CMS Releases Guidance on Medicaid Funding for LTC Ombudsman Functions

On May 18, 2013, CMS released guidance to State Medicaid Agencies and State Units on Aging on the availability of federal Medicaid administrative matching funds for the LTC Ombudsman program.  In prior years, CMS has indicated the Medicaid matching funds were not available for the LTC Ombudsman program.

The guidance lists the following activities that may be eligible for Medicaid administrative matching (50% match rate):

• Information provided to potential enrollees regarding Medicaid eligibility and facilitation of the enrollment process;
• Identifying and referring individuals who may be eligible for and in need of Medicaid services;
• Tracking and reporting to the Medicaid agency consumer requests for assistance in obtaining medical, dental, mental health, or long-term care (including home and community based) services that are covered by Medicaid;
• Providing ombudsman services to assist beneficiaries in transitioning from Medicare Part A coverage into the Medicaid nursing facility benefit or from private pay status into Medicaid funded nursing facility, home and community based services, or other Medicaid service categories;
• Consultation and direct case advocacy to assist individuals participating in home and community-based waiver programs;
• Identifying Medicaid-eligible residents who want to transition out of nursing home facilities and then connecting them with the appropriate local contact agency or other services to assist them in returning to the community.
Identifying and reporting suspected instances of Medicaid fraud to federal and state agencies for investigation and action; and
• Other LTCO activities which are determined by the Secretary of DHHS to be necessary for proper and efficient administration of the Medicaid state plan.
• State Medicaid Agencies will submit State Plan Amendments to begin to draw down such funding.  And, the CMS Regional Offices will lead in working with interested states as well as Administration for Community Living regional offices. 

In order to draw down the federal Medicaid matching funds, States must meet a number of complex requirements, including documentation of direct benefits to the Medicaid program and consistency with federal cost allocation principles.  It is unclear at this time if Indiana will utilize this new guidance, and IHCA has contacted the Indiana Division of Aging and Office of Medicaid Policy and Planning to inquire about their potential use of the potential funding.  Increased funding to the LTC Ombudsman program may help consumers and facilities in a number of ways, including better support with discharges and transfers and assisting with resident access to specialty services.