Updates on Changes to Disability Determination and Elimination of Medicaid Spend-down, now known as Disability Determination Redesign (DDR)

Earlier this year, a CCS blog post, and subsequent Common Ground, provided an overview of the State of Ohio’s plan to transition to a unified disability determination system thus ending the Medicaid spend-down program. Advocates have worked closely together, and with the Ohio Department of Medicaid (ODM), to learn about this change and how current spend-down enrollees will be impacted. ODM has named this transition the Disability Determination Redesign or DDR. The changes are on track to begin July 1, 2016. While no one will be grandfathered into the spend-down program, ODM is discussing with the federal government ways to avoid a “hard stop” or abruptly cutting people off of the program on July 1. ODM is considering aligning the transition with the enrollee’s normal redetermination date as an alternative. This is subject to federal approval, so nothing is certain yet.

ODM is developing educational letters to distribute in the spring of 2016 to people who will be impacted by the changes. The letters will contain information that is specific to the changes that each group of enrollees can expect, for example, people who are eligible to establish a qualified income trust, or Miller Trust, will receive a different letter than people who will transition to the health insurance marketplace. Advocates are working with ODM to ensure that there are resources included on the letters for people who will be expected to transition to the insurance marketplace, such as contact information for insurance navigators. ODM is also developing a list of frequently asked questions (FAQ) and educational videos. Specific information is also being prepared to share with county jobs and family services (JFS) agencies, who will undoubtedly receive requests for information from people impacted by DDR.

In recognition that some of the people who are currently enrolled in spend-down have severe mental illness, ODM is starting a special waiver program (1915i). The criteria for this waiver program has been expanded, which will allow more individuals who suffer from mental illness than previously thought to qualify for the program.

While we know preliminary information about the number of people who will be affected by DDR, recent changes to the 1915i waiver program criteria mean that the number of people in the various categories has changed. ODM shared that this information will be updated soon.

There is a new online resource for Disability Determination Redesign: http://medicaid.ohio.gov/INITIATIVES/DisabilityDeterminationRedesign.aspx.