DHS to conduct review of assisted-living eligibility decisions

The state Department of Human Services will conduct a review of assessments that affected some users’ eligibility for assisted-living programs, officials said Monday.

The three-month review by the department’s nurses and staff will look at Living Choices and ARChoices clients whose eligibility for services changed as a result of their annual reassessment.

The programs, which are funded by Medicaid, offer services that help people with disabilities and seniors live at home rather than in a nursing facility.

The review is meant to “help identify any issues that may need to be addressed with additional training” for the department and Minnesota-based health care group Optum Government Solutions, which has been contracted to conduct the assessments since 2017.

A new evaluation tool also has been used since the beginning of this year.

“With any new program or big change, [the Department of Human Services] monitors outcomes to ensure it is operating as we expected. … We’ve addressed some issues along the way,” department spokesman Amy Webb wrote in an email.

“But as we’ve continued our monitoring, we’ve continued to see the number of eligibility denials for existing clients increase. We did not expect that increase, so we want to take a more intensive look to ensure that the outcomes are accurate.”

Services offered through the programs include help with tasks such as eating, bathing and using the toilet.

Through May 30 of this year, 453 of 1,692 current ARChoices clients were deemed ineligible for program services because assessors determined they needed either a higher or lower tier of assistance.

Of 1,355 new applicants, 498 were assessed as ineligible, Webb said.

In the Living Choices program, 78 of 165 current clients and 68 of 166 new applicants were flagged as ineligible between January and May.

From both programs, a combined 198 people have recently appealed those decisions.

Last year, department officials said they didn’t anticipate most users’ eligibility would be affected by the new assessment instrument.