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Medicaid Administrative Claiming is one avenue for sustaining and supporting a NWD System

Sustaining a NWD System requires a comprehensive strategy to blend various funding streams. Statewide governance including the ability to leverage existing funding remains a key component of successful development and implementation of a mature NWD. NWD Systems use a variety of funding streams with the largest percentage (over 50 percent) coming from state and local funds and only one percent from a federal NWD grant (NWD Business Case Grantee Reporting, 2019). ACL’s Strategic Framework for Action encourages this blending and braiding of funding sources. Funding sources NWD Systems use for development and operations include federal dollars such as the Older Americans Act (i.e. Information and Referral), the Rehabilitation Act (i.e. vocational rehab), the Omnibus Budget Reconciliation Act (i.e. State Health Insurance Counseling Program grants), and the Development Disabilities Act (i.e. University Centers for Excellence in Developmental Disabilities Education, Research, and Service). Additionally, NWD Systems have leveraged the following types of funding:

Medicaid (Medicaid Managed Care, Medicaid Administrative Funding, fee for service)

State General Funds

Veterans Health Administration programs

Medicare (Medicare Advantage, Medicare Special Needs Plans)

Hospital Systems

Health Plans

Public/Private Partnerships


Leveraging federal dollars requires a strong NWD System governing structure to coordinate and identify efficient and effective ways to use federal funds. Medicaid Administrative Claiming in particular requires an established partnership with the State Medicaid Agency. More resources on how to forge this relationship can be found below. Obtaining new and non-traditional funding such as health plans and health systems requires innovation and development of new partnerships which often require a greater degree of business acumen. In addition, ACL developed a business case toolkit available at https://www.ta-community.com/category/nwd-system-business-case-toolkit.




Medicaid Administrative Claiming

Medicaid Administrative Claiming is one avenue for sustaining and supporting a NWD System Medicaid claiming, also known as Federal Financial Participation (FFP), represents a way in which Federal funds are used to reimburse agencies doing work that supports Medicaid programs.

The role that NWD System’s play in assisting individuals with understanding and navigating complicated long-term services and supports includes many administrative functions that are eligible for Medicaid claiming.

Federal matching funds under Medicaid are available for costs incurred by the state for administrative activities that directly support efforts to identify and enroll individuals into Medicaid and that directly support the provision of services covered under the Medicaid state plan, when those activities are performed either directly by the state Medicaid agency or through contract or interagency agreement by another entity. The state Medicaid agency will advise the state’s NWD System Lead Agency on the essential infrastructure needed to claim Medicaid administrative funds. Often times, infrastructure is modeled after programs that have Medicaid claiming in place. Below are some key questions for NWD Systems to consider as Medicaid administrative funding is explored:

  1. Which programs participate in Medicaid administrative claiming currently in my state? How are those programs set up, as contracts or cost allocation plan amendments?
  2. What approximate percentage of time do NWD System personnel spend on Medicaid related tasks? Which local NWD System entities would participate? How are they structured, non-profit or government entity?
  3. Has the NWD System downloaded the ACL Workbook and tools on this page and engaged a claiming team?

The NWD System activities that may be funded under Medicaid include:

Outreach

Person-Centered Counseling

Facilitating Medicaid Eligibility

Training

Programing Planning

Quality Improvement


The Centers for Medicare & Medicaid Services (CMS), in conjunction with ACL, made available on the CMS website a guidance document. This guidance outlines the basics of how states can draw down Medicaid administrative FFP for NWD Systems.

For further guidance, ACL has outlined the following steps across two phases of NWD System Medicaid administrative claiming development:

Phases for the NWD System

Toolkit

Phase 1 Tools: Establish Costs and Document Medicaid Time

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This work plan provides the high-level steps required for administrative claiming development, including timeframes and staff responsible for each task.

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This PowerPoint presentation specifically targets engagement of state level partners, such as the Medicaid agency, State Unit on Aging, fiscal and policy staff, or other partners in the NWD System. The presentation template provides a basic outline of information the NWD lead agency could cover.

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This PowerPoint presentation can be used to present an introduction for local agencies and partners that may participate in Medicaid Administrative claiming.

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This tool provides a method for identifying sources of matching funds and simulates the potential FFP reimbursement.

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This tool provides guidance for developing state-specific codes, including examples of approved time study codes, and guidance for developing and using a decision tree to inform accurate coding.



Phase 2 Tools: Develop Agreements and Approvals

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These tools include a Cost Pool Spreadsheet, which reports on the total costs associated with each time study participant and instructions on completing the spreadsheet.

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This document can serve as a template for an agreement between an operating agency and the state Medicaid agency.


Want to learn more about other claiming opportunities?
Check out this information on NWD IT and PASRR Medicaid Claiming


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Have Questions? Contact Us!

NoWrongDoor@acl.hhs.gov

Webinar Recordings and Additional Resources

March 15, 2018 Webinar - NWD Medicaid Claiming: Introduction

May 10, 2018 Webinar – Phase 1 Tools I (Creating a Work Plan, Engaging Partners, and Estimating Amounts)

June 7, 2018 Webinar – Phase II Tools (Drafting and Testing Codes, Calculating Cost Pools, Drafting MOUs)

January 10, 2019 Webinar - NWD Medicaid Claiming Overview