Grant funding vs Using insurance

chrissyfegan

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Hello,

I work for a nonprofit mental health center that accepts insurance but is largely funded by grants. I am having a hard time getting straight answers from our contracted payors (insurance companies) so I am looking for some guidance to balance grant funding for services where the client has insurance.

1. In rare, non-advertised cases, would it be compliant to use grant funds to cover client copays/deductibles? We would develop a written policy, allowing this only when requested and with documented proof from the client, and in limited amounts. Occassionally we have clients who request to terminate services because they can't afford their weekly copay -- this is the circumstance we would like to use grant funding for, if possible.

2. If a grant covers a therapist's salary, can we also bill insurance? Typically our grants only cover a small portion of a client's salary, and we use that to cover the % of time s/he spends with uninsured clients / clients who have insurances we are not contracted with. We have been approached by a grant to cover a therapist's full salary, but we're unsure how we handle our responsibilities to bill client insurance in those cases.

3. Is Medicaid still last payor if a client with Medicaid qualifies for a grant that pays us on a fee for service basis?

The commercial insurances I have contacted, have stated that COB does not apply to grant funding, and as contracted providers we have an obligation to submit claims to them. They also state that they have no part of grant distribution, which I believe is them telling me we can use it to cover copays if the patients so qualify... But just wondering what the consensus is out there.

I appreciate any input -- Thank you in advance! For reference, we are located in Texas.

Chrissy Fegan, CPPM
 
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