(TRENTON) – The General Assembly on Monday approved legislation sponsored by Assembly Democrats Gary Schaer, Vincent Mazzeo, Joseph Lagana, Dan Benson, Annette Quijano and Shavonda Sumter to help seniors and other vulnerable residents receive the specialized care they need from nursing homes when the Medicaid application approval process is delayed.
Designated the “Uncompensated Pending Medicaid Beneficiary Payment Relief Act,” the bill (A-3928), would provide payments to nursing homes for residents who have applied for Medicaid but whose eligibility has not been determined more than 90 days after the initial application.
“We are seeing significant and unwarranted delays in the application process for Medicaid and other benefits, which is creating a real problem for residents who need this assistance the most, as well as the facilities which are required to treat them,” said Schaer (D-Bergen/Passaic). “We need to do a much better job of processing these applications more efficiently. Until then, this bill will help ensure that our most vulnerable populations receive the services they need.”
“Anyone who has ever dealt with Medicaid knows how time-consuming and frustrating the process can be, especially if you’re trying to secure benefits on behalf of an ailing loved one,” said Mazzeo (D-Atlantic). “Families can often get saddled with bills while the application process drags out. This will help aging and ailing residents get the care they need at a facility designed for their needs while eliminating stress and hefty bills.”
“The need of these residents doesn’t stop while Medicaid determines whether or not they are eligible for assistance,” said Lagana (D-Bergen/Passaic). “This bill would allow for the continuation of services to seniors and other residents in need, while their Medicaid applications are processed.”
Specifically, the bill requires the state Department of Human Services to make advance payments to a nursing facility, at the facility’s request, whenever the facility is providing uncompensated services to one or more residents whose eligibility for Medicaid has not been determined more than ninety days after an application has been filed.
Any such advance payment would not exceed fifty percent of the estimated amount due for the uncompensated services.
No later than 30 days after a Medicaid application is granted and payment has been made to the facility, or after any such application has been denied, the department would be required to provide reimbursement for any balance due to the facility; or recover any advance payments made on behalf of an applicant deemed ineligible for Medicaid by reducing any payments due to the facility.
“Navigating the Medicaid system can be trying,” said Benson (D-Mercer/Middlesex). “People who require specialized care should not have to forgo these services because of bureaucratic delays. This can help provide residents the services they need while they wait for a response from Medicaid.”
“Ideally, the application process would be more efficient, but that’s not the case,” said Quijano (D-Union). “Residents who require these services, and their families – who may be stuck footing the bill while they wait for Medicaid to review their applications – should not be punished for that.”
“We would absolutely like to see Medicaid applications reviewed and processed more quickly for residents,” Sumter (D-Bergen, Passaic). “Until that happens, residents should not have to wait or pay out of pocket for medical care if they have already applied for Medicaid.”
The bill was approved 56-0-18. It was released by the Assembly Health and Senior Services Committee on March 2.