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Medical Assistance Rapid Reinstatement Project

Medical Assistance Rapid Reinstatement Project. Richard Weishaupt, Senior Attorney Justine Elliot, Staff Attorney. What happened?. In July 2011, the Department of Public Welfare (DPW) announced that it would send out packets to thousands of individuals who were overdue for redeterminations.

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Medical Assistance Rapid Reinstatement Project

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  1. Medical Assistance Rapid Reinstatement Project Richard Weishaupt, Senior Attorney Justine Elliot, Staff Attorney

  2. What happened? In July 2011, the Department of Public Welfare (DPW) announced that it would send out packets to thousands of individuals who were overdue for redeterminations. Direct service agencies saw a big increase in individuals losing Medical Assistance (MA) because packets or supporting paperwork was lost or not processed. Approximately 90,000 children lost their MA as a result.

  3. What happened? With the help of community groups across the state, CLS collected over 100 stories of individuals who lost MA. Many stories were shared with state and federal agencies. CLS and law firm partner Morgan, Lewis & Bockius LLP, began negotiations with the Department of Public Welfare (DPW) to craft a remedy for affected individuals.

  4. The solution In late October 2012, DPW will send a letter on blue paper to 100,000 individuals who were terminated from Medical Assistance in the past year. The letter will advise them on how they may seek expedited reinstatement of their benefits. Enclosed with this letter will be a simple two-sided form.

  5. Sample blue letter

  6. Sample reinstatement form

  7. Sample flyer to post in reception area or waiting room

  8. What to do with the reinstatement form? Fill it out! Send it back within 30 days of receipt. Return it to the central office listed on the envelope provided, NOT the local County Assistance (welfare) Office. Include recent pay stubs. Include medical bills and receipts from paid bills from the time without MA. Don’t delay if pay stubs or bills are not available!

  9. Important sidebar Please do not distribute the reinstatement form to anyone who did NOT receive it in the mail. Only individuals who receive it in the mail can go through the reinstatement process. Anyone else can go to the local County Assistance Office and apply for MA at any time!

  10. What happens after returning the reinstatement form? The central office should respond within 30 days with an eligibility decision (unless more information is requested). If more information is needed, a letter will be sent. Individuals will have 10 days to provide the information. Be sure to respond right away!

  11. What happens after returning the reinstatement form? An individual will be determined eligible or not eligible for MA. If the individual disagrees with the eligibility decision or MA category, he or she should appeal! Appeals should be sent to the central office. This office should help to resolve the appeal.

  12. DPW Toll-Free Hotline • DPW has created a hotline solely for the purpose of taking calls about the reinstatement project. • A live person should answer the phone. 1-866-376-8231

  13. This process should be easy! The central office will use online databases to verify income and resources if possible. Individuals should not be asked for a lot of paper verification. Income and disability verification may be requested.

  14. How will community organizations be affected? County specific legal services phone numbers were included on the blue letter -- these offices should expect to receive phone calls. Community groups and health centers may hear from individuals with questions about the form. This is a new process, so we expect that some individuals will not understand the mailing. Your assistance is very important!

  15. How can community organizations help? Train staff, especially front desk and intake staff. Post a flyer in waiting rooms. Prepare a simple plan on how to deal with phone calls and walk-ins. Advise clients on the importance of the form. Help clients fill out the form if possible. Remind clients to mail the form back in the envelope provided. Keep track of problems and questions.

  16. Philadelphia hotline In Philadelphia, CLS has a hotline dedicated to the reinstatement process. Please feel free to refer Philadelphia residents to this hotline. Hotline number: 267-765-6494

  17. Contact CLS with problems and questions Problems may include: No answer at the toll-free number at DPW listed on the blue letter. Lost paperwork. Delays in receiving an eligibility decision within 30 days (unless more information is needed, in which case a decision should be made within 45 days). Difficulty receiving reimbursement for paid medical bills or taking care of unpaid medical bills. Appeals not being processed or resolved.

  18. New Ops Memos • Two Operations Memorandum (Ops Memos) will be issued • #1 – requires supervisory review of all MA case closures using code 042 (failure to provide verification) • #2 – requires ex parte review of all MA cases at SAR and renewal

  19. Contact Information Justine M. Elliot Staff Attorney Community Legal Services, Inc. 1424 Chestnut Street Philadelphia, PA 19102 Ph: 215-981-3721 Fax: 267-765-6481 Email: Jelliot@clsphila.org Richard P. Weishaupt Senior Attorney Community Legal Services, Inc. 1424 Chestnut Street Philadelphia, PA  19102 Ph: 215-981-3773 Fax: 267-765-6481 Email: Rweishaupt@clsphila.org

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