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Virginia Health Care Association | Virginia Center for Assisted Living

COVID-19 Medicaid Eligibility Related Updates

COVID-19 Medicaid Eligibility Related Updates

VHCA-VCAL has been in close communication with DMAS and DSS to answer member questions about Medicaid eligibility, renewals, how documents are to be signed, and provisions in Virginia’s 1135 CMS waiver that are most needed by providers. 

DMAS has informed VHCA-VCAL of three policies that affect Medicaid coverage

  1. Eligibility will not be closed because of failure to complete the annual renewal for the duration of the COVID-19 emergency.
  2. All scheduled renewals falling in the June-August time frame will be delayed for three months (unfortunately, renewal information for April and May has already gone out, but again, eligibility will not be terminated for failure to complete the renewal)
  3. Medicaid coverage will not be closed due to changes in circumstances for the duration of the COVID-19 emergency.

VHCA-VCAL (and others we are sure) had expressed concern that renewals could be delayed as local Departments of Social Services deal with workload and staffing issues, and as nursing facility staff, residents, and families are dealing with the emergency. We are thankful DMAS has invoked these changes per the broad federal authority already granted. We have also voiced concern that if timelines for approval of new applications slips further due to the emergency, there may be a need to consider the financial implications for nursing facilities as applicants remain in a “pending” status. DMAS is aware of the concerns and to the extent the above policies do not assist with freeing up resources for new applications, we will revisit the issue. 

Additionally, a VHCA-VCAL member posed a question to staff regarding whether DocuSign could be used to secure signed resident documents without visitations given the restrictions put into place to stop the spread of COVID-19. According to DMAS:

VDSS does not have DocuSign capability. We can accept electronic signatures through CommonHelp, or telephonic signatures via applications filed at Cover Virginia. All of the regular channels that would accept something other than a hard copy of a signature are still available. Primarily we are talking about the signature on an application and any designation of an authorized representative. However, both of those options would require that either the person himself go online or call to apply or that someone is designated to do that for the applicant. …and that’s not always going to limit contact. We are still looking into this and if we come up with something, I will let you know.

Also, VHCA-VCAL has been assured that the 1135 waiver from DMAS to CMS will include a provision waiving the need for hospital screenings for individuals discharged to skilled care at nursing facilities. Under the blanket 3-Day Stay waiver from CMS, a three-day hospital stay is no longer required to start the skilled benefit under Medicare. However, Virginia’s current requirement for LTSS screenings in this situation is causing confusion and reducing the effectiveness of the CMS waiver. As we understand it, the screening to skilled care would be waived and should the individual have a subsequent need for the LTSS screening, nursing facility staff would conduct it through the MDS.

Finally, we have also been informed that the 1135 waiver will include a provision to suspend Medicaid MDS assessments (not the ones conducted to establish Medicaid LTSS eligibility, as above) during the emergency. Staff would be able to conduct them as resources permit but given that MDS coordinators typically have a clinical background, their skills may be better utilized elsewhere in combating this virus. As we understand it, the assessments would be reestablished on a three-month period in order to re-spread the schedule once the state of emergency is lifted. Obviously, care planning would still need to occur despite the MDS assessment suspension. From a payment perspective, the RUG on file would simply continue to be utilized. To the extent workload allows assessments to be completed, we would encourage them to be done.

While these 1135 provisions would be in effect retroactively to a point earlier this month, DMAS has not yet submitted the waiver nor has CMS approved them so they are not in effect today. This will not be the only opportunity Virginia will have applying for a waiver. If you have ideas on other opportunities, please contact Steve Ford.

If you have any questions regarding these eligibility updates, please email Steve Ford.