Will Your State Loosen Medicaid Eligibility Requirements?
OIG wants 11 states to bring their policies in line with the law.
If your state requires Medicaid beneficiaries to be homebound to qualify for home care coverage, that may change.
"In a 2000 policy letter, [the Centers for Medicare & Medicaid Services] notified State Medicaid agencies that restricting eligibility for mandatory home health services to homebound individuals violates [federal] regulations," the HHS Office of Inspector General says in a new report, "Some States Improperly Restrict Eligibility for Medicaid Mandatory Home Health Services" (OEI-07-13-00060). But eleven states continue to have language in their Medicaid policy documents restricting eligibility based on homebound status. Two states did say they don’t enforce that restriction, however.
The 11 states are Alabama, Arkansas, Indiana, Montana, Nebraska, New Mexico, North Dakota, Pennsylvania, South Dakota, Utah, and West Virginia, the OIG lists in the report at http://go.usa.gov/bJz9.
In July 2011, CMS published a proposed rule that would revise Medicaid regulations to clarify that home health services cannot be restricted to individuals who are homebound or to services furnished in the home, the OIG notes. "We encourage CMS to finalize its proposed rule clarifying that home health services cannot be restricted to individuals who are homebound or to services furnished in the home," the watchdog agency says.
