Long Term Care Staffing Support Services

The vendor is required to provide long-term care (LTC) services and supports provided by a nursing facility or through home and community-based services, making recommendations to the department regarding Medicaid LTC applicants’ financial eligibility, supporting Medicaid-enrolled providers and applicants in applying for LTC Medicaid coverage, and other related tasks determined by the department.
- Medicaid long-term care (LTC) services and reducing the number of incomplete Medicaid LTC applications by:
•    Conducting case reviews and making Medicaid LTC financial eligibility recommendations to the department.
•    conducting case reviews and making recommendations for Medicaid LTC financial eligibility redeterminations. 
•    providing sufficient staffing to support applicants, families, representatives, and providers in gathering required verification documents and other information, and submitting complete Medicaid LTC financial applications for Medicaid LTC coverage. 
•    assessing the department’s current Medicaid LTC financial eligibility process and developing a Medicaid LTC financial eligibility application process improvement and efficiency report and plan that includes systemic and strategic recommendations for process improvement.
- Medicaid LTC financial eligibility recommendations mean all that financial eligibility criteria for Medicaid LTC is met, including categorical eligibility for Medicaid, income thresholds, asset and resource tests, and review of any asset transferred for less than fair market value within a period of time up to five (5) years preceding the application date.
- Medicaid LTC financial eligibility case reviews and recommendations
•    Adding application information to the department’s eligibility system, new heights.
•    Scheduling interviews with applicants. 
•    Continue to develop the case in new heights by asking the applicant and representative applicable questions to complete the application, including but not limited to: demographics, income, resources, expenses, etc. 
•    During the interview the selected vendor must review the process, timeframes, and provide the verification checklist of required documents and submission deadline.
•    Conducting quality control reviews of Medicaid LTC case reviews to ensure consistency and accuracy of processing and recommendations and compliance with applicable state and federal requirements, that leads to final recommendations of eligibility. 
•    Quality control activities must include secondary supervisory reviews of recommendations prior to submission to the department. 
•    A daily log of in progress applications and final recommendations to the department, ensuring recommendations are submitted to the department within thirty (30) calendar days after receipt of the request from the department. 
•    Providing case maintenance and management until the department is able to make a final determination.
•    Ensuring compliance with state-specific rules and policies, including asset transfers and spend-downs. 
•    Assisting the department with appeals and fair hearings, including preparing testimony, and completing relevant forms at the request of the department.
- Medicaid LTC financial eligibility redeterminations
•    Conducting quality control reviews of Medicaid LTC case reviews to ensure consistency and accuracy of processing and recommendations and compliance with applicable state and federal requirements, that leads to final recommendations of eligibility. 
•    Quality control activities must include secondary supervisory reviews of recommendations prior to submission to the department.
•    Providing case maintenance and management until the department makes a final determination. 
•    Ensuring compliance with state-specific rules and policies, including asset transfers and spend-downs.
•    Assisting the department with appeals and fair hearings, including preparing testimony, and completing relevant forms at the request of the department.
- Medicaid LTC application assistance
•    Providing qualified staff to assist applicants, including at community provider locations as directed by the department, with the Medicaid LTC application process, including data entry, form completion, collateral contacts, and explanation of third-party liabilities and other relevant terms. 
•    Collecting, organizing, reviewing and managing documentation electronically, required for Medicaid applications, including financial records (e.g., bank accounts, income sources, assets such as, but not limited to real estate, vehicles, life insurance, and investments). 
•    Providing consultation and technical assistance on the Medicaid LTC application process to community providers, as identified by the department. 
•    Documenting and notifying the department of unsuccessful attempts to gather all required documentation needed for a complete application.
•    Maintaining case records in the state’s eligibility and enrollment IT system, new heights, and provide support for scheduling and rescheduling appointments.

- Questions/Inquires Deadline: October 08, 2025