S3 E9 - Medicaid, Pt 1
We welcome Medicaid specialists Michelle Rice and Shelby Fox from COAAA.
In this episode, we'll unpack the complexities of Medicaid, exploring its eligibility criteria, the nuances of waiver programs, and the critical role of income and resources in determining coverage. Michelle and Shelby share their extensive experience and highlight common challenges and misconceptions about Medicaid, providing clarity on how the system works and offering expert insights.
Top Takeaways
- Medicaid is a federally funded program designed to provide health coverage to low-income individuals. In Ohio, for instance, resource eligibility is also a factor, where single individuals cannot have resources exceeding $2,000.
- Medicaid Waiver programs help cover costs for specific services like home health care, which aren't typically covered under standard Medicaid. These waivers allow individuals with higher income to receive Medicaid by meeting certain medical or disability criteria, although they might have a financial liability or "spend down" to qualify.
- For traditional Community Medicaid, income limits are set at $941 (SSI amount). However, for waiver participants, any income above $1,869 might incur a personal cost contribution, known as a liability, toward the waiver services.
- Shelby explains that there are complexities in how income and resources are assessed, such as differences between types of Medicaid programs, and the process and implications of income above certain thresholds, like needing a Qualified Income Trust (QIT) for incomes above $2,829.
- A QIT is requisite for individuals whose income exceeds the Medicaid cap but who still require waiver services. The trust helps manage excess income which must be used towards medical expenses, and any remaining funds are retained in the trust with the state as the beneficiary upon the person's death.
- Medicaid does not count the home as a resource if the individual is living in it; however, if they move to a facility, the home could then count as a resource. When determining Medicaid eligibility, other financial assets including savings, investments, and additional properties are considered.
- Homestead Exemption Act allows a Medicaid recipient to transfer property titles, under specific conditions, to a caregiver relative without affecting their Medicaid eligibility. The relative must have resided with and provided care for the recipient for a minimum of two years to qualify.
- Medicaid does not 'take' one's home; instead, it may place a lien against it to recoup some of the costs provided for care if the property is sold. However, other debts are settled first, leaving Medicaid as one of the last agencies to reclaim costs.
- Specialists like Michelle and Shelby play critical roles in managing cases, ensuring timely updates of documentation, coordinating with county services, and advocating for consumers to ensure that all requirements for eligibility and continuation of services are met efficiently.
- One of the significant challenges mentioned involves communication and coordination with county offices to manage timely updates and processing of paperwork needed for service eligibility and continuation. Another challenge is ensuring consumers understand and fulfill their responsibilities, like addressing changes promptly to avoid service disruption.
Memorable Moments
05:48 Waiver income threshold determines monthly costs.
07:10 Community Medicaid eligibility based on income threshold.
10:16 Medicaid requires QIT for income over $2,829.
13:42 Medicaid can put a lien on houses.
16:28 Transfer resources to child, protect Medicaid eligibility.
22:13 Referrals come from assessment team to Michelle.
23:03 Some categories require resource verification for Medicaid.
Let me know what you think of this podcast, as well as any ideas you have for an episode. Email me at kwhite@coaaa.org!
Copyright 2024 Central Ohio Area Agency On Aging
https://creativecommons.org/licenses/by-nd/4.0/
Transcript
This episode is part one of two about Medicaid
>> Katie White: Welcome to pretend I know nothing about. I'm Katie White, your host, administrator of co tra. Today's episode is part one of two about Medicaid. We'll learn from Michelle and Shelby, our Medicaid specialists at COAA, about initial eligibility, redetermination, and the checks and balances that they offer consumers in our area.
>> Katie White: Let's get into it.
>> Katie White: Well, welcome. Today we've got with us Michelle Rice and Shelby Fox, some of our fabulous Medicaid specialists, and we are going to be talking about all things Medicaid. Welcome.
>> Michelle Rice: Thank you.
Shelby came to Coaa 24 years ago as a Medicaid specialist
>> Katie White: So, I always like to start off by just kind of getting to know both of you. So, Michelle, let's start with you. Tell us about your role and kind of how you came to co AAA.
icaid specialist. And then in:>> Katie White: Okay, wonderful. Thank you. I like that story. Shelby, how are you?
>> Shelby Fox: Hi. Um, I started here six years ago. Um, prior to that, I was at jobs and family services in Franklin county, um, in Cuyahoga county for the 14 years. So that is my Medicaid background. And I worked directly with Michelle and Addy and Galena. And when there was an opening, I said, I'm coming, so. And I work with my care, um, Aetna.
>> Katie White: Okay, waver. Wonderful. Thank you so much. You know, oftentimes we talk about six years is a long time to be somewhere, except if it's co AAA, because people are here for so much longer. It's like, okay, I'm coming up on my two year, and I feel like, all right, I'm coming along. And then 24 years, 35 years. So it's a great place to work. I love that people stay.
Medicaid is the state funded program that offers health coverage for low income people
So, Medicaid was started in:>> Michelle Rice: Sure. Medicaid, um, is a program that allows people to receive help that can't afford appointment, um, you know, like doctor's appointments or waiver services and everything. So I think it really, it's different. And every state, okay, the state of Ohio, every county, there's 88 counties, and they all have Medicaid. And so it allows people, you know, to apply, um, if their income is low. If it's SSI, that means that they automatically are, um, eligible for Medicaid.
>> Katie White: Okay.
t is, if their income is over:>> Katie White: Okay, so Medicaid is offered across the US, but each state has a different Medicaid program.
>> Michelle Rice: Correct.
a financial eligibility that:>> Shelby Fox: We would have resource eligibility as well.
>> Katie White: Okay.
>> Shelby Fox: Um, it would be under $2,000 for a single person. They cannot have resources over $2,000.
>> Katie White: Does that include house savings?
>> Shelby Fox: All of that savings, checking, iras, CDs, bonds? Yes, all of that combined, the house, as long as they're living in it, um, that is not counted as a resource.
>> Katie White: Okay.
>> Shelby Fox: However, if they would go into like, a facility, um, then their house would be considered a resource. So there's ways that they can, um, talk to JFS, learn different ways that they could settle that. And, um, most of the time it comes down to selling and then using the financial, um, assets from the sale of the house to possibly pay private until, um, they're eligible for Medicaid again.
>> Katie White: Okay. And then, um, there's a look back period as well. Right. So you could transfer some assets to other people, but it has to be at least five years. Five years.
>> Shelby Fox: Okay.
>> Katie White: Okay. Okay. So Medicaid is an insurance program. The eligibility is really based on financial criteria. And then you are saying sometimes people have a liability. What is a liability?
s if their income is over the: cross the agency, um, is that: lle Rice: For waiver, um, the:>> Katie White: Only for waiver, yes.
>> Michelle Rice: Because if someone is on community Medicaid, their income can't be over the SSI amount.
>> Katie White: And what is the SSI amount?
>> Michelle Rice: 941.
>> Katie White: Oh, my.
>> Michelle Rice: And so how it used to be, unfortunately, is if people were, um, if their income was over that amount, and for community Medicaid, they used to have to spend down and make their income less by, um, their services and stuff. And so they made everything change to where it's one flat number. And anything over that, they have a liability. And if they're not on a waiver program and they're just like out in the community, if their income is over the SSI standard of 941, then they do not qualify for Medicaid.
>> Katie White: And so what happens if they don't qualify for Medicaid? Say they're at 952.
>> Shelby Fox: They would have to go onto the portal and see what is available out in the community. What other insurance is available out in the community?
>> Michelle Rice: Yeah, they have to go to the Ww dot gov uh.com site to see what other services or what other programs are out there for them, for their insurances.
>> Katie White: Okay. And do they work with the county job and family services on that type?
>> Michelle Rice: No.
>> Shelby Fox: No.
>> Katie White: Okay. So they're just, if they don't qualify and they need community Medicaid, then you just have to kind of go out there and see what's available.
>> Shelby Fox: It would be just like anybody trying to pick up insurance for themselves. So they have to do the research, um, and figure out what they could afford.
>> Katie White: Okay.
>> Shelby Fox: So kind of like Obamacare was. That's pretty much what they would have to go out and view those options and figure out if they could afford something that would best fit their needs.
>> Katie White: Okay, but that would be someone who's 64 or younger. Correct. Because when you're 65, as we learned from Andy Haggard, then you're getting on Medicare.
>> Michelle Rice: Right. But it's different from Medicaid because it's all income base, not age based.
>> Katie White: Right. Right. Okay.
In January of:And then, so we were talking a lot about waiver, um, especially since you're from Aetna and Molina. And waiver individuals are eligible for both Medicare and Medicaid.
>> Michelle Rice: Right. What that means is that they're dual eligible, and when someone becomes dual eligible, then they're eligible for the my care program. And there's only certain counties at this moment in Ohio that are my career based counties that everyone can be switched from, you know, from the waiver to the mycare.
hat's changing. In January of:>> Michelle Rice: Yes. And another thing with Medicaid, we've been talking about the income and everything, and if someone's income is over 28, 29, $2,829, they have to do what's called a QIt to be able to pass the income test, to be on waiver. And what that means is that if their income is over that amount, they have to go to a bank and set up a qualified income trust, which we know as a QIt. And what they have to do is they take their income, and they'll minus that amount. And then the extra that's there, that's what has to go into the QIt each month. And then what they're allowed to do is take that money from the QIT, pull it out to pay on their liability, because if their income's that high, then they're gonna have a liability.
>> Katie White: Right.
>> Michelle Rice: And, um, if they don't use all that money within that month, it has to stay there, because the state is the beneficiary of that QIT.
>> Katie White: So that QIT could be growing as long as someone is receiving those services. And then when they die, the state.
>> Michelle Rice: Comes in and takes that part back. That's how the state gets paid back some of the monies that they have been putting out for someone to receive, um, services.
>> Katie White: Okay, interesting. I did not know that. So then, in keeping just a little bit longer in this, and then we'll talk about, you know, what it looks like on a daily basis in your rules. So if someone has a liability, who is sending that bill or who is. Where's the check going? What does that look like? What's that process.
>> Shelby Fox: If somebody has a liability, and if they're in passport, then the COAA would be billing the individual, um, monthly for their liability.
>> Katie White: Okay.
>> Shelby Fox: Um. If, when they come to my care, if they were previously on passport to my care, then co AAA would still be billing them their invoice.
>> Katie White: Okay.
>> Shelby Fox: If they came from another program besides passport, then they are billed by the provider that's providing the most expensive service for them. Uh, um, through, like, Molina or Aetna. That is the difference. Um, so if co AAA is, um, collecting the liability, then they would get that invoice from them, and then they would pay co AAA.
>> Katie White: Okay, interesting. And so if they're paying one of the. If they're on waiver and they're paying a waiver program, then they're paying directly to, like, their home health agency or whoever their most expensive service is.
>> Shelby Fox: Correct.
>> Katie White: Okay.
>> Shelby Fox: Hmm.
>> Katie White: It's a very complicated system.
>> Michelle Rice: It is. But it's fun at the same time, because there's challenges every day that we get to deal with, that you get to deal with.
>> Katie White: I love that phrasing.
The mindset that Medicaid or the state takes their house is incorrect
Okay, so tell me about a challenge.
>> Shelby Fox: Well, I just wanted to say, like, everybody has the. The mindset that Medicaid or the state takes their house, and that is so not correct.
>> Katie White: Okay.
>> Shelby Fox: Um.
>> Katie White: Please do explain that, because you're right, that is a common thought out there.
>> Shelby Fox: It's so common, and it's. They don't take anybody's house. What happens is if the house is sold, then obviously, then they're gonna private pay until those funds are down. If you've been on Medicaid for a long time, the state can put a lien against your house. They're not gonna come in and swoop your house up and sell it or take it from you. Um, but what they would do is they could put, like, their services against the house. So when the house is sold, they could recoup a little money from the sale of the house.
>> Katie White: Okay.
>> Shelby Fox: However, Medicaid, the state is the last person to get any payment. So if there is any other person out there that is owed money by this person, they're gonna get paid first.
>> Katie White: Okay.
>> Shelby Fox: Medicaid is gonna be the last person to get any funds. So, honestly, we can probably say they're not really recouping too much.
>> Katie White: Okay. Um.
>> Shelby Fox: There's also a homestead exemption act, which I think is really important for people to know if you're somebody that, um, is on waiver and you have a daughter or a son that's been living with you, taking care of you, and they're literally living at your residence. Uh, they don't have a different residence. There are males coming there. Everything about them is in your home, and the reason that they're there is to take care of you and help you. Um, and a doctor can fill out paperwork and say, because they lived with you all this time and took care of you, and it's a minimum of two years, then m that kept you from going into an assistant living facility or a nursing home facility. There is paperwork that can be filled out. It's called a homestead exemption act, and that paperwork will have to go to jobs and family services. They then would turn around and send that paperwork to COAA, where the assessors would look at it and view and see if you meant the criteria of being, um, with a level of care and, um, during that time. And if you did, the house can be quick deeded and transferred over to the child that was living with you. And it's not a, uh, ding against you with Medicaid. It won't count as you transferring your resources to that child. So, therefore, if that's a situation that somebody is living with, then that's a great way to end up giving that child, um, and loved one the house. Um, that doesn't affect your Medicaid. That goes into their name now. They're responsible for it, and Medicaid cannot touch that house any longer. But if that happens, it's very, very important that you get to the courthouse and you get that deed done, because if that person would pass away prior to that deed being transferred, it's null and void.
>> Katie White: Okay.
>> Shelby Fox: So it's very important. Like, if you know you're in this situation, you want to get this taken care of, and, um, it's important.
>> Katie White: Two years. If they've been living there, it's their primary residence. They're caring for their parent for two years. Then you go through this process, and you want to try to get on it quickly. Yes.
>> Shelby Fox: And there's, like, doctor paperwork that we. There's a packet we give, and doctors have to fill it out because doctors have to back it up that, yes, this person would have not been able to be by themselves without the help of their loved one. And then, of course, COAA does the level of care, uh, for that period of time. And it's just a program that's out there that I don't think is spoken enough about, because it is important, especially if you have a child living with you, and their primary purpose of living with you has been to take care of you?
>> Katie White: Absolutely. Especially now when we need family caregivers more than ever. Right. We've always needed family caregivers. Now we have a lot of paid caregivers, but there's a shortage. And so this is a really wise, um, program to know about and consider if you are that family caregiver for two years, doing that, and then being able to protect. Protect the house. And there's conversations about generational wealth and not being able to pass on the house because of some of the programs you might need. So thank you for sharing that. I had never heard of that. So that's great. So the homestead exemption act. Got it. Okay.
Some of the challenges are getting information from consumers to the county quickly
So let's talk about, um, some other challenges. So, again, I love that you said we get to work on these challenges. It's such a good focus, like, you know, being solution focused. So what are other challenges in your role?
>> Michelle Rice: I think some of the challenges are, is getting information from the consumers, getting it over to the county, and having it act upon quickly, because sometimes what we are needing is time sensitive. Um, it could be affecting the consumer's, um, services, because the county has denied out their services for different reasons. It could be that they didn't complete their redead. Um, it could be that they didn't follow through with what's called a Paris match. And so I just think some of the challenges are that is us being advocates for our consumers and making sure we get what they need done and getting response back. It could either be from the county, it could be from a case manager. Um, I know here at CUa, I work on the Molina team, but I also work with Molina. I call Molina Molina, because I have all the under sixties, and there's no waiver service coordinators here that do the under sixties. So I work with them a lot, and it's just really making sure that the consumer has what they need and also making them accountable for what they have to get us and not make it all fall back on us, but making them accountable. And now I think one of the biggest challenges is with address changes that we can't let the county know about an address change. It's up to the consumer. And our biggest fear is consumers don't know how to use computers. Some of them. I'm not saying all, but some. Or they don't have access to a computer. And so what we've been doing, and Shelby came up with a really good, um, statement that we put into the case notes that allows us to put it in there to tell that we've informed the client that they have to be the ones to reach out, and then we put in what the new address is. So that way the county does have it if they have to go and look.
>> Katie White: Okay. So, because a lot of this is done via mail, that address is crucial because there's also a time, um, requirement that comes along with getting everything in. Right.
>> Michelle Rice: They have ten days from the day that they move to get this information into the county. And what happens is all the redoubt information or any paperwork from the county is mailed to that client at the address that is listed in the case. And if they don't update it, then it's going to go to the old number, and then what they'll do is they'll get returned mail, and then at that time, sometimes they will close down their waivers.
>> Katie White: Wow. Okay. After all that work, getting qualified, and then you can just lose it like that.
>> Michelle Rice: Yeah.
>> Katie White: Those are high stakes. Those are high stakes.
So, Shelby, talk to me about a typical referral that you get
So, Shelby, talk to me about a typical referral that you get, and kind of walk me through, start to finish, what that process is.
>> Shelby Fox: Okay. So how we get our referrals would. They would come up from the assessment team. So when they come upstairs, they all go to Michelle, and then Michelle kind of trickles them down to who they belong to. And then, so at that point, we would look at the case, and then we would send an email over to JFS, um, the county that they belong in, and then we would let them know that they got a level of care, and they meet the level of care, and we need, um, a, uh, Medicaid block added. So, and then we ask them, you know, does this person look like they would. Will qualify for the waiver? Um, if they're on SSi, it's pretty simple. More than likely, they're going to qualify to come right onto waiver. We're going to be able to go ahead and approve them if they're, like, in a category, needy category or some other type of category. Sometimes, um, the county will have to send request letters out to the consumer and ask for their resources, their income, and anything, um, permanent to resources and assets. Um, because some categories, they don't need to verify any of their resources to be on, um, the Medicaid base category that they're on because it doesn't, uh, apply to them or that program. So others, when they're coming on to waiver, now they have to verify their resources because that is a qualification requirement. Uh, so once we get, um, the information back from the county, we either know we can go ahead and approve them, get them started on waiver and get their services out to the case manager to get those services rolling. If we have to wait on an answer back from county, we would just kind of note our, we all have excel sheets, and we would just note the case, like, first request went out and the due date. Then we would wait for that due date, and if we would have to go into the JFS system and look at their notes to see the status. Um, we have to look at these statuses multiple times to see if they've been updated. We do not get an email from JFS when they're ready to enroll, so we just have to keep on going in and viewing cases. Um, usually I will email the county. If I see that it was due on, say, the 15th and it's now the 17th or 18th, and there's no notes, I will email, hey, status check can be. I see the last due date was the 15th, and then usually I'll go in a few days later and see if there's a note, seeing what the status check is, seeing if it's ready to enroll, or if a second request was sent out. And that's pretty much what we do daily for our upcoming enrollments until we get them enrolled. Um, I know for myself with Aetna, on Mondays we do enrollments. So I would then contact corporate Aetna, let them know who I have on my list. That's good to enroll, and then it comes back down, and then enrollment happens.
>> Katie White: Okay, so we're getting our referrals from our assessment team because they've gone out and verified that the person is meeting, the level of care they have, the needs that support that. And then you're getting the referral to verify the Medicaid eligibility piece. You don't have access to a database that just tells us that. So we have to, uh, coordinate with county job and family services of the county that the. Am I getting that right?
>> Michelle Rice: Yes.
>> Katie White: Okay.
>> Shelby Fox: We do have access to some of the systems.
>> Katie White: Okay.
>> Shelby Fox: We do have access to the MIPS system, which is the state billing system.
>> Katie White: Okay.
>> Shelby Fox: We can see if they're on Medicaid. We can see what category they're on, but that doesn't tell us for sure that they're good for waiver. We also have access to the OB system, which is also the Ohio benefit system, and that's the system that JFS works in. We can read the notes in there and we can look at screens, but that doesn't tell you the whole picture all the time. So with the Medicaid background, that we have, we can look at that, and we can almost say, this person's probably gonna be eligible, but we can also look at it and say, hmm hm, this person's gonna have to verify a, b, and c. Okay. Um, because of the knowledge that we have with the Medicaid. But county is the final say. If we can look and we can say, oh, this person's on Social Security SSI, they should be able to come right onto waiver because SSI qualifies you for Medicaid. However, if a worker at, uh, jobs and family Services decides that they need to send out a checklist and asked for verifications, that is always going to be what trumps because they make the final say. We do not make eligibility decisions for Medicaid. We just are kind of the in between. The person who tries to keep that engine running behind the scene. That's how I explain it. Like, I'm the one behind the scene trying to keep that engine going down the track as smooth as possible. So nobody on the floor needs to know anything. Sometimes we hit bumps and people know what's happening, and there's a lot of times where we're keeping that train going down the track, and nobody even knows that there's any problems behind the scenes. So that's how I kind of explain my job, because it can be really bumpy, and hopefully, we don't let people know how bumpy it is.
>> Katie White: That's great.
>> Michelle Rice: Yeah.
>> Katie White: Michelle, what are you looking for?
>> Michelle Rice: Um.
>> Katie White: And then what's triggering this thought around? Oh, there might be some follow up, some checklist verifications.
>> Michelle Rice: Right. So when we look in the case, um, I always go to mhts first, like Shelby does, and to kind of see what kind of categories are open. Um, I also look to see if they have Medicare, because sometimes they won't have Medicare, but they've come across on the hens list as needing a new ICDs assessment. And then you're like, whoa. So then what we do as an OB is we look at their resources. Like, we go down and see what bank accounts do they have. Um, do they have life insurance policies? Um, what's their income? And that way, we're able to say, okay, yes, this person's gonna have a liability. Oh, this person has a life insurance policy. They're gonna have to verify that life insurance policy. Um, also, we look at, um, who is all in, you know, making sure that the case is all up to date with the addresses and everything and just really just verifying, um, their income, their resources, and making sure that we can kind of give the case managers an idea of what is going to be needed. Now, with Melina, I get enrollments every day. Okay, so mine's totally different. Um, I get enrollments from Melina every single day. So as soon as I get a case, if the county has two days to get back with us to let us know if it's a good case to go ahead and enroll or if there's gonna be verifications needed. So every day, we are checking the cases. Um, and I found, for me, it's easy. Icc myself on every email, and it goes into a special folder. So the next day, I start at the bottom, and I work my way up, and that's how I'm able to track what the county needs or doesn't need. And if I don't get anything back, I have an email I send out, because Melina just enrolls. They don't ask me, are they good to go or not? They just send out an enrollment date. So I have to get an email out immediately. It says, do not start services. We have no information on the case yet, so mine's a little bit more tedious that way. Um, but, yeah, it's mainly looking at the, um, resources, like the bank statements, you know, because we can see if they have a bank statement or don't have a bank statement, and if they don't have a banking account listed, then we automatically know that the county is going to be requesting. Where does that Social Security check get deposited to?
>> Katie White: Okay, so you're looking for either quick ability to see that someone's qualified, or you're looking for the bumps, like Shelby described and ways to smooth those out so that, okay, there's going to be these different challenges. We know we're going to reach out. Help here. Help here. So that this process is smooth and so someone can be determined eligible. So this is a huge resource that we provide that generally goes unnoticed and unknown, which is the point of it. Right. Because we just want to make sure that those that need our help can get it.
We do everything from the start of the case until we end up disenrolling
Do other area agencies on aging have roles like this?
>> Michelle Rice: Yes, they do, but their roles are a lot different. They are, like, we're all encompassed. We do everything from the start of the case until we end up disenrolling them. We do everything in between. At the other area on aging's, they split up, and, like, they'll have one person that just does the new enrollments. They have another person that just does the disenrollments. They have another person that just does liability changes.
>> Katie White: Interesting.
>> Michelle Rice: So they don't like, we are all encompassed, so we know everything there is to know about those cases where in the other areas, they only do one part of it, so they don't know what's happening at the beginning versus what's going to happen at the end.
>> Katie White: Okay. So just kind of a different way of doing it and kind of making experts in the different areas, whereas we're kind of, our approach is more holistic.
>> Michelle Rice: In the whole process, and I think it's a lot better, because then that way we know, oh, okay, I've had this person before, and they had troubles last year with their read that, because we've had case notes in the system, so we're able to say, this person's going to do this. And we also get a spreadsheet, which is really nice, is with updated when the redeats are due. And so we try really hard to keep Pims updated so that way our case managers can look and say, oh, the redes coming up. I better remind them that they need that, or they'll email us and say, I see there's an old date in here. Because we only update those when we touch that case, and we don't get to touch every case every day, so they bring it to our attention. We're able to look it up and say, okay, I've changed the date. This is when it's due.
The county has to redetermine Medicaid eligibility every year
>> Katie White: What is a redebt? Is that different than a liability?
>> Michelle Rice: Yeah. A, uh, redetermination is the county has to redetermine Medicaid eligibility every year.
>> Katie White: Okay.
>> Michelle Rice: And what happens is the state mails out three months prior to the redetermination, a packet, and the member needs to fill out the, um, packet. It's the renewal application, and the main important is they have to sign page nine. That is the most important page ever to sign, even if they don't fill out any of the other information. If they sign page nine, that's the important part. And then what they have to do is send that back into the county. The county will download that application, and then that's what triggers a letter to go out with what verifications are needed.
>> Katie White: Sign page nine.
>> Michelle Rice: Yes.
>> Katie White: Okay.
>> Michelle Rice: That is the most important, if nothing else. Yes.
>> Katie White: You guys need t shirts that say, that is page nine in the initial packet as well, or just the re termination.
>> Michelle Rice: Um, I don't know. In the original application that they'd fill out when they first come on and have no Medicaid.
>> Shelby Fox: It's a different package.
>> Michelle Rice: It's a different packet, and there's like twelve or 14 pages to that one.
>> Katie White: We don't have enough time or ability for me to follow up on all of these terms that I wrote down. But the complicated nature of the systems that you use, at some point, you talked about a Paris match. There's just so many nuances and potential, um, challenges that you know how to.
>> Michelle Rice: Medicaid.
>> Shelby Fox: That is Medicaid. Medicaid is very, very hard.
>> Katie White: Okay.
>> Shelby Fox: It's not, it's not consumer friendly. The whole system is based on federal regulations in government.
>> Katie White: Okay.
>> Shelby Fox: And it is very hard for our consumers, especially the population we work with, to understand the ins and outs of it. And I think that's why our positions are so important, because I will get on phones with a case manager and talk to the consumer because they don't want to turn in their personal information and they don't understand why they have to. So I will get on the phone and I'll be like, I'm a Medicaid specialist. I worked for JFS for 14 years.
>> Katie White: Huh.
>> Shelby Fox: This is why you need to do it. If you want your services, you need to complete. If you've handed it in already and they're asking for it again, give it to them again. Because if you want your services, which we want them to keep their services, the reason they're on this program is because they qualify for the services. And those services are very important to the community for them to have. But if they don't have the Medicaid, then they don't have the services. Hm. Without Medicaid, the waiver program doesn't exist. So it's there. They intermingle.
>> Katie White: Yeah.
>> Shelby Fox: Because to be on this program, you must have your Medicaid eligibility, and without it, then your services are put on hold, and then you don't get those.
>> Katie White: Services, whether that's your initial or your redetermination.
>> Shelby Fox: Correct.
>> Katie White: Wow.
>> Shelby Fox: So it's very hard for our consumers to understand all of this.
>> Katie White: Well, I would, yeah. I'm confused. I mean, I feel like I know a little bit more, but it's, it's a lot. And, you know, in this day and age, there's a lot of scams. And so you, on one hand, we're training people to be smart about what they're sending and sharing, and then on the other hand, we're getting information on their bank statements and their life insurance. And so I can understand sort of where that unease would come from. Right. And having to share all of these documents.
>> Shelby Fox: And the scams are daily. We have tons of case managers saying, hey, I have a consumer that said if they don't sign this paper that their Medicaid's gonna close. And I'm like, wait, let me go in, look through the case, because we can see the Medicaid case, we can see if a document went out. I will tell them that is not correct. Somebody is playing with this person and they need to not take any phone calls. And if they really need to know going on, they need to go to JFS, they need to go to jobs and family services. I believe that this is a scam, huh? And especially, and, um, that's with Medicaid and Medicare, it's happening, especially during open enrollment time, right? It happens. And people are giving their personal information out because you're gonna have to give your social out, your birthday and no, that's definitely a scam. If somebody's calling you and wanting all that information, JFS is never gonna ask you what your social is, okay? They already know it. Uh, if you're in their system, they already know it.
>> Katie White: Good point.
>> Shelby Fox: Um, if, if you're a brand new person, you're gonna have to give that all to them. So they're never gonna like, just be calling you, asking for your information like that. You're gonna either be doing a email, I mean a mailing, or you're going to do face to face. They're never just going to call you and be like, well, what's your social? What's your birthday? That's not going to happen.
>> Katie White: They've already got that.
So when I think about being a Medicaid specialist in the holistic nature
So when I think about our take on how to be a Medicaid specialist in the holistic nature, you are working on the initial eligibility, getting people through that process as smooth as possible. You're helping and tracking in their redeterminations to make sure they're not losing services, your checks and balances system, in terms of scams or something like that. So I can see why having you all do the entire case is good. Because you're essentially setting your future self up for success. Because you know you're going to document the things that are needed when redetermination comes, or you know that you know your future self is going to be able to read and know what you mean and whatever. So it makes sense to me to do that holistic process instead of different pieces of it.
>> Michelle Rice: I agree. Because, uh, and our spreadsheets really help a lot.
>> Katie White: I bet your spreadsheets. And then I sat with you when I first started, and you have all of those templates too. The email templates are those like the best. Shelby's getting a high five over there, giving her a high five. Uh, so those sheets are the best, I'm sure.
>> Shelby Fox: When I started, Michelle, I mean, I came in with massive Medicaid experience, obviously, but I did not know the co aaa side of things. And her training to me was so amazing. It's ABC 123, and that's how I work. So, like, her templates and her excel sheets and just how she documents stuff came in here, and I was like, yes, I can roll with this because it's easy. Everybody who reads it can understand it, and it's just, it was a very easy transition from JFS to co aaa for me.
>> Katie White: Okay, good.
>> Shelby Fox: Because she made those templates so easy and she had it all in place.
>> Katie White: Yeah.
>> Shelby Fox: And it was just so I really like to keep that in place and keep it rolling.
>> Michelle Rice: Yeah.
>> Katie White: Well, and I'm sure that you also, from your JFS perspective, add a lot of the, you know, the whole picture for us to understand, too. And even hearing you talk about when you talk to clients like, this is why. This is why it's important. These are the repercussions. So having kind of both sides of the same coin are really important.
>> Michelle Rice: Yeah, I think so, because it really helped having now we have two Medicaid specialists that came from jfs that are now us.
>> Katie White: Oh, okay.
>> Michelle Rice: And who's the other one? Michael.
>> Katie White: Oh, Michael. Aetna. Yeah.
>> Michelle Rice: Yeah. So, and they're both on Aetna's team. So, um, Holly Smith also. Yeah. Assessment from JFS.
>> Katie White: And do you all get together and meet or we're going to kind of start some of that to.
>> Michelle Rice: I'm hoping that we get together. Um, they just start it back up with meetings.
>> Katie White: Good.
>> Michelle Rice: Um, and that's really nice because then we get to brainstorm and kind of, you know, if someone's doing something different and someone, um, else can say, oh, my gosh, that would work with what I'm doing. That's really helpful. And, um, also sharing information, I think I'm a big one. If I learn something new, I'm sharing it with the whole team.
>> Katie White: Great. Yeah.
>> Michelle Rice: Um, but I, you know, that's something I feel that's very important is like, if you don't share the information, how's someone else going to know?
>> Katie White: Yeah. And it's really, again, all about just smoothing out those bumps and making sure people are getting what they need. And so if you find a little key that unlocks some other challenge, that's great. Yeah, clearly, I loved your bumps analogy because it's really working for me.
>> Michelle Rice: And I keep saying m it.
>> Shelby Fox: So I learned that when I was a social worker with juveniles and our building was beside the train tracks. So that kind of started me with that analogy. And it's always stuck.
>> Katie White: Yeah.
>> Shelby Fox: So, because the train would come by, and we would be having. And then. So it kind of, like, gotta keep the train going down the tracks.
>> Katie White: Hm.
>> Shelby Fox: And so it's always been my thing, because that's how I feel like we are the engine that's keeping things moving. So that's. That's just where that analogy came from.
>> Michelle Rice: Yeah. What I like is that the consumers don't know what we have to go through to get them to that final step, which is important, because that shouldn't be their problem.
>> Katie White: Yeah.
>> Michelle Rice: You know, they're doing this. Yeah.
About how many referrals are you getting on a weekly basis
>> Katie White: About how many referrals are you getting? Um, on a weekly basis, probably.
>> Michelle Rice: I would say around 20.
>> Katie White: Shelby?
>> Shelby Fox: I would say between michael and I.
>> Katie White: They go to you first.
>> Shelby Fox: I would say probably around the same.
>> Michelle Rice: Yeah. Okay. I get about 40 a week, so total that come to me.
>> Katie White: Okay.
>> Michelle Rice: And then I look them up and.
>> Katie White: Then sign them out.
>> Michelle Rice: Yeah. Cause I look them up to see who's with melina and who's with aetna. Uh, and aetna, uh, is divided out by Alphabet. So michael has the first part, shelby has a second part. So I can just. But what I do before I send it to them is I go into pims, and I update the whole demographic page for them.
>> Katie White: Oh, nice. So that part's already done?
>> Michelle Rice: That part's already done. And then they get to take it from there for their parts.
>> Katie White: Okay. I love all of the systems and the processes and the innovations and the rethinking things that are constantly going on across the agency. It's just so cool to see how people are so committed to just continually making things more efficient, more effective, better for the consumer, all of that.
>> Michelle Rice: I think thinking outside the box kind of helps, too, because that's my kind of thinking.
>> Katie White: Yeah.
>> Michelle Rice: So it just. And I'm all into spreadsheets, and I've created every single one that we've used, and, um, they're just very helpful.
>> Katie White: Yeah.
>> Shelby Fox: Yes. And I'm an out of the box thinker, too, because, like, when I hit the floor, I was like, just to the supervisors in my department, I was like, we're putting a lot more work on the case managers, and, like, we have to figure out how to kind of take some more off of their plate.
>> Katie White: Okay.
>> Shelby Fox: Because they were expected to do a lot with the renewals and the redets, and it was like, they already have huge caseloads. So let's try to simplify more of this and try to make it where we can encourage our consumers to do most of it on their own and a lot of it on their own because they're the ones getting all the paperwork. Or let's try to get more. Consumers have, uh, authorized reps that they designate to help them, because when somebody gets shut down, if we're expecting our case managers to then do all that running around trying to get everything together for their Medicaid to get back into order, then we're taking away what they already have on their plate and we're adding more to their plate. So, like, I know I'm in the process helping one of the supervisors come up with, uh, different templates so they can follow those and make it a little bit smoother. So, like, we're always, we're always trying to innovate and, you know, update and do those things.
>> Katie White: Yeah, well, and I would imagine rules and processes and whatever changes, too. And so whether it's an efficiency thing or just having to reimagine something, something, it's always ongoing.
What is one thing you would change or add about COAA
Let's get into the miracle question. So tell me, what is one thing you would change or add about COAA?
>> Michelle Rice: I think if I had one thing to add, um, it would be that I would hope that we could all work more as a team in our divisions instead of working separately. I wish that we could come together and just come up with ideas and be able to be open and honest and talk, and nobody's going to take it, you know, for granted what someone's saying or not putting them down, but just to kind of be more of it, have that team atmosphere.
>> Katie White: Okay, so you're talking cross agency.
>> Michelle Rice: Yes.
>> Katie White: Just opportunities to come together and have discussions on certain topics.
>> Michelle Rice: Right. And it'd be nice to kind of cross train everybody to. That was one of my big things, is I like doing training. So, um, but is have everybody, like, right now, I'm the only one that knows passport and my care.
>> Katie White: Okay.
>> Michelle Rice: Because when I was hired 24 years ago, I did passport and traditional Al, and then I went into my care where everybody else that has come in, um, like the two passport Medicaid specialists, they only know passport, and Shelby and Michael know the my care part, but not the passport part. So I just think it'd be really important if we could just start cross training all the Medicaid specialists so we would be able to help out in all the different areas that's a great idea.
>> Katie White: And, Shelby, I saw you nodding.
>> Shelby Fox: Yeah. I am a big pusher on the cross training. Um, because the situation happened that Michelle was out, um, my co partner was out on vacation. Um, there was a passport person on vacation.
>> Katie White: Oh, dear.
>> Shelby Fox: So I was taking care of my care, Melina and Aetna, and the one passport person that was here was in a car accident, and I could not jump in and help passport as much as I wish I could have, because I do not know how they do their enrollments or anything. I could give them information about the case, but I couldn't jump in and do anything. Michelle's cases, I could jump in because we've went, and I've kind of learned how she communicates with corporate Melina, et cetera, et cetera, and how she does her cases. So I could just jump in and do them. Um, so, like, it. I think it's crucial that we get some cross training, and also we do have two massas or Medicaid specialists in assessment, and they do the initial stuff and not the ongoing stuff, but even to be cross trained, so that if they were out or something happens, because you never know when there's going to be a family medical, um, emergency, a death. You go out here and get in a car accident, win the lottery.
>> Katie White: Win the lottery. Who's coming back for that after that?
>> Shelby Fox: So if one of us leaves, nobody else knows how to step in and take. And, um, there's not. I wish we had a supervisor that could be over, all of us as a whole, that knew Medicaid, that knew how to work the systems, that had eligibility to get into the systems that we work in, because not everybody even has access to them.
>> Katie White: Interesting.
>> Shelby Fox: Um, that knows how to communicate with the jfs and actually approve cases, deny cases, be able to look at cases and kind of know, like, oh, this is what needs to happen, because we have wonderful supervisors, but they do not know what we do, and they do not know. They could never go to the.
>> Katie White: They could never step in.
>> Shelby Fox: No. And so I think that just the cross training and also possibly that, I think that would be very, very important.
>> Katie White: It's really interesting, and especially after sitting through and kind of learning all of this, um, if we don't have a cross training and we don't have a full backup system, the train stops.
>> Michelle Rice: Right. It does.
>> Katie White: And if the train stops, then the consumers don't get what they need. Correct.
>> Michelle Rice: Right.
>> Shelby Fox: And it's gonna be a lot harder for the stuff to get finished for them because they're gonna have to go to jfs, and they're gonna have to sit in those lobbies for hours. They're gonna be on the phone and never get a response for hours. Um, and that's our biggest thing. Well, I was on the phone for 6 hours, or I went to jfs, and I sat in the lobby for 3 hours and still never got things resolved. Well, I sent the stuff in three times already. That's where we come in, and we can kind of push the stuff through, um, because we have people that we can just push it to.
>> Katie White: At JFS, you have the connections, you have the knowledge, you have the databases, you have all those things that a consumer wouldn't necessarily have. Correct.
>> Shelby Fox: And sometimes they go to, like, say, in franklin county, there's so many different centers. They go to the north center, but the long term care center is the west center. They have to go to the west center if they want to talk to somebody in the long term care unit, which is the unit they want to talk to.
>> Katie White: Okay.
>> Shelby Fox: Um, so there's just all those little details. But what really hit me was when everybody was out, and all of a sudden, that next person went out, and I was the only person here.
>> Michelle Rice: Mhm.
>> Shelby Fox: To help Melina, Aetna, and passport, and I'm like, I don't know how to work all their systems.
>> Katie White: It showcased the flaw in our system. We have a lot of subject matter experts, but if you're not cross trained, then things can kind of go down.
Any final thoughts that you want to make sure listeners know about your role? Medicaid itself?
Any final thoughts that you want to make sure listeners know about your role? Medicaid itself? Medicaid specialist.
>> Michelle Rice: I think if you have questions, please ask. Don't think that any question is not a question that should be asked. Call in, ask us, and we can try and answer it the best we can. And I have the theory if I don't know the answer, I'm going to find the answer, and then I'll get back with you. That's awesome.
>> Katie White: I, um, love that. Shelby.
>> Shelby Fox: I will roll off Michelle, because I am really that person. I'm a service person. So we're here to help you and serve you as our customers, as our consumers. Um, and we just want things to go smooth for you because you're the ones that need the benefit. So that's what I feel like my job is here, and I miss the one on one with consumers, but I feel like I'm still doing a very important job.
>> Katie White: Absolutely. Your impact is there, and it's such a servant leadership way of doing something, because, again, there's really no um, accolades coming out of this. It's just making sure that people get what they need to get, and that is. That is just something to be so proud of. So thank you both so much.
>> Michelle Rice: You're welcome. Thank you for having us.
>> Katie White: I hope now you know something about Medicaid.
