A little while ago, we introduced readers to the new Medicaid Managed Care program which is currently going statewide in Florida. You can read our post on Florida Medicaid Managed Care (SMMC: Statewide Medicaid Managed Care) to find out more about how this change affects current Medicaid recipients and others who may need Medicaid assistance for long-term care.
One important aspect of the managed care process is the assessment used to determine level of care and services. Medicaid eligibility has two pieces: the financial qualifications and “medical eligibility” or care-related qualifications (level of care). Medical qualification must meet federal guidelines, but is state-determined, so a person eligible in another state may not be eligible in Florida. The form used to gather assessment information to determine level of care is the 701B form. This form gathers comprehensive information on a number of areas about a client, attempting to provide a picture of his/her care needs and situational factors. Some of the most important aspects of the assessment in the level of care determination are these sections: mental health/behavior/cognition, nutrition, health conditions, specialized services and medications.
The determination relies on this information as well as that provided by the client’s physician. Therefore, it is vital that good information is provided. If a client and caregivers provide the “rosiest” picture of how things can be or gloss over potential problems, they may be doing themselves harm because the client really needs more than the assessor may understand. We find that for clients and families, the whole Medicaid eligibility process can be very confusing and many little things can go wrong along the way, whether it is missing a step, poor timing, inaccurate information given or not following through with various steps.
With SMMC, the assessment takes on additional importance. At one time, the eligibility process was mainly determining whether someone was eligible or not…typically for care in a long-term care nursing home. Today there are various options for where care might be provided. Under the managed care system, the providers will be looking to provide care in a way that is most cost-effective (and the program has always had a goal of attempting to provide care in the least restrictive environment, through sometimes options have been limited due to limited program funding for alternative care).
Under SMMC, each Medicaid recipient will be asked to choose a managed care plan to manage their care under Medicaid benefits. A plan representative meets with the recipient to determine a care plan. The client is supposed to have input in to this plan (including personal goals) and is entitled to have an advocate present. During this meeting, a care plan is developed outlining what services will be provided. This process is very important (and the care plan generally stays in effect for a year) in determining what care you will receive. Once again, the accuracy of the information given is essential and we believe that having an advocate there with you is also essential. There is a process to complain and make plan changes if you are not satisfied with the care being provided. It is also important to note that since the care is being managed by private companies, they create contractual relationships with care providers. So, Plan X may or may not contract with a specific Assisted Living Facility or home care provider. Therefore, there are many factors in play throughout the process. All of these factors can ultimately affect the care you are receiving.
Several Aging Wisely care managers have trained and become certified in the Florida Medicaid 701B assessment process. We can offer guidance through the Medicaid eligibility, enrollment and care planning process. We work with qualified elder law attorneys if you need help with financial qualification/Medicaid planning and we can coordinate the process for you to help you understand the various steps and get the optimal care situation for your circumstances. Give us a call today at 727-447-5845 to find out more about how we can help.
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