Medicaid Redeterminations Revisited – Part 2

In my blog post last week, I wrote about changes in Medicaid’s redetermination process, especially in the last 6 to 7 years.  More recently, in the last 6 to 7 months, Medicaid has changed the redetermination application itself.  Before the change, the “redet” application  was 7 pages.  Now it is more than double that, at 15 pages.

More important, however, is what is being asked on this new application.  Many of the questions being asked are identical to the original application.  In other words, to many it looks like  the redet app is an entirely new application process with a new 5 year look back – except that it’s not supposed to be that way.

There are two primary reasons for the redetermination application process.  One is to be certain that the Medicaid recipient still meets the resource eligibility standard of having no more than $2000 of assets.  What would have changed in a year, you may ask?  A Medicaid recipient may have received an inheritance from a family member, a settlement of a lawsuit or may now be divorced.  That’s why on the old redetermination application there was a question asking about changes in the past year.  On the new application, however, that question has been removed.

The second purpose for the redetermination is to recalculate the cost share – that amount of a person’s income that must be given to the facility (or to the State of New Jersey in the case of home based Medicaid benefits) as part of his or her contribution towards their care.  Because Social Security and pension income often have cost of living adjustments and health insurance premiums (which can be deducted in the cost share calculation) have rate increases, the cost share calculation must be recomputed each year.

So what then accounts for the longer redet application?  I’ll explain that next week.