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Originally published: 2013-01-12 15:55:13
Last modified: 2013-01-13 09:37:36

Medicaid eligibility changes affect thousands

by Anna Oakes

Thousands of residents in adult-care facilities across the state, including the elderly, persons with mental illness and adults with developmental disabilities, could soon be forced to move as a result of new Medicaid eligibility rules.

Effective Jan. 1, the state requires persons who are reimbursed by Medicaid for personal care services to need limited hands-on assistance with at least three of five qualifying daily living activities: eating, dressing, bathing, toileting and mobility. Persons can also qualify if they need assistance with two of those activities in which one requires extensive assistance.

The change raised the bar on eligibility requirements — prior to Jan. 1, adult-care home residents qualified for the Medicaid reimbursement if they needed assistance with one daily living activity.

Late last year, The Carolinas Center for Medical Excellence conducted assessments of all residents receiving personal care services in adult-care homes and group homes across North Carolina.

Out of 20,221 facility residents who were admitted as of Nov. 30, 8,897 — or 44 percent — were determined to be ineligible for Medicaid billing under the new standards, according to Brad Deen, a spokesman for the N.C. Department of Health and Human Services. Assessments for residents admitted after Nov. 30 are not yet complete.

“A number of people have been taken by surprise,” despite media coverage of the Medicaid changes last year, Deen said. “A lot of people are bewildered by the process. A lot of these people have become accustomed to residing in the facilities in which they reside and do not want to make a change.”

Many of the residents deemed ineligible, or their families or representatives, are currently appealing their assessments.

At Forest Ridge Assisted Living in West Jefferson, nine of about 50 residents were deemed ineligible after their assessments, and all of them are currently appealing, said Melissa Deskins, executive director.

Deskins feels the new eligibility rules are too stringent and do not include other important activities for which people may need assistance, such as taking medication.

Among the Forest Ridge residents found to be ineligible is a woman in her 70s who is partially blind and cannot read labels on medication, she noted. In addition, she has to be prompted to use the restroom, is sometimes unsteady while using a walker and cannot cook for herself.

“She has a very supportive family, but her daughter and son both are elderly just like she is — they can’t provide her care. And her extended family members all have families and jobs of their own.

“During the day there would be no one with her,” Deskins said.

Although Forest Ridge’s parent company, Ridge Care, is financially stable, Deskins said, the eligibility change could affect the financial viability of many facilities.

Deskins said she and others at assisted living facilities across state have encouraged residents and their families to contact their legislators to ask for help.

“If there’s anything people can do to help our elderly, we need it,” she said. “It makes all of us in assisted living feel like the state is forgetting about the elderly.”