Until January of this year, DHS staff used to determine whether people were eligible. The criteria include their medical condition, for example, whether or not they have a disability or dementia. Also, their financial income is a factor.
One of the most important criteria is their “functionality,” which means how well they can get around, clean themselves, prepare meals and go to the bathroom by themselves.
People who are elderly and frail qualify, as do people 21 and over who have a physical disability.
In January, DHS began using a new assessment tool to determine eligibility. The assessments are also used to set levels of care. Under federal regulations, eligibility for home care and assisted living is determined by an independent agency, not by the beneficiary’s physician or health care provider.
DHS has a contract with a private company called Optum Healthcare Solutions, Inc. to conduct the assessments.
Since January, DHS officials and legislators have been receiving complaints from people who have been denied services from Living Choices and ARChoices. Of the people who have been assessed this year, 44 percent of those in assisted living were denied and 31 percent who received some type of help from ARChoices have been denied.
DHS is working with Optum, and is reviewing 551 denials in the ARChoices program and 225 denials in the Living Choices program. A deputy director from DHS told lawmakers that the reviews should be complete by the end of July.
People who have been denied already and have filed an appeal have the option of continuing with their appeal or choosing a new assessment.
According to testimony at the legislative committee, people who have been in assisted living facilities for several years have been denied renewal. That is frightening to the ones who no longer have a home or resources to find a place to live. That’s why DHS is making it a priority to review their cases.
At a joint meeting of Senate and House Committees, several legislators expressed their frustration with the denials and with Optum, in strong terms. One frustration is that it takes too long to get an assessment, because of a lack of personnel.
According to the DHS official, Optum has replaced some of its staff since the complaints have become more numerous.
Other lawmakers reminded their colleagues on the committee that it was the legislature that directed DHS to find cost savings in Medicaid and health programs.
One legislator said that it would be good if the state “grandfathered in” everyone who already is in assisted living, but a DHS official said that federal law requires regular reassessments to determine eligibility.
When the state’s contract with Optum is due to be renewed, it’s expected that the controversy over assessments will come up again.
Living Choices serves about 1,000 people in 59 assisted living facilities across Arkansas, and ARChoices about 8,800 people.