What if:
- You break your hip and, after a short hospitalization, need long-term services and supports (LTSS); and
- Like most people, you want to receive LTSS at home through home and community-based services (HCBS).
Result:
Unfortunately, most states’ Medicaid policies essentially force older adults to receive LTSS in a nursing facility rather than at home. Medicaid payment for HCBS generally does not become effective until an HCBS service plan is approved, which may take weeks. But Medicaid payment to a nursing facility can be made retroactive to the first day in the facility, even if official approval doesn’t occur until weeks or even months later.
A state can fix this unfair discrepancy through use of the provisional service plans explained in the federal government’s Olmstead Letter No. 3, Attachment 3-a. A provisional service plan identifies the essential LTSS that a person needs, and, importantly, allows Medicaid HCBS coverage to begin almost immediately. A more comprehensive service plan then is completed within the next 60 days.
Provisional service plans are grossly underutilized by state Medicaid programs. Justice in Aging encourages advocates and HCBS service providers to explore this issue in your state and advocate with state officials to authorize use of provisional service plans. Forcing Medicaid enrollees into nursing facilities is harmful to older adults and people with disabilities and unnecessarily costly for states.
Please contact Justice in Aging with any questions or suggestions, and let us know how your advocacy for provisional service plans is going. For more information, consult the Justice in Aging issue brief, Medicaid’s Unfair Choice: Waits Months for In-Home Assistance —or Get Nursing Facility Coverage Today. You can also consult two CMS resources: the Technical Guide for HCBS waivers (pp. 194-95) and a recent presentation on HCBS service planning (slide #18).