Page 134
133
Attachment K: Protocol for Assessment of Beneficiary Eligibility and Needs, and Provider Qualifications
Services Protocol
List of Medicaid Covered Health-Related Social Needs (HRSN) Services Medicaid covered HRSN services and housing-related supportive services include:
1. Short Term Pre-Procedure Housing 2. Short Term Post Transition Housing HRSN service description, frequency, duration, setting and provider requirements, and minimum eligibility criteria are described in Exhibit 1.
Eligible provider types and requirements for each service are indicated in Exhibit 2.
Services under the TEAMKY Recuperative Care Pilot benefit will be provided to individuals who reside and receive services in their home or in the community, not in an institution.
Establish Eligibility and Medical Necessity for TEAMKY Recuperative Care Pilot HRSN Services Eligibility: All Kentucky beneficiaries eligible through mandatory, optional, or expansion eligibility groups, receiving full Medicaid coverage, ages 18 or older, with income up to 213 percent of the federal poverty level (FPL), who meet the clinical and social risk factors described below, will be eligible for HRSN services. Individuals eligible for the TEAMKY 1115 Recuperative Care Pilot must be experiencing homelessness or at risk of homelessness, as defined under federal regulation 24 CFR 91.5 except for the annual income requirement in 24 CFR 91.5 (1)(i). These definitions encompass a broad range of housing instability scenarios, such as individuals without access to a fixed, regular, and adequate over-night residence, or those at imminent risk of losing their primary housing due to financial hardship or other life circumstances. Eligible individuals must also face a heightened risk of hospitalization or readmission and have specific aftercare needs. This includes those recently discharged from an acute care facility or emergency department, as well as individuals requiring pre- or post-procedure care for planned medical interventions such as surgeries, chemotherapy, or other intensive treatments. The model provides critical support for stabilizing their medical condition during this vulnerable period.