FRANKFORT, Ky. -- Gov. Ernie Fletcher announced today that he is changing the regulation used to determine who qualifies for long term care services through the Medicaid program.
The change – which takes effect Jan. 30 – means that people will have to meet just two instead of three criteria to qualify for Medicaid coverage. This reverses a regulation that took effect last April and resulted in hundreds of people being denied services.
"This amended emergency regulation will ensure that the families affected by the former regulation will be treated in a manner that meets the test of my administration – it makes sense and it is how we all want our parents to be treated,” Governor Fletcher stated.
The governor pointed out that last year's regulation did not save the money that had been projected.
The change applies to people seeking to be in a nursing home as well as those seeking in-home services through the state's Home and Community Based Waiver program.
Medicaid recipients who were denied services since early April will be mailed notices telling them the criteria has changed and that they may reapply. Those with appeals pending will have their cases remanded to the Department for Medicaid Services for review.
(Those who appealed their denials within the deadline continued receiving Medicaid coverage as long as their appeal was pending.)
There are 1,792 administrative appeals pending related to nursing facility and waiver services. Another 634 appeals have already been decided, according to the Cabinet for Health and Family Services.
Between April 3, 2003, and Jan. 3, 2004, more than 2,800 people were determined not to meet nursing facility level of care criteria.
The emergency regulation does not affect people with autism or those who qualify for personal care services. The Department for Medicaid Services is seeking a federal waiver that would allow coverage for some people with autism.
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