Medicaid Medically Frail Designation Now Available
Thursday, August 16, 2018
The recent court decision on June 29, 2018 halted most components of the KY HEALTH Medicaid program for now; however the Medically Frail designation component is currently in place with the various Medicaid managed care organizations.
Should KY HEALTH be fully implemented, Medicaid members that are designated as Medically Frail will be exempt from the employment and cost sharing components of the plan. The Medically Frail designation could prevent potential suspension of Medicaid coverage in the future.
Beneficiaries may be considered medically frail for many different reasons. Some of those reasons include:
- disabling mental health diagnosis
- chronic substance use disorder
- serious and complex medical conditions
- significant impairment in ability to perform activities of daily living
- diagnosed with HIV/AIDs
- eligible for social security disability
- chronic homelessness
Medically Frail designation can be reviewed using four key methods:
- Medicaid system will look at state health registries;
- managed care organizations will look at beneficiary's medical services or use a tool to screen for medically frail status;
- doctors can report that their patient may be medically frail to the managed care organization;
- and, the beneficiary can report that he/she may be medically frail to the managed care organization.
KY Medicaid Providers can submit a medically frail attestation form directly online, via email or via fax directly to the patient's MCO. The attestation requires the provider's NPI number and signature.
Contact information for the MCOs:
Please Note: The Eligibility and Enrollment Services department (EES) has Patient Advocates at the KentuckyOne Health hospitals to screen uninsured patients and assist with Medicaid applications as needed. EES works closely with Care Management and other clinical staff to understand the patient's health condition. From time to time the patient advocate will require assistance from a physician to complete and sign a medically frail attestation form for submission to the patient's MCO. Your assistance is greatly appreciated!
For questions, please feel free to reach out to Debra Marshall at 770.401.7202 or firstname.lastname@example.org