Medicaid Medically Frail Designation Now Available


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:

  1. Medicaid system will look at state health registries;
  2. managed care organizations will look at beneficiary's medical services or use a tool to screen for medically frail status;
  3. doctors can report that their patient may be medically frail to the managed care organization;
  4. 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:

MCO:

Aetna

Anthem

Mail:

Aetna Better Health of KY

Attn:  Case Management Department

9900 Corporate Campus Dr.

Suite 1000

Louisville, KY  40222

Anthem Blue Cross and Blue Shield Medicaid

Attn:  Attestation Processing - 3rd Floor

13550 Triton Park Blvd.

Louisville, KY  40223-9704

Fax:

959-282-8582

844-480-6838

E-Mail:

KENTUCKY_MEDICALLYFRAILATTESTATION@Aetna.com

kymedicallyfrail@anthem.com

Online:

 http://www.aetnabetterhealth.com/Kentucky 

https://mediproviders.anthem.com/ky

Help Line:

1-855-300-5528

Ask for Medically Frail Case Management

Provider Help Line: 1???855???661???2028

Member Help Line: 1-855-690-7784

MCO:

Humana

Passport

Mail:

Humana - CareSource 

10200 Forest Green Blvd.

Suite 400

Louisville, KY  40223

Passport Health Plan

Attn:  Care Connectors Medically Frail

5100 Commerce Crossing

Louisville, KY  40219

Fax:

937-487-1649

502-585-8457

E-Mail:

KYHealthMedFrail@caresource.com

provider.attestations@passporthealthplan.com

Online:

https://providerportal.caresource.com/KY/ Assessments/MedicallyFrail.aspx

https://phkyportal.valence.care

Help Line:

1-855-852-7005 (TTY: 1-800-648-6056 or 711)

 

1-877-903-0082

MCO:

WellCare

 

Mail:

WellCare Health Plans

Attention Kentucky Frail Clinical Attestations

P.O. Box 31497

Tampa, FL 33631-3497

 

Fax:

(813) 283-3665

 

E-Mail:

kyfrail@wellcare.com

 

Online:

https://provider.wellcare.com/

 

Help Line:

1-877-389-9457

 


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 debra.marshall@coniferhealth.com.