Q. My mom, who you recently did asset protection for and got qualified for Medicaid, recently received a letter in the mail from the Virginia Department of Medical Services that welcomed her to Commonwealth Coordinated Care Plus (CCC Plus), Virginia Medicaid’s new, required managed care program.
The letter mentions that her mandatory enrollment in the CCC Plus Medicaid Health Plan will give her all her Medicaid health care, long-term services and supports, and prescription drug benefits, and that she will have a care team that works with her and her providers for primary care, mental health, hospital, nursing facility, and specialty care; and that she will have the added benefit of a care coordinator.
Can you explain more clearly what this is all about and what these changes mean for my dad? My dad will likely need long-term care in the not-so-distant future, and also wants to know how this will affect him if he qualifies for Medicaid through your office, and wants to know if there are other alternatives to CCC Plus. Thanks for your help!
A. Commonwealth Coordinated Care Plus (CCC Plus) is a new Medicaid program that provides medical, behavioral, substance use disorder, and long-term services and supports all under one program. CCC Plus is being phased in by region across Virginia, as follows:
Tidewater – August 1, 2017
Central – September 1, 2017
Charlottesville/Western – October 1, 2017
Roanoke/Alleghany – November 1, 2017
Southwest – November 1, 2017
Northern/Winchester; December 1, 2017
The letter your mom received was from the Commonwealth of Virginia Department of Medical Assistance Services. It welcomed her to CCC and should have included the following information:
Your CCC Plus Medicaid health plan is SAMPLE MEDICAID HEALTH PLAN. Your coverage will begin October 1, 2017.
Your Medicaid ID # is 00999999999
If this is the letter that your mom received, below is some information about the CCC program, her next steps, and other options:
Who is Covered?
Medicaid individuals who meet CCC Plus participation criteria are required to participate. You are eligible for CCC Plus when you have full Medicaid benefits, and meet one of the following categories:
· You are age 65 and older
· You are an adult or child with a disability
· You reside in a nursing facility (NF)
· You receive services through the CCC Plus home and community based services waiver — formerly called the Elderly or Disabled with Consumer Direction (EDCD) Waivers and the Technology Assisted Waiver.
· You receive services through any of the three waivers serving people with developmental disabilities (Building Independence, Family & Individual Supports, and Community Living Waivers), also known as the DD Waivers.
Health Plan Choice
Your mom’s CCC Plus health plan will give her all of her Medicaid health care, long-term services and supports, and prescription drug benefits. She should have a care team that works with her and her providers for primary care, mental health, hospital, nursing facility, and specialty care.
In the initial letter that your mom received, she was presented with the ability to choose a different health plan or keep the assigned health plan. A health plan comparison chart should have been included in the mailing to help her decide. If she opts to choose a different health plan, she must do so within 90 days of her enrollment date (which is included in the letter) by calling the CCC Plus Help Line at 1-844-374-9159, or going online at www.cccplusva.com and requesting the change. She may also call the help line to find out if her doctor and other health care providers are in the network of her new health plan. If she wants to keep the Medicaid health plan that was chosen for her, she does not need to do anything. She will receive a health plan ID card. She should keep her Medicaid card, and show both cards when she gets care.
The Care Coordinator
As a CCC Plus member, your mom will be assigned a Care Coordinator through her health plan. The Care Coordinator is supposed to work with her and her providers to make sure she is receiving the services she needs. If she is enrolled in Medicare, her Care Coordinator can assist her with coordinating her Medicare and Medicaid benefits.
Your mom’s Care Coordinator can help her understand and access her plan benefits.
Another Alternative to the CCC Plus Program
As mentioned previously, enrollment of all CCC Plus eligible Medicaid members into the CCC Plus program is required. If you meet certain eligibility criteria, however, the Program of All-Inclusive Care for the Elderly (PACE) may be another option. This program helps people with their health care needs in the community instead of a nursing home or other facility.
The PACE program uses an adult day-care model to deliver the entire continuum of care and services to those with chronic care needs, while maintaining their independence at home for as long as possible. PACE was created as a way to provide family, caregivers, and professional health care providers the flexibility to meet health care needs and to help those who wish to continue living in their own homes.
If your mom or your dad are age 55 or older, they may qualify for PACE. For those in the Fairfax area, InovaCares for Seniors Fairfax is the sole PACE provider, and they can be reached at 703-239-5888, or by email at pace@inova.org. To learn more about PACE, go to: www.PACE4you.org. The website also has a “PACE Finder” to will help you find out if there is a PACE site in your area. If you qualify for and enroll in PACE, you will be “disenrolled” (dropped) from your CCC Plus health plan.
Planning for Long-Term Care for Your Father
You mentioned that your father is interested in applying for Medicaid soon, to help pay for the catastrophic costs of long-term care ($10,000 – $14,000 a month in the Metro DC area). As you know, Life Care Planning and Medicaid Asset Protection is the process of protecting your assets from having to be spent down in connection with entry into a nursing home, while also helping ensure that you or your loved one get the best possible care and maintain the highest possible quality of life, whether at home, in an assisted living facility, or in a nursing home. Your father should call us as soon as possible to make an appointment for his own planning:
Fairfax Elder Law: 703-691-1888
Fredericksburg Elder Law: 540-479-1435
Rockville Elder Law: 301- 519-8041
DC Elder Law: 202-587-2797
About Evan H Farr, CELA, CAP
