From: Langmead, Jon P. (CMS/CFMFFSO)
Date: Mon, Feb 24, 2014 at 6:02 PM
To: Bill Fearneyhough, Pima County Medical Society
Cc: “Thompson, Betsy L. (CMS/CQISCO)”
Hi Mr. Fearneyhough,
I work with Dr. Thompson in the San Francisco Regional Office of CMS and am responding on her behalf to questions you’d sent in to her. Please let me know if these help or if you need any more information.
1) Is it possible for a patient who is enrolled in Medicaid through the Exchange to disenroll? If so, what is the procedure for doing so?
The best procedure right now for individuals who are enrolled in Medicaid/CHIP is to contact the State to disenroll. We have some information on HealthCare.gov for people who are newly enrolled in Medicaid here: https://www.healthcare.gov/what-if-i-have-new-medicaid-or-chip-coverage/.
The State’s [Arizona] web site (healthearizonaplus.gov) indicates that individuals with an account on healthearizonaplus.gov can request that their benefits be stopped online or by submitting a written request. There is an FAQ on this subject on the state’s site and I’m pasting the text of it below:
I want to stop getting benefits. What do I need to do?
[Ed. Note: The below information on disenrolling is specific to the State of Arizona. If you live in another state, please contact your state’s Medcaid administrator for details.]
You can stop your benefits by doing one of the following:
- Click on “Report a Change” and fill out the information after selecting “Stop Receiving Benefits”
- Upload or fax a written request into the verification section
- Call Customer Support at 1-855-HEA-PLUS (432-7587)
- Mail a written request to:
PO Box 19009
Phoenix AZ 85005
2) If the person is enrolled in Medicaid, is he or she given a disclosure about potential estate recovery? As you know, as a consequence of the Affordable Care Act, enrollment in Medicaid may now be contingent only upon income, not assets, so many of the people who are being enrolled have assets that potentially could be seized upon their death. If disclosure is made, are the provisions guaranteed to apply at the time of the person’s death, or could these be changed by state law at some future time?
Currently, we believe it’s the state’s procedure to give this kind of information to all applicants for long term care and home and community based services. Arizona has posted a detailed brochure about its estate recovery program online here: http://www.azahcccs.gov/community/Downloads/Publications/DE-810_english.pdf.
CMS released a State Medicaid’s Director letter on Friday that provides guidance on how the long-term services and supports-related rules, including the estate recovery rules, apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules. You can access the letter here: http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-14-001.pdf In it, we write, “Due to the potential barrier to enrollment that future estate recovery may create for some individuals, CMS intends to thoroughly explore options and to use any available authorities to eliminate recovery of Medicaid benefits consisting of items or services other than long term care and related services in the case of individuals who are determined eligible for Medicaid benefits using the MAGI methodology.”
The Medicaid estate recovery program is a requirement of federal law. Section 1917(b) of the Social Security Act requires States to seek recovery of Medicaid payments for nursing facility services, home and community based waiver services, and related hospital and prescription drug services on behalf of individuals aged 55 and older from their estates. States must also recover for all long-term services provided to permanently institutionalized individuals, either from their estate after death or from the sale or transfer of property subject to a lien. These estate recovery provisions do not apply where there is a surviving spouse, a dependent child under the age of 21, or a blind or disabled child. States are also required to have provisions that waive estate recovery in cases of undue hardship. What constitutes an “estate” for estate recovery purposes is defined by the state, but at a minimum, it must meet the definition of an “estate” under state probate law.
Arizona has an approved demonstration waiver under section 1115 of the Social Security Act under which enrollees of an Arizona Acute Care health plan aged 55 or older who receive long term care services are exempt from estate recovery. Individuals enrolled in the Arizona Long Term Care System (ALTCS) are not exempt from the estate recovery requirements.
3) If a person is enrolled in Medicaid, does he or she have the option of simply not using these benefits and seeking private care? If the patient does choose to pay a physician or facility privately, is the physician or facility potentially subject to fine or prosecution because of accepting the payment?
We are not aware of any statute or regulation that requires an individual who is enrolled in Medicaid to use their Medicaid benefits. We are also not aware of any statute or regulation that would impose a penalty on a provider for accepting a payment from a Medicaid-eligible individual who voluntarily chooses not to access their Medicaid coverage.
Thanks very much,
Jon
Jon Langmead
Centers for Medicare and Medicaid Services
San Francisco Regional Office
415-744-3667
[Ed. Physicians who want to privately contract with Medicaid patients should double check with their state and get something in writing to verify that private contracting is allowed. The physician could use a modified Medicare private contract with self-pay Medicaid patients so there can be no misunderstanding about advice given to the patient.]
From: Bill Fearneyhough, PCMS
Sent: Tuesday, February 18, 2014 9:44 AM
To: Thompson, Betsy L. (CMS/CQISCO)
Subject: Answers needed
Member questions concerning ACA come my way almost daily. In most cases I can provide answers but occasionally I’m stumped. Here are three I was unable to answer. Your assistance in providing answers would be appreciated.
1) Is it possible for a patient who is enrolled in Medicaid through the Exchange to disenroll? If so, what is the procedure for doing so?
2) If the person is enrolled in Medicaid, is he or she given a disclosure about potential estate recovery? As you know, as a consequence of the Affordable Care Act, enrollment in Medicaid may now be contingent only upon income, not assets, so many of the people who are being enrolled have assets that potentially could be seized upon their death. If disclosure is made, are the provisions guaranteed to apply at the time of the person’s death, or could these be changed by state law at some future time?
3) If a person is enrolled in Medicaid, does he or she have the option of simply not using these benefits and seeking private care? If the patient does choose to pay a physician or facility privately, is the physician or facility potentially subject to fine or prosecution because of accepting the payment?
Thanks a bunch.
Bill Fearneyhough
Executive Director
Pima County Medical Society
5199 E. Farness Drive
Tucson, AZ 85712
