A Georgia health agency Thursday delayed approval of a change in the Medicaid eligibility system for people in long-term care whose incomes are above the government program's thresholds.
The Department of Community Health's board had been set to approve a switch for some lower-income Georgians — who now use "Qualified Income Trusts" to qualify for Medicaid — to a "medically needy" eligibility program.
These people make too much money to qualify for regular Medicaid, but not enough money to pay for their health-care needs.
But consumer advocates have expressed concerns that the change in eligibility methods would help only people in nursing homes and institutional hospice programs — and not those with Medicaid "waivers'' who live in community settings. The new policy could also limit people's choices in long-term care arrangements, the advocacy groups say.
Department of Community Health officials said Thursday that in delaying the board vote, they sought additional time before implementation.
"We want to make sure it's done right rather than fast,'' said Jerry Dubberly, the Georgia Medicaid director.
Since 2004, many Georgians seeking to qualify for Medicaid have moved their income into a Qualified Income Trust, from which they paid a provider for their care. The money in these trusts goes to paying for their medical care.But setting up the trust is a complicated procedure.
"All in all, the process created unnecessary burdens with no benefit to the state, DCH, to the resident or the facility,'' said Melanie McNeil, the state's long-term care ombudsman, in her written comments about the change.
For that reason and others, the switch to a medically needy program — allowing the person to qualify for Medicaid without setting up a trust — has generally been viewed favorably by consumer advocacy groups.
But those groups have also expressed concerns about people possibly losing eligibility for Medicaid if they have trusts and are currently in waiver programs that allow them to live in community settings rather than institutions.
The consumer groups are also worried that people seeking to qualify for a waiver in the future won't be able to use a trust or the medically needy program to do so.
"First, we want to ensure that any change does not result in people currently on the waiver losing their eligibility,'' said Dawn Alford of the Georgia Council on Developmental Disabilities, in her written comments on the change.
"Furthermore, we also want to ensure that any change which takes place does not create a situation in which an individual can more easily qualify for Medicaid by entering an institutional setting than qualifying for a Medicaid waiver."
Community Health told Georgia Health News last week that the medically needy program would not apply to people in waiver programs.
Officials added in an email to Georgia Health News on Thursday evening that the agency would have to amend the waiver and get federal approval, along with a legislative and budgetary OK, to allow the medically needy program for people with waivers.
The Community Health statement also said it does not have a set date for a new proposal to be brought again before the board, but indicated that revisions were needed.
"DCH would need the assurance from (the federal Centers for Medicare and Medicaid Services) that the waivers can be amended to accommodate (medical needy) without creating an institutional bias,'' the email from the agency said. "Additionally, the department would need to be assured of operational readiness, and thorough communication to the affected members must be planned."
More than 50 Georgians in waiver programs currently have trusts that allow them to live in their community, said the Georgia Legal Services Program in its written comments.
The Legal Services Program said these people include "E.B.," a woman with disabilities who formerly lived in a nursing home but used a trust to qualify for a Medicaid waiver "so she could live at home with her family.''
Losing that mechanism and her in-home services that the waiver provides would force her to return to a nursing home, the Georgia Legal Services Program said.
The Community Health email said it intends to grandfather in those waiver members so they don't lose their eligibility.