Benefits are ending, state mistakenly tells Medicaid patients

The state Medicaid program notified 4,500 aged, blind or disabled individuals last month that their benefits would end on a certain date but now says that is not the case.

"The Department of Human Services wants to reassure beneficiaries who continue to meet financial and clinical eligibility criteria that they will continue to receive long-term care services regardless of the end date stated in a recently received notice," the DHS said in a news release. "There have been no changes to eligibility criteria for aged, blind or disabled individuals, or for long-term care services."

The state sent the notices from May 16 until Friday to medical assistance beneficiaries who receive long-term care services in facilities and community-based settings, as well as in their own homes.

"The nursing home administrators and department have been working together to try to clarify the matter, especially with respect to the people we care for in our nursing facilities," said Tony Krieg, chief executive officer of long-term care provider Hale Makua Health Services.

Beneficiaries must meet financial and clinical requirements to be eligible for long-term care services, including a minimum level of functional impairment, which may be approved for a maximum 12-month period, the DHS said.

"This has been and continues to be the requirement," the department said in a news release, adding that long-term care providers typically handle eligibility renewals for their Medicaid patients. "Beneficiaries have largely not been responsible for this process and end date information was previously not conveyed to them," the DHS said. "Because the recent notices included the end date, beneficiaries may be concerned about losing or having lost long-term care coverage as of the noted end date."

For those deemed ineligible for benefits, long-term care services will not end until after a beneficiary is notified by a health plan or the individual loses Medicaid eligibility altogether, the DHS said.

The notices were generated "as a result of adding new long-term care functionality" to DHS’ $95 million eligibility system, the state said. The new online system has been plagued with software problems since it was launched Oct. 1, according to DHS eligibility workers who asked not to be further identified because they were not authorized to release the information.

DHS Deputy Director Barbara Yama­shita said the system has had no software problems, but acknowledged that eligibility workers’ access to the system was interrupted Friday due to problems with the state’s network.

The DHS said it is replacing its eligibility system to meet federal requirements, enhance its ability to serve beneficiaries and improve program integrity.

"The DHS apologies for any inconvenience during this modernization and appreciates the public’s understanding and patience," the department said.

Separately, the state terminated Medicaid health insurance coverage for 11,600 Hawaii residents in April because they failed to return renewal forms as part of a new policy.

DHS said it will be mailing letters to aged, blind or disabled beneficiaries to provide clarification.