The Perils of Medicaid “Redets” – Part 2

In my blog post last week, I talked about a recent trend we are seeing – clients getting terminated from Medicaid as a result of a failed redetermination (“redet”). The purpose of a redet is for Medicaid to confirm that eligibility still exists (ie. the assets are still below the applicable limits and the QIT – if required –  is being used correctly) and also to update the calculations of the Medicaid recipient’s cost share (the amount he or she is required to contribute from income towards the cost of care) due to cost of living and other adjustments.

That being said, too many people are still losing benefits – sometimes in unfair ways.  It starts with notice.  When Medicaid is approved, the PR (the form with rows and columns of numbers used to calculate the cost share) also states at the top the month and year when the first redet is anticipated.  That is just an estimate, however, since we have found the notice can arrive before or after that month.

The problem is that the notice can be sent to the person who filed the original Medicaid application, a family member or the Medicaid recipient’s him or herself.  Some counties insist they will only mail it to the recipient which is problematic if that person lives in a facility and/or has dementia.  They don’t know and are unable to tell anyone that they have received the form.

We tell families when Medicaid is approved that they need to be “on the lookout for the redet notice” and to communicate directly with the facility to be sure it is forwarded to them.  Nevertheless, we have seen numerous instances in which the notice is never received and only on a second warning notice or a termination notice for failure to respond do these letters come to the attention of family.

There are other more substantive ways that a Medicaid redet is denied and benefits terminated.  Next week I’ll give you examples.