Sustaining a No Wrong Door System

Medicaid Administrative Claiming

Medicaid Administrative Claiming is one avenue for sustaining and supporting a No Wrong Door system. Medicaid claiming, also known as Federal Financial Participation, allows federal funds to be used to reimburse agencies engaged in work that supports Medicaid programs.

No Wrong Door systems that help individuals understand and navigate complicated long-term services and supports (including many administrative functions) are eligible for Medicaid claiming.

Federal matching funds under Medicaid are available for costs incurred by the state for administrative activities that directly support efforts to identify and enroll individuals into Medicaid and that directly support the provision of services covered under the Medicaid state plan, when those activities are performed either directly by the state Medicaid agency or through contract or interagency agreement by another entity. The No Wrong Door system activities that may be funded under Medicaid include outreach, person-centered counseling, facilitating Medicaid eligibility, training, programing planning, and quality improvement.

The state Medicaid agency will advise the state’s No Wrong Door system lead agency on the essential infrastructure needed to claim Medicaid administrative funds. The infrastructure used is often modeled after programs that have Medicaid claiming in place. Below are some key questions for No Wrong Door systems to consider as Medicaid administrative funding is explored:

• Which programs participate in Medicaid administrative claiming currently in my state? How are those programs set up, as contracts or cost allocation plan amendments?
• What approximate percentage of time do No Wrong Door system personnel spend on Medicaid-related tasks? Which local No Wrong Door system entities would participate? How are they structured: nonprofit or government entity?
• Has the state downloaded the ACL project work plan and tools on this page (below) as a first step in planning the claiming process?

The Centers for Medicare & Medicaid Services, in conjunction with ACL, produced a No Wrong Door system guidance document.This guidance outlines the basics of how states can draw down Medicaid claiming for No Wrong Door systems.

Further Guidance

For further guidance, ACL has outlined the following steps across two phases of NWD System Medicaid Administrative Claiming development: 

Phase 1 Tools: Establish Costs and Document Medicaid Time 

• Tool 1: Project Work Plan— This work plan provides the high-level steps required for administrative claiming development, including timeframes and staff responsible for each task.
• Tool 2: Presentation for State Level Partner Agencies— This PowerPoint presentation specifically targets engagement of state level partners, such as the Medicaid agency, state unit on aging, fiscal and policy staff, or other partners in the No Wrong Door system. The presentation template provides a basic outline of information the No Wrong Door lead agency could cover.
• Tool 3: Presentation for Stakeholders— This PowerPoint presentation can be used to present an introduction for local agencies and partners that may participate in Medicaid Administrative Claiming.
• Tool 4: Cost Simulator— This tool provides a method for identifying sources of matching funds and simulates the potential FFP reimbursement.
• Tool 5: Code Development Guidance— This tool provides guidance for developing state-specific codes, including examples of approved time study codes, and guidance for developing and using a decision tree to inform accurate coding. 

Phase 2 Tools: Develop Agreements and Approvals

• Tool 6: Cost Pool Guidanceand Tool 6(a) Cost Pool Spreadsheet— These tools include a cost pool spreadsheet, which reports on the total costs associated with each time study participant and instructions on completing the spreadsheet.
• Tool 7: Sample MOU Language— This document can serve as a template for an agreement between an operating agency and the state Medicaid agency.