Medicaid Success™ is a highly effective and low-cost way to manage your facility’s Medicaid population.
Over 60% of all long-term care Medicaid applications are denied or abandoned because of the complexity of the Medicaid requirements. Leaving the residents or resident’s families to complete the application process alone could result in delayed payment or payment lapses if an application is denied.
Some facilities choose to use existing staff to help their residents qualify for Medicaid. This ends up becoming a huge staffing cost for the facility with dedicated staff or a massive distraction to facilities that use non-dedicated staff to fill this role. The Medicaid Success™ program allows your facility to hand off all of the facility’s Medicaid applications for one low cost fee.
The Medicaid Success™ program has a low-cost monthly fee that covers: all Medicaid applications for Medicaid-eligible facility residents. This service includes all process fair hearings, as needed, and all subsequent recertifications.
One of the strongest elements of the Medicaid Success™ program is leveraging our focus and experience to get maximum reimbursement for your facility. We are skilled at handling undue
hardship requests when there are problems with penalty-causing transfers.
Your facility can send a resident referral to the Medicaid Success™ team and expect that the resident and their family will be treated to the highest level of professionalism. Our Medicaid Eligibility Specialists are highly trained and skilled at guiding the family through the Medicaid application process. Our program will make your facility look even better by extension.
Lower staff hours for existing facility personnel lead to higher productivity or the ability to eliminate unnecessary overhead. Additionally, Medicaid Success™ has trained staff familiar with all aspects of the Medicaid application process. Our streamlined document collection service and case management system allow us to manage a large volume of Medicaid applications without losing the personal touch. Each resident will have a Medicaid Eligibility Specialist dedicated to their case and a single point of contact throughout the process.
The Medicaid Success™ team does a lot more than process Medicaid applications. Each of our Medicaid Eligibility Specialists serve as an authorized representative with the Medicaid agency, advocating for approval and maximum reimbursement throughout the process. Each Medicaid Eligibility Specialist also holds the accredited designation of a Certified Medicaid Planner™. We are well skilled at overcoming barriers to eligibility including:
Pre-Eligibility Case Assessment: Our team reviews the facts of each case before filing the application to determine if there are any outstanding issues that could cause problems with approval. Our team will work with the residents and their families to help fix issues such as being over the income cap or disqualifying transfers.
Authorized Representative: A member of the Medicaid Success™ team serves as an authorized representative on all resident Medicaid applications, assuring direct contact with the Medicaid department and timely notice of office actions.
Undue Hardship Requests: As much as we would like to always have simple spenddown applications, our experience shows that there are oftentimes disqualifying transfers within the lookback period that, if not caught early enough to plan around, can lead to lost Medicaid reimbursement for the facility. As part of our application service, we also identify disqualifying transfers and seek to find evidence to have them disregarded or seek a an undue hardship waiver of any imposed penalty period.
Process Fair Hearing: No matter how skilled an application specialist is, there are often cases where the Medicaid agency wrongfully denies the case. When this happens, the Medicaid Success™ team has an entire mitigation effort designed to get the case back.
With Medicaid Success™, everybody wins. Your spent-down residents will be hand-held through the Medicaid application process by skilled and trained professionals who care about your bottom line.
This is done at a fraction of the cost for managing the process internally. With a dedicated professional staff working with your residents, cases get approved timely, maximum Medicaid reimbursements get made timely, and your facility will have increased and measurable financial stability.
For those facilities who actively participate in the ISNP program for dual eligibles, our program will also work with residents to secure I-SNP participation once Medicaid is approved. Additionally, as part of the program we offer a no-cost spenddown analysis for all over-resourced residents and their families to help begin the process of I-SNP eligibility.