Modify computer systems to reduce eligibility errors
Modify computer systems to reduce eligibility errors
If states have not properly modified their computerized eligibility systems in response to changes in eligibility rules affecting cash assistance and Medicaid, some applicants may be erroneously denied Medicaid enrollment, says Federal Medicaid director Timothy Westmoreland. Also, some beneficiaries may lose coverage even if they are still eligible.
Federal law requires states to ensure that their computer systems are not improperly denying enrollment in, or terminating clients from, Medicaid.
In his April 7 letter to state Medicaid directors regarding identifying and reinstating those who were improperly dropped from Medicaid, Mr. Westmoreland makes clear that the need to use resources for Y2K programming changes is not a satisfactory reason for not promptly reprogramming for de-linking.
"States have an obligation to move expeditiously to correct computer programming problems that are leading to erroneous Medicaid denials and terminations," he says. "In the meantime, no person should be denied Medicaid inappropriately due to computer error, and no person should have his or her Medicaid coverage terminated erroneously due to computer error. Once a problem with a state’s computerized eligibility system has been identified, the state must take immediate action to correct the problem. If programming changes cannot be made immediately, an interim system to override computer errors must be put in place to ensure that eligible individuals are not denied or losing Medicaid."
Based on reports from various states, Mr. Westmoreland says that the most direct way to fix the problem is to make the necessary programming changes as quickly as possible. While programming changes are being made, states must still ensure that improper adjudications don’t occur.
These are four approaches states have used:
1.Assign supervisors to review all TANF case closures before any Medicaid termination can proceed.
2.Assign local supervisors and a state-level task force the responsibility for reviewing all Medicaid denials and terminations that coincide with a TANF denial or termination.
3.Give cases to be terminated a next-day audit by caseworkers and managers, reinstating cases that continue to be eligible for Medicaid before they are scheduled to be closed.
4.Put a short-term hold on Medicaid case closings based on certain computer codes pending implementation of other solutions.
Mr. Westmoreland reminds states that prior HCFA authorization is required for them to receive federal matching funds for changes in their computer systems. Federal funding is available from computer modifications related to de-linking.
If states have not properly modified their computerized eligibility systems in response to changes in eligibility rules affecting cash assistance and Medicaid, some applicants may be erroneously denied Medicaid enrollment, says federal Medicaid director Timothy Westmoreland. Also, some beneficiaries may lose coverage even if they are still eligible.
Federal law requires states to ensure that their computer systems are not improperly denying enrollment in, or terminating clients from, Medicaid.
In his April 7 letter to state Medicaid directors regarding identifying and reinstating those who were improperly dropped from Medicaid, Mr. Westmoreland makes clear that the need to use resources for Y2K programming changes is not a satisfactory reason for not promptly reprogramming for de-linking.
"States have an obligation to move expeditiously to correct computer programming problems that are leading to erroneous Medicaid denials and terminations," he says. "In the meantime, no person should be denied Medicaid inappropriately due to computer error, and no person should have his or her Medicaid coverage terminated erroneously due to computer error. Once a problem with a state’s computerized eligibility system has been identified, the state must take immediate action to correct the problem. If programming changes cannot be made immediately, an interim system to override computer errors must be put in place to ensure that eligible individuals are not denied or losing Medicaid."
Based on reports from various states, Mr. Westmoreland says that the most direct way to fix the problem is to make the necessary programming changes as quickly as possible. While programming changes are being made, states must still ensure that improper adjudications don’t occur.
These are four approaches states have used:
1. Assign supervisors to review all Temporary Assistance for Needy Families (TANF) case closures before any Medicaid termination can proceed.
2. Assign local supervisors and a state-level task force the responsibility for reviewing all Medicaid denials and terminations that coincide with a TANF denial or termination.
3. Give cases to be terminated a next-day audit by caseworkers and managers, reinstating cases that continue to be eligible for Medicaid before they are scheduled to be closed.
4. Put a short-term hold on Medicaid case closings based on certain computer codes pending implementation of other solutions.
Mr. Westmoreland reminds states that prior HCFA authorization is required for them to receive federal matching funds for changes in their computer systems. Federal funding is available from computer modifications related to de-linking.
[Contact Mr. Westmoreland at (410) 786-3870.]
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