Introduction
The Department on Aging (DoA) Community Care Program (CCP) plays a vital role in providing essential services to seniors, enabling them to remain in their homes and communities. Recently, an important policy update has been implemented that significantly impacts individuals enrolled in or applying for this program in Illinois. Effective September 1, 2010, the costs associated with DoA/CCP services are now recognized as allowable medical expenses for meeting Medicaid spenddown requirements. This change, driven by an agency initiative, aims to streamline access to medical assistance for seniors receiving community care services. This article will delve into the details of this policy change, explaining its implications for both current and prospective DoA/CCP participants.
Policy Change: CCP Service Costs as Medical Expenses
Prior to this update, the expenses incurred through the Department on Aging’s Community Care Program were not explicitly considered medical expenses for the purpose of meeting Medicaid spenddown. Spenddown is a process by which individuals with income exceeding Medicaid limits can become eligible for Medicaid by deducting incurred medical expenses from their income. This new initiative recognizes the essential healthcare nature of CCP services, such as in-home care and adult day care, and acknowledges their role in maintaining the health and well-being of elderly individuals.
By allowing CCP service costs to count towards spenddown, the policy aims to reduce the financial burden on seniors who require both community care and medical assistance. This change simplifies the process for eligible individuals to access Medicaid benefits, ensuring they can receive comprehensive care without facing undue financial hardship.
Application Requirements and Assistance
Individuals interested in accessing the Department on Aging’s Community Care Program are required to apply for medical benefits as part of the application process. This requirement ensures that individuals who may be eligible for Medicaid are identified and can access these crucial benefits alongside CCP services. To facilitate this process, Care Coordination Units (CCUs) are available to assist applicants in completing the necessary medical benefit application. These units play a crucial role in guiding applicants through the paperwork and ensuring they understand the requirements.
The CCU will provide applicants with Form HFS 2378H, the Mail-In Application for Medical Benefits, and Form HFS 2538B, the IDoA Notification form. Form HFS 2538B is sent to the Family Community Resource Center (FCRC) to initiate the medical benefits application process. Applicants are expected to cooperate with the verification process to determine their eligibility for medical benefits, ensuring a smooth and efficient application experience.
Utilizing CCP Services to Meet Spenddown: A Detailed Look
The core of this policy change lies in the ability to use the cost of Department on Aging Community Care Program services to meet Medicaid spenddown. This means that for individuals with a spenddown requirement, the expenses for CCP services can be applied to reduce their excess income, potentially making them eligible for Medicaid.
It’s important to note that these services are applied to the individual’s spenddown obligation. In cases where a one-person standard is used for determining eligibility, DoA/CCP services cannot be applied to a spouse’s spenddown. Furthermore, in situations where one spouse begins receiving DoA services, companion spenddown cases need to be separated to ensure accurate calculation and application of expenses.
When calculating spenddown status, the estimated cost of DoA/CCP services is considered to be incurred on the first day of the month, regardless of when the services are actually delivered. These costs are prioritized and applied to the spenddown requirement before any other medical expenses. If the CCP service costs are not sufficient to meet the spenddown in the month they are incurred, these costs can be carried forward and used to meet spenddown in subsequent months. There is no time limit on utilizing these carried-over costs, offering flexibility in managing spenddown. However, once CCP service costs for a specific month have been used to meet spenddown, any remaining amount from that month cannot be carried over further.
To verify the costs of CCP services when spenddown is not centrally met, the CCU will provide Form 2538B. This form serves as official verification of the service costs and is used by the FCRC to apply these costs to the spenddown requirement, starting from the first month of DoA service approval. Expense Type ‘A’ should be used in the Automated Support Desk System (ASDS) when entering DoA/CCP service costs, ensuring proper categorization and processing of these expenses.
Centralized System for Meeting Spenddown with CCP Services
To streamline the spenddown process, a centralized computer system has been implemented. This system automatically identifies individuals whose monthly CCP service costs meet or exceed their monthly spenddown amount. When this occurs, the system takes central action to mark the case as “met,” simplifying administrative procedures and ensuring timely recognition of spenddown fulfillment. This automated process is conducted monthly at schedule 08 cut-off.
To monitor these changes, several Mobius reports are generated. Report #R8450469-03 is produced daily and lists cases that have received either a Notice of Determination of Spenddown Met (Form 458SP-2) or a Notice of End of Eligibility for Medical Assistance (Form 3358A). These notices are automatically sent when a case’s status changes between met and unmet. Report #R83003741 is produced monthly and identifies cases that have been terminated or where the monthly service costs are no longer sufficient to meet spenddown through the central process.
In cases where DoA services are sufficient to meet spenddown, the system automatically updates relevant codes and generates a TA 31/TAR A4 transaction. Form 458SP-2 is then sent to the client, informing them of their met spenddown status. Conversely, when DoA services are terminated or the costs are insufficient to meet spenddown, the system updates codes, generates a TA 31/TAR A5 transaction, and sends Form 3358A to the customer, notifying them of the change in their status. In situations where CCP service costs are not enough to meet spenddown centrally, these costs can still be manually applied towards spenddown within the ASDS system using expense Type A.
Medical Backdating and CCP Services
The policy also allows for medical backdating using CCP service costs. Specifically, DoA/CCP service costs can be used to backdate medical eligibility for up to 3 months prior to September 1, 2010. If an individual was receiving CCP services during those months and the monthly cost was equal to or greater than their spenddown amount, the system will centrally backdate eligibility. If medical backdating is not processed centrally, the FCRC can manually apply CCP service costs to backdate medical eligibility upon receiving Form HFS 2538B verifying the costs from the CCU.
Pay-in Spenddown Option for CCP Service Recipients
Individuals receiving Department on Aging Community Care Program services also have the option to enroll in Pay-in Spenddown. This allows individuals to proactively pay the difference between their income and the Medicaid income limit to meet their spenddown requirement. Those interested in enrolling in Pay-in Spenddown can obtain Form HFS 458SP-4, the Pay-In Spenddown Enrollment Form, by contacting the Healthcare and Family Services (HFS) Hotline.
Conclusion
This policy update represents a significant improvement in the accessibility of medical assistance for seniors participating in the Department on Aging’s Community Care Program. By recognizing CCP service costs as allowable medical expenses for spenddown, the state of Illinois is streamlining the process for eligible individuals to receive the comprehensive care they need. This change not only reduces financial barriers but also simplifies administrative processes, ultimately benefiting both seniors and the agencies that serve them. The automated system and clear guidelines outlined in this policy ensure efficient and accurate implementation, making it easier for seniors to navigate the complexities of healthcare and long-term care funding.
Forms Referenced
- HFS 458SP2
- HFS 3358A
- HFS 2378H
- HFS 2538B
- HFS 2538C
