In early 2020, we reported that in response to the COVID-19 public health emergency, an individual’s Medicaid benefit could not be reduced or terminated during the public health emergency.  Although the COVID-19 public health emergency continues, the United States Congress has passed legislation that will end this continuous enrollment condition effective March 31, 2023.

What does this mean for Medicaid recipients?

For most Medicaid recipients who have maintained eligibility criteria (i.e. kept assets below resource limit, income is below income standard, etc.), the recipient will see no change in his or her benefits.  He or she will just receive a redetermination notice during his or her annual renewal time.  However, those who made a post-eligibility transfer during the pandemic and has unserved time on his or her penalty or those who received benefits despite not maintaining eligibility standards may need to take action and/or be aware that their benefits could change.

Unserved Transfer Penalties

The Indiana Family and Social Services Administration (FSSA), the state agency that administers Indiana’s Medicaid program, has indicated that it intends to implement any remaining transfer penalty period beginning April 1, 2023.  Here is an example of a recipient that this decision will effect:

Lisa moved into a nursing home and starting receiving Medicaid benefits April 1, 2022.  On May 1, 2022, Lisa sold her home and gifted $105,000 to her family.  Typically this transfer results in transfer of asset penalty (a period of no help by Medicaid for nursing home care) of about 15 months which begins May 1, 2022 and ends July 31, 2023.  However, the continuous enrollment condition of the COVID public health emergency prohibited the State from applying a penalty on May 1, 2022.  On April 1, 2023, Lisa will still have four months left of her original 15 month penalty.  So, the FSSA will issue a notice of action indicating that Lisa is under a Medicaid transfer of assets penalty from April 1, 2023 to July 31, 2023.

The FSSA will need to issue a notice of action prior to the intended penalty start date.  The Stinson Law Firm is currently notifying its clients who have remaining time on their penalty period from a post-eligibility transfer.  However, if you are a client of the Stinson Law Firm that has not been otherwise notified and believe this provision affects you, please contact us at 317-622-8181.  Individuals who may have remaining time left on a penalty period and do not have representation, should consider hiring legal counsel to advise them of their options.

Individuals not Otherwise Eligible,

but Who Have Continued to Receive Benefits Because of Continuous Enrollment Requirement of the COVID Public Health Emergency

The recently passed legislation requires that the State provide every recipient with a fresh redetermination process even if they are not otherwise eligible for benefits.  The FSSA has not issued a finalized plan as to how it intends to do this, but in November, it publicized it potential plan of action.

First, the FSSA intends to review one-twelfth of these individuals each month for 12 months.  For those who are reviewed, it will send a mailer 60 days prior to the upcoming redetermination due date reminding the recipient that a redetermination is forthcoming.  Next, the FSSA will send the redetermination form (requesting evidence to support eligibility) 45 days prior to the redetermination due date.  After redetermination, the FSSA will issue a notice of action.  The recipient will then have the opportunity to appeal the decision.  Recipients who fail to return information will still have 90 days after the decision to come back into compliance after the redetermination due date and potentially regain eligibility without submitting a new application.

Recipients who have continued to receive benefits despite not meeting eligibility standards should consider remediating barriers to eligibility now.  Legal counsel can advise you of your options.  One example may be individuals whose assets currently exceed the Medicaid asset limit.  An elder law attorney can assist with a plan to reduce assets to Medicaid standards prior to the individual’s redetermination.

Individuals Subject to Cost-sharing

Although Indiana has not issued a finalized plan, Indiana has indicated it is likely to provide individuals enrolled in a Medicaid program that requires cost-sharing with a notice at least one month prior to the restart of cost-sharing.  However, cost-sharing will not resume until the first of the calendar quarter after such notice.  So, for example, if the cost-sharing notice is issued in April, cost-sharing will not resume until July.

Know Your Appeal Rights

The State of Indiana has indicated that at least 500,000 individuals currently enrolled in the Medicaid program do not meet eligibility standards.  The FSSA has a daunting task of eliminating individuals who are not eligible.  Consequently, it conceivable that mistakes will be made.  For most Medicaid programs, a recipient who timely appeals a decision will continue to receive benefits until a decision is made on the recipient’s appeal.  Appealing first prior to seeking resolution with the agency is typically preferable as benefits will be maintained while the recipient sorts out any errors with the agency.  Recipients who believe they are still eligible for a benefit and receive a notice terminating coverage, should consider contacting an elder law attorney to review their rights.