Moratorium lifted on state Medicaid waiver programs

Applications again accepted for home and community care

Posted: Sunday, August 30, 2009

The federal government has lifted a moratorium it slapped on several home- and community-care programs operated by the state two months ago.

The programs use federal Medicaid dollars to help several thousand vulnerable Alaskans with medical, aging and developmental problems.

"We're thrilled to open these programs again," said Rebecca Hilgendorf, director of the state Division of Senior and Disabilities Services.

The move to lift the moratorium comes even before the submission of a final plan to the federal Centers for Medicaid and Medicare Services (CMS) on how they'll correct problems the federal agency found with Alaska's management of the programs.

Commissioner Bill Hogan of the Department of Health and Social Services said that despite the imposition of the moratorium on new enrollees, the federal agency worked cooperatively with Alaska to help it solve the problems.

In two earlier actions, parts of the waiver had been lifted, allowing some people to get services earlier.

Chief among concerns expressed by CMS was a backlog of people seeking services provided by the programs. To be enrolled in one of the four programs still under the waiver, an initial assessment needs to be done and then periodically updated with a reassessment.

Currently there are 3,689 Alaskans receiving help under the four programs, which serve people with serious health problems who would otherwise need hospital, nursing home or other care.

A CMS review found the assessments and reassessments weren't being done in a timely manner, which led to the moratorium.

Alaska has added new staff to do the reviews and made significant progress in dealing with the backlog, Hogan said. There are now less than 400 applicants awaiting assessments and reassessments, compared to more than 1,000 at the time the moratorium was imposed.

The division had earlier announced a backlog of 1,800 assessments at the time the moratorium was imposed, but that was based on an incorrect definition, said Sarana Schell, spokeswoman for the division.

The state's Personal Care Assistant program had originally been included in the moratorium as well, but was excluded when CMS officials found that it was operated independently of the waiver programs.

In an Aug. 27 letter to the state, CMS's regional administrator wrote that the waiver was lifted based on Alaska's "ongoing progress in curing the deficiencies" and assurances of continued improvement.

Alaska's U.S. senators both joined the state officials in praising the lifting of the moratorium. Democrat Mark Begich and Republican Lisa Murkowski spoke with Health and Human Services Secretary Kathleen Sebelius about the impact of the moratorium on Alaskans.

Begich said CMS has confidence that Alaska will follow through on its pledges, allowing the moratorium to end early.

"While the State of Alaska and the federal agency continue to work together to address problems with the program, Alaskans will continue to be served," he said.

Murkowski said she'll continue to monitor the situation to ensure that no future moratoriums delay Alaskans' ability to get home care instead of facility care.

It is still not entirely clear how the crisis that led to the moratorium came about.

Hogan said the state itself knew that it has a problem, and brought it to CMS's attention.

"I don't know if it was naïve, or what it was, but we went to CMS for help," he said.

While they were disappointed that the agency responded with the moratorium, Hogan acknowledged that Alaska was out of compliance with federal rules.

That failure may have started with the rapid growth in recent years of the related Personal Care Assistance program, which grew from $8 million a year to $80 million, Hogan said.

"The Legislature was quite concerned about the rapid growth in PCA services," Hogan said.

To make sure that services only went to those who were qualified, the state stepped up its assessments, and they began taking more than four hours each to complete.

The state failed to find a contractor to handle the assessments, and when it began doing them in-house, it didn't have enough qualified staff.

"We just had a bear of a time recruiting people to do the assessments," he said.

They had money in the budget, but they couldn't find enough nurses to hire to do the assessments.

"In the HSS workforce, we really have a very difficult time recruiting all sorts of people, not the least of which are nurses," Hogan said.

While the PCA program was not one of the four programs that needed the Medicaid waiver to operate, assessment issues may have affected them as well.

"My thinking is that the problems in PCA began to bleed over into the waiver programs," he said.

The staff of 14 which had been doing assessments is now at 25, which is why there's progress on the backlog, he said.

• Contact reporter Pat Forgey at 523-2250 or

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