Without timely redetermination, clients will lose their Medicaid eligibility and access to medical and non-medical services, as providers will no longer get paid for the services they provide. This means that providers will either have to stop services or continue funding the services they provide for an uncertain period of time (i.e. the agency pays the caregiver’s wages, while not getting reimbursed by Medicaid). Even larger providers, such as Alpine, typically cannot continue to provide services for an extended period of time, if a significant portion of clients has lost / is losing their Medicaid. There simply would not be enough revenue to make payroll. So, sooner or later, an agency would be forced to suspend services, unless they are able to restore Medicaid back to a sufficiently large number of their clients in a timely matter.
Having been one of the first agencies to raise awareness for this issue with our trade associations (HHAC & Alliance) and our state partners, Alpine was also one of the first to jump into action to help our clients with this issue. Alpine created a crisis team consisting of management, billing, and case management staff in order to help our clients to navigate the redetermination process. The tasks of the team were: 1) Monitor expiring Medicaid eligibility, 2) Determine the status of the redetermination application by communicating with clients, CMAs (functional assessment) and counties (financial assessment), 3) Help clients to gather and file any missing paperwork, 4) File escalation forms with HCPF, 5) File appeals on client’s behalf with the Office of Administrative Court (where warranted), and 6) Prepare and assist clients in administrative court appearances.
Alpine’s overreaching goal here was to continue serving our clients and avoid the suspension of home care services to our clients due to them losing their Medicaid eligibility, (in most cases) through no fault of their own.
Consequently, the Alpine team was able to help over 130 of our clients who lost their Medicaid / HCBS waivers in the second half of 2023 to get their programs reinstated. To accomplish this, the Alpine team filed over 80 appeals with the Office of Administrative Courts and 60 complaints/escalation forms with HCPF. So far, Alpine boasts a 100% success rate with respect to appealed cases with 85% of appeals being resolved without a hearing. During this time, Alpine was able continue services / fund these clients’ services in all but a handful of cases, because we were confident that we would be able to (eventually) get their Medicaid eligibility restored. Ultimately, Alpine only lost two clients due to Medicaid redetermination being denied (one client was uncooperative, the other lost their financial eligibility).
As a result of our efforts, Alpine’s team was able to develop good personal relationships with Denver, Arapahoe and Adams County eligibility specialists, which has added efficiency and speediness in dealing with these types of cases going forward. While there is an ongoing concerted effort by the State, HCPF (e.g. emergency loan program for struggling providers), the Counties, the provider community, advocates, and clients to combat these issues, Medicaid redetermination challenges continue to persist in early 2024 and Alpine’s crisis team continues to help our clients to navigate these issues. Alpine is also continuing its general practice of not stopping services to these clients, but to continue funding them until Medicaid can be restored.
Founded in 2000, Alpine Homecare, LLC is a family-owned, Denver-based non-medical home care agency serving over 400 primarily Medicaid clients in various metro Denver counties.