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07/20/2024 02:36 PM
Pennsylvania House of Representatives
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House of Representatives
Session of 2023 - 2024 Regular Session


Posted: May 16, 2024 09:08 PM
From: Representative Arvind Venkat
To: All House members
Subject: Medicaid Pendency and Timely Reimbursement for Long-Term Nursing Home Care
For many older adults, Medicaid is an essential lifeline that plays a pivotal role when living at home is no longer a safe option. Many skilled nursing homes choose only to accept an individual into their facility if that person is private paying. This is because there is no guarantee that a pending Medical Assistance (MA) application will be approved. However, there are long-term care (LTC) facilities that are mission driven and work to accept all those in need.
Medicaid pendency refers to the period during which an older adult seeking assistance in paying for care has applied for MA and their submitted application is under review. In our Commonwealth, MA pending applicants receive services and care immediately even though the provider does not yet receive any payment. Additionally, existing nursing home residents who had previously paid a private rate may also spend down to become Medicaid eligible and enter an MA pending period. Once approved, the care provider is paid retroactively. However, if the person is denied MA eligibility the facility has very little recourse to cover the cost of the person’s care. 
Frequent reports of delays in these applications being approved and/or renewed leave LTC providers in an unstable financial situation. Providers across the state have reported an increase to MA pending days and a lack of standardization in the application process. In some cases, applications are reported by providers to take over a year to process resulting in hundreds of thousands of dollars in uncompensated care providers must cover throughout the delay or absorb altogether if the application is ultimately denied.
I am introducing legislation that would establish reasonable timelines for the Department of Human Services (DHS) and the County Assistance Offices (CAO) to process these applications. If there are excessive delays, this bill would allow providers to get a portion of their reimbursement sooner and allow the provider to have the ability to request an individual’s application status while it is pending. If ultimately the individual is determined to not be eligible for MA, DHS could clawback interim reimbursement.
Please join me in sponsoring this legislation which supports LTC providers' mission caring for our state’s most vulnerable population, without forcing them to endure devastating financial risk.   

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Introduced as HB2320