News from the Kaiser Family Foundation
“In 8 of the 10 states w/ approved or pending waivers as of March, #Medicaid #workrequirements would apply to all or most older nonelderly adults. #AR & #WI would exempt those age 50+. #AZ would exempt 55 and older and #IN & #UT would exempt 60 and older.”
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Updated: 7/20/18 2:00pm
The PASSE system was voted in by our legislature last year. This year, they are taking on managing clients’ care, and in January 2019, their decisions about our care will matter. DHS/Medicaid will give them the money and allow them to decide how to use it.
If you need a reminder, the PASSE stands for Provider-led Arkansas Shared Savings Entity, and like insurance companies, they will be covering the care for tiers 2 & 3, what DHS considers to be higher level need, of behavioral health and developmental disability services.
DHS has assigned thousands of people to the 4 licensed PASSEs after each person’s Independent Assessment completion. If you are affected, you will likely first receive a letter or some sort of notification to schedule an Independent Assessment.
If you have questions, DHS has a PASSE counseling line: 1-833-402-0672. They also have regional people you can talk to.
MSL is actively working to get you more information on the PASSEs themselves. Now that details are coming together, we should be able to get more. The information we have so far is listed below in steps that should help you.
These changes may be happening to you or a loved one, but you can do these 8 things to help yourself in this new process:
It’s important that you ask your provider to join every PASSE. What if next year, you need to switch PASSEs because of a bad experience, but your provider isn’t in any other PASSE? If they choose to join only one PASSE, you could be forced to make a decision between 2 (or more) providers you really like. What if your trusted Cardiologist who did your surgery is in only one PASSE and your Therapist who you’ve been with for years is only in another? You might have to choose. However, even after you ask your provider to join all PASSEs, they may still choose to join only one because they have invested in that PASSE or simply because it’s a business decision. They have that right, but you still have to look out for what’s best for you; for the people whose care and services will be managed by the PASSEs, it’s best for us to have as much choice and freedom as possible. The only way you can have that is when providers give you choices by joining all PASSEs. Some PASSEs have said they will pay for out-of-network costs or make special agreements, but that’s probably only for providers you don’t see often.
DHS said that they are in the process of setting reimbursement rates for providers – the actuary process. Because of that, some providers will not know what you mean when you mention the PASSE to them. Their business office may know and may be waiting on these rates before making any decisions. However, you can still take this information to your provider and/or to the business office.
The following packets are ones that DHS has distributed to providers. Don’t assume yours has received it. Every provider you use needs to be sure they understand this info about the PASSEs. The last is a collection of contact information of all PASSEs specifically for providers to help them join. Take care of yourself, and take these to every provider you see.
Some have been concerned whether ACH is covered. This is the response:
“State supported hospitals UAMS and ACH will be enrolled with every PASSE. Many doctors are enrolled through their networks but may not know that yet. You can call every PASSE and interview them so you are making an informed choice.”
*MSL has requested websites for all – check back for updates.
Each PASSE is required by Act 775 (pg 9, line 21) to have an Advisory Council to give them feedback. They know how things are supposed to happen, but it’s up to you to keep them informed of what’s really happening.
Once you have been assigned a PASSE, you have 90 days to change to another. Call your PASSE, and make sure they include your providers. If they don’t, use the info above to find a PASSE that better suits you. DHS is also going to offer open enrollment in October 2018. We will continue to provide more info as we can!
You have rights, and you can appeal DHS decisions. This is a very new process, and assessors can make mistakes. Check this post to see what your rights are and how to file an appeal. Watch our Q & A with Disability Rights where we answered common questions.
What is a PASSE? Will you be affected? MSL has been following the PASSE from the very beginning. Take some time to catch up and read all about them.
If you learn anything, especially from a specific PASSE, share it with us! If you have any problems, MSL works to solve those for you. Please let us know by:
Our legislature voted this into effect. We called, we emailed, and we visited – all to let them know what we need. If you feel that this good for you, remember that, and perhaps send a note to let them know. You might want to vote for your representatives again. If you feel they didn’t listen to you or didn’t represent you well by voting for this, you should send them a letter to let them know. However, you also have the power to change who is in office. Make sure you place an informed vote. See how your local Representatives or Senators voted on Act 775.
Here’s a health policy toolkit to help you understand advocacy and policy. You can apply this to your efforts to advocate for Medicaid recipients.
Why reinvent the wheel? ASAN already has this great resource to help you understand Medicaid, no matter which state you live in.
The Disability community is calling far and wide for people to take action against H.R. 620, saying that it is a bill that “fundamentally weakens the protections of the American with Disabilities Act.” Here are some resources to help you determine if it affects you or someone you love, as well as resources to help you to take action!
A link originally shared by Disability Rights Arkansas gives these tips:
“Please contact your House Representative(and others from your state) and encourage them to stay strong in their opposition to H.R.620 and any “notice and cure” bill, as a rollback of civil rights. SAVE THE ADA!
“Hello, my name is [your name]. I’m a constituent from [your state], zip code [your zip code]. I am opposed to H.R. 620 and any change to the equal access protections of the Americans with Disabilities Act. I strongly encourage Representative [add last name] to oppose any reform efforts. Thank you.”
DHS recently hosted a FB live about the PASSE to answer our questions, but some of your questions were not answered at that time. The images below show DHS’s follow-up answers to some of the questions.
For those of you who would like to go back and watch the Facebook live video from January 19, click here.
MSL took your questions to DHS, and they answered live on Facebook. This video has several good demonstrations and answers that you might need to see. The PASSEs will start taking clients in February 2018.
Watch the video:
Updated 1/3/18 09:30
We requested information on the change, and this was DHS’ response:
The Arkansas Department of Human Services is changing its dental program. Beginning January 1, 2018, two companies will provide dental coverage for families enrolled in Medicaid. Those companies are:
- Delta Dental of Arkansas
- Managed Care of North America (MCNA)
There will be no changes to the dental services that are covered. Families will be assigned to one of the two companies in December 2017 and will get new dental cards and a welcome packet in the mail for each enrolled family member.
If members want to switch to the other company, they will have 90 days to do so.
Families can begin scheduling appointments for covered dental services after January 1, 2018. Information about what is covered will be in the welcome packet.
Clients living in Human Development Centers, individuals enrolled in the Program for All Inclusive Care for the Elderly (PACE), and individuals who are eligible for Medicaid only after incurring medical expenses that cause them to “spend down” to Medicaid eligibility levels will not be enrolled in a dental plan.It is important to note that as new beneficiaries apply for Arkansas Medicaid benefits, if they qualify for dental benefits, it will take between 15 and 45 days for them to be assigned to a plan and for the plan to complete the enrollment process.
Then we requested information on the difference between the companies, and this is what DHS said about the new dental plans:
The benefits are identical and the number of dentists in each network is very close to the same (within 1%). The only real difference I can recommend is for the client to check to see if their preferred dentist is in the network to which they were assigned. If confirmed, I suggest they stay with that plan. If not, they should check with the other option to see if their preferred dentist is in that network and they will have until the end of March to change plans if they want to.
Both companies are very good at what they do and have been excellent partners for us to work with.
We also asked DHS to address the rumor that ACH Dentists won’t be covered:
Delta Dental AR has 12 of 17 dental providers at ACH credentialed and in the network. The other five have submitted their applications and are undergoing the credentialing process with the expectation that they will also be admitted to the Delta network. They added that MCNA has also had a meeting with ACH, so we can hopefully expect them to cover ACH dentists as well.
After the new year, DHS sent us more clarifying information on the providers who are included:
[We want to] share the details below to demonstrate how very close the dental provider counts are between the two managed dental care organizations now serving Medicaid clients. MCNA received slightly fewer enrollees due to assignments happening by family (keeping family members in the same plan) but the total number of providers in each network varied by 1 last month. Both companies are continuing to enroll providers including ACH.On 12/15/17 (the last phase of the auto assignment period) a total of 610,945 beneficiaries were assigned to our two dental managed care companies as follows:
- MCNA – 304,789
- Delta Dental of Arkansas – 306,156
As you know, there will be some movement as beneficiaries work through their 90 day choice period.
As of 12/20/17 the two MCO’s have contracted with, or have contracts pending for the following number of dental providers:
- MCNA
- Contracts complete – 646
- Contracts pending – 60
- 706 Dental Providers
- Delta Dental of Arkansas
- Contracts complete – 673
- Contracts pending – 34
- 707 Dental Providers
Watch the video above to get all of the contact information to get contact information and tips.
Other helpful links:
https://www.npr.org/templates/event/embeddedVideo.php?storyId=567758536&mediaId=567762951
It’s customary this time of year to count our blessings, and there’s one in particular that millions of Americans shouldn’t forget: Medicaid.
If you’re a recipient (or know a recipient), think for a second what your life would be like without Medicaid.
My little girl qualifies for TEFRA because of her diagnosis, and she’s thriving because Medicaid gives her treatments like therapy and medicines that we simply can’t afford. Medicaid not only helps her day-to-day, but it’s also giving her a future where she may someday be able to live on her own and provide for herself. Because of Medicaid, she can climb stairs, say that she wants a drink, draw a line, feed herself with a spoon, and sit quietly with other students around a table. When I think of life without Medicaid, I see many who would be crushed under personal debt and suffering without hope.
If you’re thankful for Medicaid, please tell those who make our state and national policies, especially if you need to continue receiving it.
This is the perfect time of year to let our lawmakers know that we’re thankful for Medicaid. Why? Because it’s improving and even saving lives! I ask you to take a moment, and write your elected officials a note. Even better, include a photo. Tell them why Medicaid is important to you. If writing several is overwhelming, just start with one.
You can also post on social media about why Medicaid is important to you using the hashtag #thankful4Medicaid to help others see why Medicaid is so important.
We need to tell everyone the great things that Medicaid does and who it helps. People need to hear this positive message. By sending notes, calling, and posting on social media, we are clearly communicating that we still need Medicaid, and we’re directly asking the people in charge to continue funding Medicaid for us.
Let’s flood our government with letters and calls this holiday season!
Arkansas Only
Contact any elected official in the US!
Medicaid Saves Lives 