There is a small group of participants authorized to receive services under the Non-Medicaid Eligible (NME) program. The NME program is funded through General Revenue (GR) and is currently available only to participants who were receiving services prior to June 30, 2005. This program will sunset through attrition, at such time the last participant becomes deceased. The program was designed to assist those participants who have heavy health care needs but did not qualify within the guidelines to receive Medicaid.
Financial eligibility for NME services is determined by Central Office and is income based. Regional offices are responsible for completing an annual reassessment by utilizing the NME Home and Community Based Services Referral/Assessment (DA-2) form. Those receiving NME funding are eligible for services for life and may be added or removed from the program throughout their lifetime. No new authorizations may be made to the NME program. NME participants can only be authorized in the CDS database and are not to be entered into the Web Tool.
The following requirements (verified by Central Office staff) must be met to remain on the NME program:
The participant and the participant’s spouse must have an adjusted gross income, minus disability-related medical expenses, equal to or less than three hundred percent (300%) of the federal poverty level. Adjusted gross income is based on the previous year federal income tax return.
The participant and participant’s spouse shall not have assets in excess of $250,000.
The participant has been found by the Department of Social Services not to be eligible to participate under guidelines established by the Medicaid State Plan.
The participant must not have access to affordable health care coverage that included personal care assistance services as a benefit.
The participant must meet the criteria of the Medicaid funded Consumer-Directed Services program (excluding Medicaid eligibility), which included but is not limited to:
Central Office maintains a list of all participants eligible to receive NME services. All monitoring and enrollment changes of any participant receiving NME funding is the responsibility of Central Office. Central Office is responsible for adverse action notifications when NME participants are no longer eligible due to exceeding asset limits, and when spenddown is not met. If care plan adjustments are necessary Central Office will be responsible for relaying that information to the appropriate regional office. When a spenddown case is adjusted Central Office will be responsible for sending a copy of the Vendor Authorization and the notification letter to the provider and the NME participant. Central Office will be required to maintain all documentation regarding case adjustment and correspondence mailed.
Any questions regarding the NME program may be directed by email to Bureau of Program Integrity (BPI) at email@example.com or contact the Bureau of Senior Programs at 573-526-4542. The program requirements are also outlined in 19 CSR 15-8.300.