Medicaid Advocates Successfully Use Medicaid Exception Requests and Requests for Memoranda of Understanding to Meet Clients’ Urgent and Unmet Needs

Medicaid Advocates Successfully Use Medicaid Exception Requests and Requests for Memoranda of Understanding  to Meet Clients’ Urgent and Unmet Needs

Medicaid client advocates have found a sympathetic ear in State Medicaid Director Paul Reinhart.  Director Reinhart has been willing to grant numerous exception requests for clients who would not otherwise have received services and to enter into memoranda of understanding with nursing homes and MiChoice providers who serve particularly expensive clients.  Examples of exceptions that have been granted include:

·                 A client with urgent health care needs who returned to the state was refused admission by more than 150 Michigan nursing homes because of his heavy care needs.  He was granted an exception so that he could be immediately admitted to the MiChoice program.

·                 Clients who have been in a nursing home for less than six months and wish to transition into the MiChoice  program and clients who are in the community at imminent risk of nursing home placement have frequently  been granted exceptions so that they can be immediately admitted to the MiChoice program with appropriate funding.

·                 An extremely fragile heavy care recipient with challenging behaviors had been involuntarily discharged from a multitude of facilities.  No other facility was initially willing to admit him.  Advocates  obtained a memorandum of understanding to provide substantially increased funding to one of the few facilities in the state that was equipped to care for him and educated the facility about the availability of additional funding for other applicants whose care needs were extremely expensive. 

Advocates have also had some success in working with the Medicaid policy staff to obtain hardship waivers for Medicaid applicants who have been unable to provide adequate financial or other documentation.  One advocate is now requesting an exception for payment of medications that are not provided pursuant to Medicaid policy but that are medically necessary for a client.  Other advocates are encouraged to be creative and assertive in seeking exceptions, memoranda of understanding, and hardship waivers in urgent and difficult cases and are likely to find Medicaid policy staff more receptive to requests for help than DHS caseworkers.