Virginia Regulatory Town Hall
Department of Medical Assistance Services
Board of Medical Assistance Services
Eligibility and Appeals [12 VAC 30 ‑ 110]
Action Client Appeals Update
Stage Emergency/NOIRA
Comment Period Ended on 10/26/2022
Next Comment     Back to List of Comments
9/27/22  8:55 am
Commenter: Anonymous

No concern for local government agencies

These policies (including the de-novo process, 90 day reinstate rule, etc) are all written with little to NO regard for the impact on local agencies. When (IF) this PHE ever ends, the local agencies are going to get SLAMMED with appeals.... SLAMMED! 

DMAS, CPU, and other entities have continued to incorrectly approve people. At which point the local agency CANT CLOSE the case. The local workers are going to have to close hundreds of incorrectly enrolled cases and will get ALL APPEALS. The process gets easier and easier for the client to "slide by" but the workers are left with NO support from the state. "Overtime" is not a solution to overworked and burnt out staff. All of these "assistance at the state level" ideas crash and burn and offer no real support but only cause more issues because they aren't trained fully - just thrown into things and hope for the best. Over and Over we see it. Meanwhile - the Medicaid and SNAP caseloads have more than tripled in some areas with no efforts to provide local agencies additional funding for extra positions. 

The appeals process at current is validating what seems like EVERYTHING!!! They have no regard for the amount of work an appeals summary takes for a local worker to complete. They have this new AIMs portal to again - make it easier for them but with no regard for the locals. (All the information is already in VaCMS and DMIS but because they are so short sighted and don't care about the locals - its too much effort for them to find documents in a system that is so terrible (we know - we have to everyday and especially have to when we download, save, and reupload for the appeals office.) The work on for end is unbelievable and they keep selling "efficiency." VaCMS and DMIS are always down. You can't label documents in a way that is later searchable in DMIS. VaCMS is constantly causing and creating errors for local workers. But - "hey y'all... here's ANOTHER system to use called AIMS. It will make life easier?"  But - you can't log in with one password, you have to get the password that then sends a code to your email. You have to go to VaCMS and DMIS (where everything is ALREADY SAVED!!!! to find, download, save, rename EVERY DOCUMENT that supports the appeal, then RE-UPLOAD it to the AIMS system PLUS rewrite the entire case into an appeals summary because it's also too much work to just read the narrative." There's also a SEPERATE process for QC (by the way.) 

In nursing homes, you have people approved for full benefits - STATE TAX PAYER DOLLARS paying for nursing home care while the clients have a $0 co pay due to a system error that can't be corrected due to PHE or clients that have SOLD A HOME and are literally sitting on $350,000+ in resources but still getting STATE TAX DOLLARS to pay for their care while they live off the money getting all kinds of extras that other patients aren't getting.  There are clients on caseloads across the state right now that should be paying a copay/Patient pay of over $1000+ per month but aren't because the VaCMS system is crap and PHE doesn't allow us to fix errors. 

However, the state policy writers are SO out of touch with what is happening at a local level and so focused on getting socialism in place so that healthcare is free for all - they don't care that the turnover in benefits has gone up so much in past years. (Just look at the State profiles for this! it's true!) 

END PHE and QUIT giving people SO MANY LOOPHOLES! you are going to bankrupt the state and federal funds, as well as run off ALL qualified staff that care deeply about what they do.  We can't even access MMIS any longer to make changes and be trusted as competent people who have been working in the field and know the manual better than most at the state. We can't be trusted? VaCMS is a MAJOR MAJOR issue! Hornby Zeller?? You tell me the last time a long term care review took only 1 hour. But when PHE ends (if PHE ends) you want us to do x number of reviews per month? ok!?! Sure! We will do as many as possible and try as hard as we can (like always) - promise that. we will be superhuman as always - promise that. But your quota - who knows.  We know at a local level that on the other end of all of this is a client that needs help, a client that needs food, care, but the state has left us with lacking customer services because we don't even have time to eat lunch let-alone explain what the 30+ page notice of action says to the client on the phone, who by the way is old and half blind and can't ready font size 8.  

CommentID: 145159