Home Health & Hospice Week

Missouri lawmakers are planning to make changes to the eligibility criteria for Medicaid home care services, after previous changes failed to produce the cuts they had estimated.

Background: The legislature raised the threshold for eligibility from a “level of care” score of 21 to 24. It estimated the state would save $43 million due to the change in 2018, but the change cut only $11 million from home care spending, according to a new report from the Missouri state auditor. The changes came after Medicaid home care spending increased from $620 million in 2014 to $816 million in 2017, the report notes.

Expenditures for 2018 fell to $805 million. The report blamed the smaller drop on multiple factors, ranging from failing to take patients’ deteriorating health into consideration to intimating that providers may be upcoding patients’ LOC scores.

An “unusually large percentage of reassessments in fiscal year 2018 resulting in higher LOC scores creates questions as to whether some participants were improperly found to remain eligible for services under the higher LOC threshold,” the report says. “The unexpected results occurred despite refresher training.”

The state plans to change the way it calculates participants’ scores, reports St. Louis Public Radio. It is seeking public comment from people who use home-based services online through the end of March, the National Public Radio affiliate says. The audit report is at https://app.auditor.mo.gov/Repository/Press/2018125101429.pdf.