“WE are trying our best, doing what we can,” said CNMI Medicaid Agency Acting Director Vicenta Borja on Monday regarding the medical referral program and the Presumptive Eligibility for Medicaid period.
“It’s a lot, but we are forever grateful for [Commonwealth Healthcare Corporation Chief Executive Officer Esther L. Muna’s] assistance, working with us to address our Medicaid patients, especially those who are being referred,” she added.
Borja said their agency has a plan in place to address the influx of Medicaid applicants due to the Presumptive Eligibility or PE for Medicaid.
Presumptive Medicaid is an expedited process of enrolling eligible residents into the CNMI Medicaid Program.
It allows patients to have their care covered while waiting for their application to be fully processed.
However, it is only temporary coverage provided by Medicaid for those who are uninsured.
It ends when the public health emergency ends, or if a full Medicaid application is submitted prior to the end of the Presumptive Eligibility period and an eligibility determination is made on that application, whichever is earlier.
Applicants are able to apply for regular Medicaid prior to the expiration of their Presumptive Eligibility for Medicaid.
“We have been in constant communication with [Centers for Medicare and Medicaid Services] Region IX. [They] have been scheduling monthly calls to give us updates, walking us through and advising us on how to handle it. There are a lot of options. We have not figured out the exact plan yet, but we do have a plan A, B, and C in preparation for the influx,” Borja said.
She said these involve hiring temporary staff. “That’s something that we have yet to discuss and work with the governor’s office. Nothing is solid yet,” she added.
The agency has three eligibility workers on Saipan, one on Rota, and one on Tinian.
It likewise has an eligibility supervisor who oversees the eligibility department.
CHCC CEO Muna lauded the agency for managing this increase in enrollment.
“You have to understand that they have been managing an increase in enrollment because of the Presumptive Eligibility, and they’re really doing an excellent job. It’s a lot of work for them…because they would have to make a determination, but otherwise, they’re doing what they can do, and they’re doing a good job,” Muna added.
She said the PE period is likely to be extended until January 2023, adding that it is based on the renewal of the Covid-19 public health emergency declaration.
The program was due to expire in October. However, because a mandatory two months’ notice from the federal government has not been issued and the pandemic is still ongoing, it has likely been extended for another quarter, or another three months.
