LAWMAKER CONCERNED WITH PATIENT DUMPING, POSSIBLE MEDICAID VIOLATIONS AT A COMMUNITY MEDICAID FOSTER HOME

Rep. Mizuno says move may put $2.6 billion in Federal Medicaid funding in jeopardy

  Honolulu, Hawaiʻi – Representative John M. Mizuno, Chair of the House Health Committee, is concerned that a Community Care Family Foster Home (CCFFH), hence a Medicaid care home, may force a current private pay patient to leave its three-patient facility because that patient is transitioning from private pay status to Medicaid pay status.

“I was contacted by a person concerned that his father, who is a private pay client in a Medicaid community care home, would be kicked out of his current care home because he will become a Medicaid status patient," Rep. Mizuno said.

Mizuno said the fee that homes can charge Medicaid patients each month is less than they charge a private patient. But Hawaiʻi Revised Statutes Sec. 321-481 provides in part, “The department, in its discretion, may certify a [community Medicaid] home for a third adult who is at the nursing facility level of care and is a Medicaid recipient.”

"What this means is that Medicaid care homes are allowed no more than two patients, however, if in the discretion of the health department such a Medicaid care home is allowed a third patient, such a patient MUST be a Medicaid patient," Mizuno said.

The intent of the law is for these Medicaid homes to ensure beds for the Medicaid patient population, he said.

"If a Medicaid care home 'dumps' a private pay patient because he/she will become a Medicaid patient, this action circumvents the entire foundation of legally certifying Medicaid care homes in our state. This may be a violation of the law,” Mizuno said.

Mizuno is also concerned that this type of dumping may put more than $2.6 billion in annual Federal Medicaid funding in jeopardy.

“I plan on submitting a letter to our State Attorney General’s office, the Department of Health, and the Department of Human Services to secure clarification and review of this incident," he said. "If a Medicaid care home dumps a patient simply because said patient is changing his or her status from private, it may be in conflict with federal requirements that are a prescribed condition for the allocation of federal Medicaid funds to the State."