Disaster Relief

Healthcare Services for Katrina Evacuees

As thousands of Gulf Coast residents sought refuge from the devastation
of Hurricane Katrina, the Texas medical community quickly mobilized to
care for the storm's victims. On September 15, 2005, the Centers for
Medicare and Medicaid Services (CMS) approved a waiver to ensure that
Katrina evacuees in Texas continue to have access to medical services.
The waiver covers care provided to Medicaid-eligible and non-Medicaid
eligible people displaced by the disaster.

The waiver establishes a separate eligibility category for evacuees from
counties and parishes that have been declared national disaster areas
due to Hurricane Katrina, and the costs of services provided through the
waiver will be paid solely from federal funds. The coverage period may
be retroactive to August 24, 2005, to cover any medical expenses
evacuees already have incurred.  Providers will receive specific
instructions for filing claims under this waiver as soon as possible.

Up to five months of Medicaid coverage will be provided for eligible
storm evacuees who are:

* Children up to age 19 if the family's income is at or below 200
percent of the Federal Poverty Level (FPL).[FN1]
* Parents of these children if the family's income is at or below
100 percent of the FPL.
* Pregnant women up to 185 percent of the FPL.
* Individuals with disabilities and low-income individuals in need
of long-term care up to 300 percent of the Supplementary Security Income
(SSI) level.

Up to five months of coverage will be provided for eligible storm
evacuees not otherwise eligible for Medicaid for:

* Individuals (including childless adults) who have no other
insurance, Medicaid, or CHIP coverage up to an income limit to be
identified by Texas.
* Medically necessary services not reimbursable through Medicaid.

Evacuees can apply for this coverage using a simplified application by
calling 2-1-1. Normal documentation and residency requirements
for Medicaid eligibility have been waived. To qualify for coverage, the
evacuee must attest to displacement, resources, income, county of
origin, and immigration status.

Evacuees can apply through January 31, 2006, for up to five months of
coverage. The waiver program will continue through June 30, 2006.

Evacuees will have access to the same benefits provided by the Texas
fee-for-service[FN2] Medicaid program. Benefits include health care,
long-term care, prescription medicines, and medical transportation. To
ensure continuity of healthcare services, additional services for
eligible evacuees, when medically necessary, may include:

* Hearing aids.
* Eyeglasses and contact lenses.
* Outpatient substance abuse treatment for adults 21 years and
older.
* Psychiatric inpatient care in a freestanding psychiatric
facility for individuals ages 21 through 64.

Eligible evacuees also may receive services provided by podiatrists,
chiropractors, licensed clinical social workers, licensed marriage and
family therapists, licensed psychologists, and licensed professional
counselors.

Texas will waive the requirement for functional assessment scores for
evacuees who need community care services, such as Community Attendant Services, Primary Home Care, and Day Activity and Health Services. Texas will accept a physician's statement to determine eligibility for these programs. A physician's statement also will be accepted as proof of disability.

Providers will be able to file claims retroactively for services
provided since August 24, 2005.  To receive payment for services, most
providers will need to file claims through the Texas Medicaid system.
Providers will receive specific instructions for filing claims under the
waiver as soon as possible.

If an evacuee seeks services before enrolling in the waiver program,
providers should collect the following information:

* Name and Social Security number.
* Citizen status.
* County or parish where evacuee had resided (see attachment for
counties/parishes covered).
* Monthly income.
* Whether the evacuee has insurance.
* Demographics including age, gender and race.
* Household composition including the names of others in the
client's household, their ages, and relationships to client.
* Whether the evacuee is pregnant.
* Whether the evacuee is disabled.
* Signature of client.

HHSC will be providing more information about claims submissions in the
coming days, and the Commission will work with relief agencies to make
sure evacuees are aware of this program. 

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[1] 100% of the FPL is $1,613 in monthly income for a family of four;
$19,350 annual income for a family of four.

[2] In the Dallas area, mental health and substance abuse services will
be provided through the NorthSTAR system.

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