The Department of Social Services will continue meeting with those connected Medicaid in Missouri to discuss how the spend down provision of that program is applied.

Director of the Department of Social Services' Family Services Division Alyson Campbell conducted a recent meeting with Medicaid stakeholders to discuss how the spend down is applied.

Family Support Division Director Alyson Campbell says it was discovered that some of the Division’s staff were allowing costs paid by Medicare or private insurance to count toward patients’ spend down amounts, which by federal guidelines is incorrect. When it began those staff members, individually, to amend that practice, the patients they worked with were impacted.

Division staff have held one meeting with providers and other stakeholders to discuss the situation. Campbell says the goal is to help people understand how the spend down must be applied and to look for other ways patients’ needs can be met within that structure.

She says the greatest impact regards the use of what she calls “wraparound services,” including transportation and homecare. “People are receiving those services today, and with the changes, or with the correction of the policy that we’re trying to implement, it’s possible that those services…they would not qualify for those services because the Medicaid coverage wouldn’t kick in as early in the month as it did previously.”

Campbell says right now the discussion is centered on what other options are available within federal guidelines.

The Division will host another meeting from 10:00 a.m. until noon January 5 in Room 400 of the Harry S. Truman Building in Jefferson City.

The House Appropriations Committee on Health, Mental Health and Social Services has heard testimony about the Department of Social Services‘ handling of the so-called “spend down,” and what change, if any, has occurred in how it is administered.

The spend down was created for Missourians with a disability or aged 65 or older whose income exceeds the limits of Medicaid eligibility. Those persons can qualify for Medicaid if they incur medical bills that exceed the difference between their net income and the eligibility limit. The amount that exceeds that limit is called the “spend down” amount.

Participants must meet the spend down monthly. One of the ways that is done is by having medical expenses that are not covered by a third party, such as Medicare or private insurance. At issue is that some providers have been allowing expenses that were covered by Medicaid or private insurance, which the Department says goes against the Federal policy for the plan.

Family Support Division Directory Alyson Campbell says the Department began correcting that practice. Providers who were allowing ineligible expenses were approached on an individual basis and told to follow Federal policy.

As those providers changed their practices, the recipients they dealt with had to stop using other supplemental services, like transportation to get to appointments and procedures.

Acting Director Brian Kincaid told the Committee the Department’s policy regarding the spend down has not changed. Rather, he says some of the Department’s workers were applying the program incorrectly.

The Committee also heard testimony from a man who says his mother was dealing with a provider who was asked to stop accepting some bills being covered by Medicare, toward the spend down. Michael Oliver’s mother has used a wheelchair since her leg was amputated and depends on dialysis. He says until the policy changed with her provider, she was transported to dialysis by a van with a wheelchair lift paid for by Medicaid. Now, he says she may have to move to a facility to receive treatment and be separated from her husband. He says going to such a facility or using other transportation sources will cost more than she makes in a month.

Kincaid says no more changes in application will be taking place for the time being. “Because of the confusion and the anxiety around the issue of…that’s what we tried to clarify earlier in the month by having our workers continue to do…however they were doing spindown, continue to do that so we keep an even keel.”

The Division is preparing to assemble a committee to try and explain the issue. Campbell says they will, “walk through what is ‘spend down,’ and to make sure that everyone understand that we are attempting to, and it’s our responsibility to follow the Federal law. So we want to have discussion with the people that will be impacted by this so that we can all get on the same page.” A meeting has been scheduled for December 14.

Campbell says an administrative rule will also be filed. “In my review of the situation, it’s very apparent that we need to be more specific in the regulation that governs the spend down program for Missouri. By doing that, we can also make sure that our policy is in line with the regulation in the federal law.’

Kincaid says providers, patients and patient advocates need to contact the Department with any issues.

The Committee has asked to have a representative present when that committee meets.

AUDIO:  Hear the testimony of Acting Director of the Department of Social Services, Brian Kincaid and Family Services Division Director Alyson Campbell before the House Appropriations Committee on Health, Mental Health and Social Services – 49:09