State health advocates are appealing to the federal Center for Medicare and Medicaid Services with concerns that the Mississippi Division of Medicaid is discouraging eligible disabled beneficiaries from seeking Medicaid home care services.
The Mississippi Coalition for Citizens with Disabilities and the Mississippi Center for Justice have argued for months that the state Division of Medicaid is illegally inserting extra hurdles into the division's home-health services qualification process that are not mandated by the federal government's Center for Medicare and Medicaid Services. Coalition Executive Director Mary Troupe said the extra criteria puts the state at risk for federal penalties.
"We've already been in contact with the Center for Medicare and Medicaid Services, and they are aware of the situation and will be issuing a recommendation to the division," Troupe said. "We have a suit in the back of our mind, but we're waiting for CMMS to issue a decision. They have already come down hard on several states that violated policy like Mississippi."
The U.S. Center for Medicare and Medicaid Services prohibits state agencies from providing Medicaid home-health services exclusively to people who are homebound. CMMS policy outlines that it "is not necessary that the person be confined to the home for the services to be covered under the Medicaid home health benefit."
Section 40.02 of the Mississippi Division of Medicaid's Provider Policy Manual currently limits home-health benefits to beneficiaries "confined to the home" and who are "under the care of a physician."
A proposed revision of the manual, however, strikes the homebound requirement and the requirement of a physician's care. The Coalition, however, complains that new proposed requirements still establishes criteria that indicate a homebound status.
The revision, for example, demands that a potential beneficiary have a condition that makes leaving the home inadvisable because it increases medical risk, and that leaving the home and going to a clinic could potentially exacerbate their illness or "create a medical hardship," all of which must be supported by medical record.
The state Division also plans to monitor the number of times a Medicaid recipient leaves his or her home, and requires the recipient's medical record to "justify the purpose and frequency of all absences" known by the recipient's caretakers.
"The Division's proposal would eliminate the word 'homebound' from the policy; however, this is only a cosmetic change, and the Division's proposed criteria indicate that it is targeted at evaluating the homebound status of a Medicaid beneficiary seeking home-health coverage," the Coalition states in a November letter to the Mississippi Division of Medicaid.
A similar issue arose in Missouri last year, when CMS determined that Missouri had chosen to "withdraw the page containing the homebound language, but did not reverse the policy" of requiring homebound circumstances as an eligibility requirement. The decision put the Missouri's Medicaid program's funding at risk.
Mississippi Division of Medicaid spokesman Francis Rullan said the agency is still in the early stages of updating the policy.
"We're still in the public-comment phase of establishing that policy, so it's premature to ask us if there's any kind of comfort level with this," Rullen said. "When you're in the public-comment period you take the opinion of anybody with meaningful input to suggest, and we evaluate it and make changes as necessary. It's a little preliminary to ask us about the policy because the policy, right now, is being reviewed for change."
CORRECTION: In a previous version of this article, Jackson Free Press reporter Adam Lynch misspelled the name of Mississippi Division of Medicaid spokesman Francis Rullan. We apologize for the error.