No Medicaid terminations from March 2020 by way of the top of the federal public well being emergency. The nationwide public well being emergency has existed since January 27, 2020 and has been renewed by the Secretary of the U.S. Division of Well being & Human Providers in 90-day increments since that point. The newest renewal is efficient July 20, 2021.
On March 31, 2020, AHCA alerted suppliers and DCF posted on the ACCESS web site that:
- No Medicaid recipient will lose Medicaid eligibility in the course of the COVID-19 public well being emergency (until the person is now not a state resident or request voluntary termination); underneath the newly enacted Households First Coronavirus Response Act, a state is prohibited from ending protection for recipients enrolled as of March 18th in the course of the general public well being emergency if the state opts to acquire an enhanced federal Medicaid match.
- AHCA is working to inform recipients who could have obtained a termination discover within the month of March that their advantages might be reinstated.
- An FAQ launched by federal CMS gives some examples of Medicaid eligibility teams protected underneath these “no termination” necessities together with: former foster care youth getting old out once they flip 26; youth getting old out of kids’s eligibility once they flip 19; people who grow to be ineligible for SSI; people now not qualifying for Certified Medicare Advantages (QMB). In a Might 5, 2020 replace, CMS states that this “no termination” requirement additionally applies to medically needy people decided eligible in the course of the public well being emergency even when they don’t proceed to fulfill their month-to-month share of value in subsequent months. This safety extends by way of the final day of the month the general public well being emergency ends.
- On October 28, 2020, federal CMS issued a brand new interim closing rule weakening the continual protection, “no termination” requirement. In states like Florida which have opted to cowl full advantages for lawfully residing youngsters within the first 5 years after entry into the US, as soon as they flip 18, states at the moment are required to restrict their protection to emergency providers. As well as, states at the moment are permitted to scale back non-obligatory advantages comparable to dental protection or improve cost-sharing comparable to requiring nursing house residents to contribute extra to their prices of care. However in Florida the sort of change would require the Legislature to amend state Medicaid legislation.
Redetermination/recertification instances are reinstated. As of October 1, 2020 AHCA’s web site is alerting recipients that the Division of Youngsters and Households is now mailing letters for case evaluations to examine if a family continues to be eligible for Medicaid and/or Medically Needy. AHCA is urging folks receiving these letters to take steps now to re-apply. However be aware, Medicaid protection won’t finish in the course of the COVID-19 Public Well being Emergency. In January 2021 DCF performed one-year “automated renewals” for folks whose sole revenue is social safety and SSI and are enrolled in an SSI-related Medicaid program (e.g., MEDS/AD, Medically Needy and Medicare Financial savings Packages). Individuals getting VA revenue weren’t included within the automated renewal.
Prolonged software time. Efficient with functions filed in February 2020, the time for submitting documentation required to course of an software is prolonged for 120 days from the date of the appliance and eligibility will nonetheless be efficient the primary day of the month the appliance was obtained. Efficient July 1, 2021, this coverage has been rescinded. Medicaid functions submitted on or after July 1, 2021 could also be denied on the 30th day after software or the day after verification data is due. Purposes filed previous to July 1, might be allowed 120 days to offer requested verification to determine Medicaid eligibility.
Exclusion of further unemployment funds in figuring out eligibility. The $600/week of further unemployment insurance coverage funds underneath the CARES Act won’t be counted as revenue in figuring out Medicaid eligibility. (Nevertheless, these funds might be counted as revenue in figuring out market subsidy calculations.)
Protection of Medicaid providers in the course of the state of emergency
- Protection of all medically vital providers to COVID-19 testing and therapy.
- Waiver of limits on providers that should be exceeded to keep up the well being and security of recipients identified with COVID-19 or when vital to keep up a recipient safely of their house
- Waiver of prior authorization necessities for hospital, doctor, superior observe registered nursing, doctor assistant, house well being providers and sturdy medical gear and provides. As of June 19, 2020, AHCA reinstated prior authorization necessities for all of those providers.
- Waiver of copayments for all providers
- Waiver of limits on early prescription refills, aside from managed substances
- Protection of a 90-day provide of upkeep prescriptions when out there on the pharmacy
- Reimbursement of out-of-state suppliers offering medically vital providers to Florida Medicaid beneficiaries. As of July 1, 2021, the supply of supplier “provisional enrollment” for in-state and out-of-state suppliers will finish.
- Delay of honest hearings solely in these situations when the recipient is continuous to obtain providers pending the end result of the listening to
COVID-19 Vaccines for Medicaid Enrollees. In an govt order revealed March 16, 2021 Governor DeSantis revised the vaccine distribution plan, which applies to most of the people together with Medicaid enrollees, to decrease the age requirement to 40 efficient March 29, 2021 after which efficient April 5, 2021 all Floridians are eligible to obtain any COVID-19 vaccination accepted by the Meals and Drug Administration.
Medicaid enrollees eligible to obtain the vaccine could go to myvaccine.fl.gov to discover a location distributing the vaccine and to schedule an appointment.
On March 12, 2021, AHCA revealed directions for Medicaid enrollees on receive Medicaid transportation as soon as they’ve scheduled an appointment for a vaccine. AHCA states: “Florida Medicaid will take you to get the COVID-19 vaccine without charge. All you could do is ready up a time to get your vaccine. Subsequent, let your Medicaid plan know you want a trip and they’re going to maintain the remaining. In case you are not enrolled in a plan, name the Medicaid Helpline at 1-877-254-1055 to search out out the identify and telephone quantity for a transportation service.”
The state has additionally just lately launched a brand new e mail system to assist carry COVID-19 vaccines to homebound seniors. Seniors will be capable of signal as much as have the vaccine come to them by emailing a request to [email protected]
AHCA has posted Medicaid Alerts and FAQs offering extra element on Medicaid service modifications in response to COVID-19. They handle a variety of matters together with, however not restricted to: telemedicine steerage for medical, behavioral well being, and early intervention providers suppliers; long-term care supplier community flexibilities permitting extra forms of suppliers to ship specified long run care providers; and continuity of take care of grownup day care heart enrollees in the course of the time these facilities are closed.
AHCA is loosening protection restrictions for behavioral well being providers. Efficient Might 5, 2020, all prior authorization necessities for psychological well being or substance use dysfunction therapy are waived and repair limitations (frequency and period) are lifted. For behavioral evaluation providers, present authorizations might be prolonged by way of an “administrative approval course of” which doesn’t require suppliers to reassess beneficiaries presently getting providers. Efficient July 1, 2021 service limits might be reinstated for behavioral well being providers and efficient July 15, 2021 Medicaid prior authorization necessities might be reinstated for behavioral well being providers.
Per a Might 29, 2020 supplier alert, in the course of the state of emergency AHCA might be reimbursing suppliers for telemedicine well-child visits supplied to youngsters older than 24 months by way of age 20. Suppliers are directed to actively work to schedule follow-up in-person visits to manage immunizations and different bodily parts of the examination which can’t be completed by way of telemedicine.
The general public cost rule won’t be utilized to immigrants’ use of Medicaid advantages for COVID-19 testing and therapy.
Protection of house and community-based waiver providers (HCBS) – In response to the general public emergency, Florida obtained approval from the federal authorities to make modifications in HCBS waiver applications, together with the Lengthy Time period Care and Developmental Disabilities applications. The modifications are efficient retroactively from January 27, 2020 to January 26, 2021. Particulars will be discovered right here. They embody, however usually are not restricted to:
- allowing digital evaluations, assessments and care planning conferences in lieu of head to head conferences and use of digital signatures;
- lifting service limits so as to handle well being and welfare problems with enrollees;
- adjusting service prior authorization necessities;
- briefly increasing the settings the place providers will be supplied;
- permitting funds for help providers supplied to enrollees in hospital or short- time period institutional settings; and
- prohibiting guests in sure residential settings to attenuate the unfold of an infection.
Notice on COVID-19 testing, therapy, and vaccines for the uninsured. Florida has not opted to obtain 100 p.c federal Medicaid funding for COVID-19 testing of individuals with out medical health insurance. Underneath the 2021 American Rescue Plan Act this feature has been expanded to cowl COVID-19 therapy and vaccines for the uninsured as nicely. Because the state has not taken up this feature Floridians should look to an uneven patchwork of free testing, therapy, and vaccine assets scattered across the state. AHCA advises that uninsured folks could obtain free testing from their county well being division or a federally certified well being heart and that “many communities present testing totally free for people who should not have insurance coverage. Please [click here] to discover a check web site in your space. Uninsured people ought to ask earlier than the check whether or not testing is freed from cost.” There are not any state company directions on the place uninsured folks can obtain free therapy. Nevertheless, extra data on doable sources totally free therapy is obtainable right here.
Residency proof now not required at some vaccine websites, “paving the best way for migrants.” – On April 29, 2021 Surgeon Normal Rivkees issued a brand new public well being advisory specifying that COVID-19 vaccines can be found to “a Florida resident” or somebody “who’s current in Florida for the aim of offering items or providers for the advantages of residents and guests of the State of Florida.” This new coverage applies to all state-run and federally supported vaccination websites. It rescinds an advisory issued in January that had restricted vaccinations to individuals who might present proof of Florida residency
2021 unemployment compensation claimants can entry free or decreased value medical health insurance by way of the ACA market. The Reasonably priced Care Act (ACA) Market was re-opened in February 2021 to present individuals who want medical health insurance a brand new “particular enrollment” alternative to get lined. The 2021 American Rescue Plan eradicated or vastly decreased premiums for many individuals with low or average incomes.
Beginning July 1, 2021, individuals who obtained or have been accepted for unemployment compensation for any week starting in 2021 can entry free or decreased value complete medical health insurance plans by way of the ACA market. This profit is obtainable no matter somebody’s present revenue. To get this profit, folks should enroll within the market no later than August 15, 2021. For assist with enrollment, contact Overlaying Florida at 877-813-9115.