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 CMS Reverses Course, Will Help Fund LTC Ombudsmen

The Obama Administration will help will help states pay for Medicaid ombudsmen, the Centers for Medicare & Medicaid Services (CMS) have announced.

CMS had long refused to release Medicaid dollars to pay for ombudsman programs, insisting that the dollars come from separate appropriations under the Older Americans Act. But the agency reversed course in an announcement late Tuesday, saying that it would provide some matching dollars for the states.

Many saw Tuesday’s reversal as a victory for the newly created Administration for Community Living, which had been pushing to free up Medicaid dollars for state ombudsmen.

Under the guidance issued by CMS, Older Americans Act dollars will still have a role to play, but federal officials may be willing to match funds for:

•    Information about Medicaid eligibility and enrollment;
•    Finding potential Medicaid patients;
•    Tracking and reporting to customer service requests for help in all kinds of health care under Medicaid; 
•    Services to help patients transition from Medicare Part A coverage into the Medicaid nursing facility benefit or from private pay status;
•    Advocacy for patients in home- and community-based waiver programs;
•    Finding Medicaid-eligible patients who want to leave nursing homes; and
•    Hunting out fraud.

States will now have to come up with plans for winning the matching dollars, CMS said. All costs have to be “proper and efficient” under current law, CMS said.

There are still a lot of questions left on the structure of the ombudsman programs, but CMS’ guidance will bring relief to hard-pressed state officers. Under the Older Americans law, dollars had been scarce, experts say. 
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