Another DSNP thread

[AgentGeneral]

Michigan.

It's been not so fun with the DSNP crowd.

One day there Full QMB plus. Next QMB, next week SLMB.

Then theyre getting a letter from Soc security saying theyll no longer be paying their Part B premium, when they 100% qualify and already sent in all docs.

THen another letter from DHS back to full medicaid, or they lost it altogether.

It's getting bumped all over the place.

I've been saving screen shots because it looks like I'm not doing my job by checking eligibililty. It will show QMB+ then go to CMS and get shot down...."not eligible due to not having medicaid" when in fact they DO as shown by their own screen shots on their own DHS sites, their own benefit letters.

I am so over this market. 30% is where I'm at in the book total with it, and I need it to be down to 10 or less.

I am thinking of just letting these start to fall away, but I don't want to risk my reputation with Humana, and it feels like a double edged sword bc it looks like I don't do the eligibility when in fact I ALWAYS do, it just happens to be changing like a wonky eyed donkey daily.

Any advice? Every day there are calls coming in and screen shots of letters and never ending issues.

I think this is a DonP request. What's happening in Az? with this...

as much as I can I'm refraining, unless it's a referral. I've been sticking with another non DSNP bag.

 

[policywunk]

Michigan.

It's been not so fun with the DSNP crowd.

One day there Full QMB plus. Next QMB, next week SLMB.

Then theyre getting a letter from Soc security saying theyll no longer be paying their Part B premium, when they 100% qualify and already sent in all docs.

THen another letter from DHS back to full medicaid, or they lost it altogether.

It's getting bumped all over the place.

I've been saving screen shots because it looks like I'm not doing my job by checking eligibililty. It will show QMB+ then go to CMS and get shot down...."not eligible due to not having medicaid" when in fact they DO as shown by their own screen shots on their own DHS sites, their own benefit letters.

I am so over this market. 30% is where I'm at in the book total with it, and I need it to be down to 10 or less.

I am thinking of just letting these start to fall away, but I don't want to risk my reputation with Humana, and it feels like a double edged sword bc it looks like I don't do the eligibility when in fact I ALWAYS do, it just happens to be changing like a wonky eyed donkey daily.

Any advice? Every day there are calls coming in and screen shots of letters and never ending issues.

I think this is a DonP request. What's happening in Az? with this...

as much as I can I'm refraining, unless it's a referral. I've been sticking with another non DSNP bag.

I use their income as the determiner of what level of medicaid they SHOULD have.In Fl i have seen a partial get temporally get bumped up to a full dual for the month if they had met their share of cost amount for the month .

 

[AgentGeneral]

I use their income as the determiner of what level of medicaid they SHOULD have.In Fl i have seen a partial get temporally get bumped up to a full dual for the month if they had met their share of cost amount for the month .

Does Fla have spend down plans?

I've been wondering this for awhile and keep forgetting to figure that out.

I'm going to be working there eventually. I'm there about as much as I am in michigan these days

 

[policywunk]

Does Fla have spend down plans?

I've been wondering this for awhile and keep forgetting to figure that out.

I'm going to be working there eventually. I'm there about as much as I am in michigan these days[/QUOTE

Plans for partials are available in fl.Share of cost dollar amount can be approximated by subtracting 200.00 for their monthly income.In Florida i have heard that a partial who is on any DSNP plan who meets the share of cost for the month cannot submit to medicaid since their medicaid is being managed by the DSNP whereas a partial on non DSNP plan can.

 

[20th Maine]

Your post just says "Michigan" I assume thats your state?

 

[AgentGeneral]

Your post just says "Michigan" I assume thats your state?

yes thats my state

 

[20th Maine]

I USED to write a lot of DSNP in the spring slow time. In KS and MO its apparently not as volatile as there. I had a few "Service Coordinators" in HUD bldgs that made it a lot easier by setting up meetings/kiosks etc. But those gigs are hard to fill now and most posts are vacant and trying to deal with the DSNP crowd without a shepherd is hard. Supposed to be one coordinator per 50-100 residents but never seen that. If you can find a few bldgs with service coordinators that are not brain dead and lazy it can make it worthwhile

I just checked and Aetna is in MI. In my area the Aetna DSNP is good for SLMB, QMB, QMB plus and FBDE. If I use UHC they are FBDE only and yes as the income guidelines change clients get booted off. Switch them to Aetna

Aetna also has a great new plan for 2024 the "Value Plus" plan which only requires LIS but has Medicaid like benefits. AND you can do the online LIS app for them if they are below about $22,000 income and $16,000 assets.

Hope this helps

 

[GoPokes]

Michigan.

It's been not so fun with the DSNP crowd.

One day there Full QMB plus. Next QMB, next week SLMB.

Then theyre getting a letter from Soc security saying theyll no longer be paying their Part B premium, when they 100% qualify and already sent in all docs.

THen another letter from DHS back to full medicaid, or they lost it altogether.

It's getting bumped all over the place.

I've been saving screen shots because it looks like I'm not doing my job by checking eligibililty. It will show QMB+ then go to CMS and get shot down...."not eligible due to not having medicaid" when in fact they DO as shown by their own screen shots on their own DHS sites, their own benefit letters.

I am so over this market. 30% is where I'm at in the book total with it, and I need it to be down to 10 or less.

I am thinking of just letting these start to fall away, but I don't want to risk my reputation with Humana, and it feels like a double edged sword bc it looks like I don't do the eligibility when in fact I ALWAYS do, it just happens to be changing like a wonky eyed donkey daily.

Any advice? Every day there are calls coming in and screen shots of letters and never ending issues.

I think this is a DonP request. What's happening in Az? with this...

as much as I can I'm refraining, unless it's a referral. I've been sticking with another non DSNP bag.

I have certainly had more issues with this in the past couple months, than ever before. The redeterminations, people losing medicaid, and also people who were recently approved for QMB and elegible for the UHC DSNP, will soon thereafter be shown as "ineligible medicaid plan" or something like that.

In some state like OK, DHS is impossible to communicate with. Even a beneficiary cannot contact them without going in person to their office. Other states, I have found to have significantly better systems in place, and we can reach them on the phone within minutes, and get solid answers.

I was recently asking myself, I wonder if UHC doesnt want the DSNP business? Maybe they are sabotaging this, with Jarvis going back and forth? Surely that is not the case, but I am trying out what has changed...

 

[DonP]

Over the last 2-3 yrs I’d say I’m up there with the top dsnp/ lis agents in the country . That said the last 6 months I’m no longer really targeting it . I still get a ton of referrals. I got 20-30 clients in the deeming period I’m watching and will move the month before disenrollment.Im sure I have 20-30 I don’t know about yet . You got to watch your future disenrollments like an hawk to catch .Another issue hitting is people losing lis . The issue there is they’ll be charged the $30-$50 premium and have a $525 part d copay . 2020-2023 was a free for all as nobody got booted . I refuse to move people on and off constantly as they gain and lose Medicare . Go pokes you better be careful with Aetnas partial duals can get full dual benefits . They got 20% coshares from drs ti all services . Eventually I’ll get my dual/ lis book down to 10-15% . 98% of the problems and service from them .

 

[AgentGeneral]

I use their income as the determiner of what level of medicaid they SHOULD have.In Fl i have seen a partial get temporally get bumped up to a full dual for the month if they had met their share of cost amount for the month .

I think it was a mess through the covid emergency. I saw so many making $3000 or more and on full medicaid. Ex: Someone goes into hosp for a minor surgery and boom, social worker signed em up on medicaid. Not even eligible under non covid times.

It seems so messed up at the moment as they try to unwind it.

I knew Dsnp was quite a bit of maintenance but I didn't expect that when I do due diligence that it still wouldn't pan out right.

I USED to write a lot of DSNP in the spring slow time. In KS and MO its apparently not as volatile as there. I had a few "Service Coordinators" in HUD bldgs that made it a lot easier by setting up meetings/kiosks etc. But those gigs are hard to fill now and most posts are vacant and trying to deal with the DSNP crowd without a shepherd is hard. Supposed to be one coordinator per 50-100 residents but never seen that. If you can find a few bldgs with service coordinators that are not brain dead and lazy it can make it worthwhile

I just checked and Aetna is in MI. In my area the Aetna DSNP is good for SLMB, QMB, QMB plus and FBDE. If I use UHC they are FBDE only and yes as the income guidelines change clients get booted off. Switch them to Aetna

Aetna also has a great new plan for 2024 the "Value Plus" plan which only requires LIS but has Medicaid like benefits. AND you can do the online LIS app for them if they are below about $22,000 income and $16,000 assets.

Hope this helps

I like the idea, but in reality Aetna DSNP isn't in the one county I work heavily. The county south that I also work hard it is and it's an HMO, which I veer away from. I'd probably do a BCBSM PPO before an HMO and explain why to the client.