Anyone working with Medicaid recipients...

[Rossat]

If so, has anyone noticed an uptick of people having Medicaid, but not qualifying for a DSNP? Also advised they are getting MSP, but not qualifying for DSNP?

I've just noticed more and more who have Medicaid, are getting into Medicare, and don't qualify for the program (from a Medicaid eligibility tool), but are getting the full Medicaid benefits.

If you're experiencing this too, what are you putting them in? Just a PDP?

 

[wehotex]

If so, has anyone noticed an uptick of people having Medicaid, but not qualifying for a DSNP? Also advised they are getting MSP, but not qualifying for DSNP?

I've just noticed more and more who have Medicaid, are getting into Medicare, and don't qualify for the program (from a Medicaid eligibility tool), but are getting the full Medicaid benefits.

If you're experiencing this too, what are you putting them in? Just a PDP?

Are you talking about Full Duals vs Partial Duals?
Most of the plans want the Full Duals and leave out the Partials for their SNPs.
Which state are you in?

 

[AugustaMi]

yes, most my low-end clients aren't eligible for the DSNP, but yes can have MSP and Medicaid. They fall into a spend-down Medicaid plan. A little caveat is I am new myself, just started this right at AEP, and had to learn the hard way after a first appt. It wasn't clear in the paperwork and training...all I saw was if they have Medicaid/Medicare, they'd be eligible. Not the case.

I'm in Michigan, so this is what happens here. Also, be careful bc at least in this state, the state auto enrolls people into plans and if you do enroll someone in DSNP they could be bumped. I think there's only two states that do this...idk, I just do Mi. Theres a number for them to call to prevent this.

Then after you get people enrolled into a non DSNP plan, prepare for the calls on "I was just told I could get the $50 food card, why didn't you give it to me?" They still will get 100s of calls with agents telling them they qualify. And it WILL confuse them and they WILL call you. lol. In my eyes, I'd rather deal with this than them being able to switch every 3 months (and many will do this who do qualify).

You can enroll them in suitable plans and they work similarly, just without the food card, extra otc, etc. And, they still will get better Dental and vision options.

There are levels. QMB+ (qualified medicare bene), SLMB (specified low income bene), QI (qualified indy), and QDWI (qualified disabled working indy).

It's the QMBs that qualify for DSNP.

More info can be found online.

 

[AugustaMi]

Just another side note: Humana now lets you submit Medicaid approval paperwork so if it's not updated fast enough, if they are QMB it can go through faster that way as well.

Not a great market as I am learning (DSNP). It is too good to be true, in the way I see it. A real PITA from what I've learned since last October.

 

[DonP]

Auto enroll happens in every state . I saved 1 a few weeks ago . Plus 15 mil are coming off Medicaid in next 6 months so a lot of duals gone . I started in duals and am diversifying quickly . Duals overall will never be loyal . They get 100 calls a week . They fill out cards monthly . There always looking for more more . I’d advise greatly against making duals the Corner stone of your business . They switch and take a ton of your time .

 

[AugustaMi]

Auto enroll happens in every state . I saved 1 a few weeks ago . Plus 15 mil are coming off Medicaid in next 6 months so a lot of duals gone . I started in duals and am diversifying quickly . Duals overall will never be loyal . They get 100 calls a week . They fill out cards monthly . There always looking for more more . I’d advise greatly against making duals the Corner stone of your business . They switch and take a ton of your time .

Great reminder Don about the 15 mil coming off. That'll open up a SEP though and then it's a slightly better situation in that they can't bounce at the next free bell or whistle. But oh hell yah...I am so over it. Glad I didn't do too many DSNP, most of mine did fall into that weird spend down, but even those slip and slide and take work to keep (the calls of "hey, so and so said I could get a food card, why didn't you do it?) I mean gotta continually explain they do NOT qualify for the GD food cards/flex cards. LOL--- I get that though even from some not even on Medicaid.

Surely this can't go on forever. Soon I suspect itll be a thing of the past, just like the good ol U65 days...I mean seriously, just the doctors office personnel must get tired of spending so much time switching the Rx, between Express Scripts, CVS, Humana, and on and on and on, over and over and over again, and what not. I know a few that are simply refusing to accept certain ones now. They have to re-credential with each carrier and that costs money, and they're tired of it too, not to mention the cost on time it takes for the office personnel to continually have to deal with that....

Gonna door knock a few tomr b4 my real day job starts for the day...not DSNP, thanks for the reminder on that too.

 

[DonP]

There are csnp food card plans in some states for diabetes and heart conditions. Every yr plans change and angles to switch people change . It’s never ending . Unless you can get a way to connect with clients it will be never ending switching people around . The duals that lose their full Medicaid will mostl likely drop to partial Medicaid or lis and can still switch every 3 months

 

[AugustaMi]

There are csnp food card plans in some states for diabetes and heart conditions. Every yr plans change and angles to switch people change . It’s never ending . Unless you can get a way to connect with clients it will be never ending switching people around . The duals that lose their full Medicaid will mostl likely drop to partial Medicaid or lis and can still switch every 3 months

Oh ok, didn't realize that. Jesus the whole medicaid thing sucks. Thought only the DSNP eligible could switch every 3 months. Still learning. I better get with the program, or you know, stay away from it altogether. LOL.

 

[DonP]

Duals and partial duals ( full and partial Medicaid) lis ( extra help 25,50,75,100%) and Csnps( Disbetes , heart conditions some states lung issues ) can switch every 3 months . All that combined puts 30-40% of Medicare recipients in that category that can switch every 3 months . With low income your always playing defense .

 

[MedicareAgent]

I run from duals, they are not loyal and you are chasing chargebacks, not worth the work needed to hand hold completely.