two years. The DHS apologies for any inconvenience during this modernization and appreciates the public’s understanding and patience.