CMS summarizes the basic requirements for Medicaid administrative claiming for the state LTCO program. The ombudsman program is partially funded through the Older Americans Act (OAA), however the bulletin draws attention to activities that may qualify for Medicaid administrative funding. In the bulletin, CMS notes that some states are expanding the populations served by the LTCO program to include individuals receiving LTSS in their own homes and the community.
The LTCO program activities that may be eligible for Medicaid administrative funding include:
· Tracking and reporting consumer requests for assistance in obtaining medical, dental, mental health or long-term care (including home and community-based services) to the Medicaid agency;
· Consultation and direct advocacy to assist individuals participating in HCBS waiver programs;
· Identifying Medicaid-eligible residents who want to transition out of nursing home facilities and connecting them with appropriate local contact agencies or other services to assist them in returning to the community; and
· Other LTCO activities which are determined by the Department of Health and Human Services (HHS) Secretary to be necessary for proper and efficient administration for the Medicaid state plan.
Medicaid administrative funding is not available for the following
activities: assisting individuals with gaining access to or coordinating
non-Medicaid benefits such as social, educational, vocational, legal advocacy,
or other non-Medicaid services.
Read the bulletin.