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Updates for local agencies, community-based organizations, and providers who provide assistance to members of Wisconsin's health and nutrition public assistance programs.
Patient Liability and Cost Share Eligibility Changes to Medicaid Starting July 1, 2020
Patient liability or cost share is the monthly amount members pay to their nursing home, care facility, managed care organization (MCO), or fiscal employer agent (FEA) for their long-term care.
If a member’s cost share or patient liability payment was higher than it should have been, the nursing home, care facility, MCO, or FEA must reimburse that member for the excess payment.
Starting July 1, 2020, these reimbursements from MCOs, nursing homes, or FEAs do not count as an asset in the month the reimbursement was received and for the following nine months.
Prior to July 1, such reimbursements could have caused members to exceed the Medicaid asset limit, causing them to lose their Medicaid benefits. This change helps ensure members keep getting their Medicaid benefits and have time to spend the reimbursed amount.
After nine months, any remaining reimbursement amount a member has not spent will count as an asset for Medicaid eligibility.
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