Centers for Medicare & Medicaid Services (CMS) Bulletin Summarizes Criteria for Medicaid Funding of Long-Term Care Ombudsman (LTCO) Programs

CMS summarizes the basic requirements for Medicaid administrative
claiming for the state LTCO program. The ombudsman program is partially funded
through the Older Americans Act (OAA), however the bulletin draws attention to
activities that may qualify for Medicaid administrative funding. In the
bulletin, CMS notes that some states are expanding the populations served by
the LTCO program to include individuals receiving LTSS in their own homes and
the community.

The LTCO program activities that may be eligible for Medicaid
administrative funding include:

·        
Tracking and reporting
consumer requests for assistance in obtaining medical, dental, mental health or
long-term care (including home and community-based services) to the Medicaid
agency;

·        
Consultation and direct
advocacy to assist individuals participating in HCBS waiver programs;

·        
Identifying
Medicaid-eligible residents who want to transition out of nursing home
facilities and connecting them with appropriate local contact agencies or other
services to assist them in returning to the community; and

·        
Other LTCO activities
which are determined by the Department of Health and Human Services (HHS)
Secretary to be necessary for proper and efficient administration for the Medicaid
state plan.

Medicaid administrative funding is not available for the following
activities: assisting individuals with gaining access to or coordinating
non-Medicaid benefits such as social, educational, vocational, legal advocacy,
or other non-Medicaid services.

Read the bulletin.