Unlocking the Secrets to Medicaid Certification for Assisted Living

Transcript

00:00:00
It is Brandon Gustafson with Assisted Living Investing. Excited to have you here with me on the channel today. Uh I help beginners like you launch their assisted living business in the next 12 months. And in today's video, we're going to be getting into the topic of understanding exactly how the Medicaid certification process works. Um this is something that is difficult. It's I talk about Medicaid often on this channel because uh it I believe is one of the best ways for you to become profitable

00:00:26
in assisted living while also serving a population that really needs that. And you can kind of blend the both the the best of both worlds. And I was actually just recently going through a medic Medicaid reertification process with one of our payers. And so I thought, hey, now's a good time to kind of share a little bit of that. It's fresh in my mind. I can uh get this out there. so you understand exactly what it's like to become Medicaid certified, what that process is going to look like, and how

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you're going to be able to navigate it. Um, and so that's what we're going to be talking about today. For those of you um that need a need some help, I've got a free resource for you as well. Make sure you go and grab that. It's at assisted living.net/bp checklist. It's our free under our our free business plan checklist that's going to help you uh get, you know, some of the the things that you need in order to to make some progress and and help you launch your uh assisted living business. Building your

00:01:22
foundation is one of the most important things that you can do uh along the way. And the business plan checklist is a great way for you to continue making progress and getting what you need uh to help you, you know, help you reach your goals and and and get to where you want to be in in launching that assisted living business. So, with that said, uh let's go ahead and uh dive into the topic for today. Let me shift a few screens around right here. Um so, again, we're talking about understanding the

00:01:53
Medicaid certification process. For those of you who don't know me, my name is Brandon Gustafson. I own and operate two assisted living facilities. I do it out of state. So, I live in Utah and I operate in uh Colorado and in Idaho. I've been doing this since 2020. I've secured over $1.5 million in SBA funding. My facilities are largely um Medicaid. I would say 85 90% of our residents are on Medicaid. So this is something that I do in my facilities and has allowed us to be um be profitable.

00:02:25
Um so that's that's the goal, right? Um I also um have a masters in healthcare administration. So I've worked in the healthcare industry for over a decade. Have a lot of experience there and have been coaching people for I don't know since 2021 I think in how to how to go through this process. I would love to help you. I help like I said at the beginning beginners like you launch their assisted living business in the next 12 months. So with that let's get into our topic. So first off I always

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want to level set what is Medicaid. So Medicaid is different from Medicare. It's confusing. I know they both sound the same. There's just a few uh a few letters off but they are different programs. Medicare is a federally funded federally administered program. It has three different parts. Part A which is inpatient stays. Part B, which is outpatient, and part D as in dog, which is for prescriptions. So, it is a completely separate thing. Generally, to be on Medicare, you only qualify for

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that via age. There's other ways, but by and large, most people qualify for Medicare because of age. They they age into it. Medicaid is fedally funded still, but it's administered at a state level. And the biggest way for a person to qualify for Medicaid is financially. they they show a financial need and that's how they met they they qualify for Medicaid. So that's the the biggest difference between the two. I do wish they were called something different and and had different names so it was less

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confusing. But inside of Medicaid, that's what you're going to be able to do with assisted living. Assisted living does not work with Medicare. You can have residents that are on Medicare, but you're never going to get a reimbursement check from Medicare. You will never bill Medicare. You can do that with Medicaid, though. The other thing, and we talked about this a few weeks ago, um is Medicaid is not always called Medicaid in your specific state. So, uh it could be a waiver program,

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could be, um California, for example, is medical. That's what they call their Medicaid program. It it just kind of depends on on what the state has decided to call it. I just call it Medicaid. It's the easiest way to do it. It's the one that I think most people are familiar with. But just know if you're researching it and you can't find Medicaid in your state, it doesn't mean it doesn't exist. It just means that it's probably called something different and and so you just want to be aware

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that when you're looking for it that you might have to look at it uh and under something that that's slightly different. So that's what Medicaid is. Now, let's talk about the enrollment process. So I want to also be clear here. There's there's two things with when it comes to Medicaid. there is getting enrolled as a Medicaid provider and there's becoming a certified Medicaid provider. These are two separate things, two separate processes are very very similar but they are two

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different um distinct things you have to do and this is also separate from becoming a licensed provider in your state. So an an extra complexity. This is where I really help people out inside of my coaching programs is help you navigate all of this because it can be really confusing to know which license you need to get, who you need to talk to, how you're going to get whichever specific license. Healthcare, it can be confusing. Um there's a lot of regulations involved. And that's something that I help people um help

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people out here on the channel, but also in my coaching programs to understand how to navigate those things and make sure that you are going down the right path so that you're not going to make any mistakes that can either cost you a lot of money or cost you a lot of time, which eventually means money, right? And so that's that's what we want to talk about uh as we get into this. So, when it comes to getting enrolled, the first thing you're going to do is need to find that provider enrollment application

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page, uh, where it's going to have the information. So, you want to search for something when you're looking for this to become a Medicaid provider. You want to search for something like your state and the program name. So, I have the example here, um, Idaho Health and Welfare Medicaid Provider Application. So, in Idaho, which is where I have one of my facilities, it's the Health and Welfare Medicaid. That's that's who administers Medicaid. It's a health and welfare program. Your state could be

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very different. It could be something that that has nothing to do with health and welfare. It could be health and human services. It could just be a welfare um type of a program. It could be um the Department of Health. It just depends on what it is in your state. Each state kind of structures this slightly differently. So, you want to know who's doing it, um what Medicaid is called. But once you have that, then you want to be looking for the provider application. That's what you want to

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look for. And if you don't specify provider, if you don't put in that word provider application, you're probably going to get information on how to enroll in the Medicaid program in your state as a participant, not as a provider. And that can be really confusing as well because uh what you have to remember here is your application process is different from from a person that is trying to get Medicaid as a benefit for them. They're going to go through a different application process than you are. So you

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need to specify I'm looking for the provider application when I go through this. Okay. You should get something like this this uh search screenshot that I've shown you here. Um, I have the Idaho Health and Welfare Provider Application. The first result that came up for me is provider enrollment for Idaho Department of Health and Welfare. And when I clicked on it, it took me to the page. And then it actually takes me over to another spot that actually um houses the the full application, but

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that page is a landing page that is designed to get me to the right spot to fill out my application. So you should find something very similar to that in your state as you're trying to become Medicaid certified first by enrolling and becoming a Medicaid participant provider participant so that you can then start serving a Medicaid population. Okay. Next is that application process. So this enrollment process to become um to become a Medicaid provider. uh you're you're going to potentially be directed to a

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thirdparty site, could be ha hosted uh inside of the inside of that health and welfare um site, whoever it is that administers Medicaid could be on their site. It could transition you over to a third party site. Just kind of pay attention to where you're going so you know where this is. Then you're going to need to find your provider type. And this can be different for each state as well. So this is another level of complexity. I was looking at this u with the Colorado process. So, in Colorado,

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you have we are what's called an alternative care facility. Um, that that's that's what our license type is. And so, when I'm looking for um Medicaid to be a Medicaid provider, I need to search for an alternative care facility. I might need to search for a residential care home or a residential assisted living facility or just assisted living or it could be long-term. So, you need to find what does your state call um assisted living? Not not the license type necessarily that that you're

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getting when you get your license, but what does it call it from a Medicaid standpoint, the benefit that it's going to to be administering for for that uh particular resident uh for the services that you're going to be providing and you need to find that and that's the application process that you want to go through. It is it can be the reason for that is they have all kinds of different providers. So they could have a mental health provider. They could have uh somebody that just like provides food or

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transportation or any number of things. They have uh several different provider types and they have different applications for each of those provider types. So you're going to have to go find who's who's doing this and you're going to have to go find um the your specific type of provider. You're going to get that application. And once you do that, it becomes a lot more simple. It's just you have to figure out all the hoops and the things that you go you need to go through to find the exact one

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that you're looking for. Once you find that application, it is usually now um now that we're in the 21st century, you're going to find all of these forms and applications online. It will be in a portal. It will be on a form online most of the time. You may come across things though where they want you to print a physical copy. They want you to fill it out and then they want you to have a wet signature. At the very least, you're probably going to have to do a wet signature of something

00:11:08
at some point. Sign it, scan it in, and send it off to them. A lot of complexity here. You can already tell, right? Um, so make sure that you save that application information. This is often the only way that you can follow up on an application. So, I I've told this story several times, but when we were applying to get our our Medicaid um certification, which is what I'm going to talk about here in just a second, in Colorado, took us about 4 months to become Medicaid certified. And the only way for me to follow up and

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see get a status update on my application on my certification application was to call in. There wasn't a portal where I could put in this number. was to call in and give them my application ID, which was like an alpha numeric um six to eight digit uh character uh application ID and give that to the person on the phone who would then go look it up in a computer and tell me the status of what it was. It was usually a very vague status like we're still looking at it kind of a thing. So, you're going to want to when you

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fill out that application, take a screenshot, write it down, make sure you keep that because chances are these systems are a little bit antiquated. They're not going to even send you an email that you've submitted the application. You have to take a lot of responsibility on this and it's it's frustrating um to be honest. So, you're going to fill out the application. You're going to submit it. Make sure you copy the information for your application so that you can then follow

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up with them. Um, now the horror story there with Colorado is it took us four months. I used what I learned from that process when we applied for this in Idaho. Took us about 2 to 3 weeks. Much much quicker. Just went through a reertification process for one of our um providers in Idaho. Took two days to process. So, it doesn't have to take long. It just can. And the more that you're able to give them all of the information upfront that they are asking for, the better off you're going to be.

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Uh, but you just need to kind of learn how to navigate this and make sure you give them all the information upfront, get it to them correctly, and then make sure you have a way to follow up with a person that's going to help you achieve your goals. Okay. So, let's talk about some of the paperwork you're going to need as you are trying to do this process, the enrollment, the certification, uh the paperwork that they're going to be asking for. There's the application itself, um, which we

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which we just talked about, but in addition to that, they're going to ask for a few other pieces of information. They're going to want to see your facility license. So, in order for you to become a Medicaid provider, you have to be a licensed facility. So, if you're thinking to become an unlicensed care home, that's great. I have videos on the channel that can kind of help you out through that process and understand what it is. I uh something that I personally am not comfortable with just because

00:14:05
generally with an unlicensed care home, you're looking at something that is smaller and you have really slim profit margins. I have a tool that can help you out with that. It's called the profit path tool. So, if you go to assisted livinginvesting.net/profit path, it's a tool that you can run a few different scenarios and see what's going to be best for you. Uh so, go and grab that tool and see. But what you'll find there is smaller care homes, especially ones that you are doing the renovations on

00:14:32
yourself, it's possible, you can be profitable, but it it shrinks your ability to be profitable significantly. So, I highly suggest you are licensed. Um, and if you go the unlicensed route, then still treat yourself as a licensed facility because you never know what regulations might change. I'll get off my soap box on that one. In order for you to become a Medicaid, a Medicaid provider, you will need a facility license. Okay? You will need a certificate of insurance or a COI uh is the acronym for it. Stands for

00:15:04
certificate of insurance. That means you need to provide your liability at property and probably your workers's comp insurance. Um these are very common. They're very easy to get. Most insurance companies have a portal online where you can just generate the COI right there for it. So very easy to get if you're working with an insurance broker. You just ask them, they turn it around for you very quickly within 24 hours. So very common thing to get, but if you're new to business, COI,

00:15:31
certificate of insurance can be very confusing. That's what it is. Next, you're going to need your bank information. This is what really held us up in our Colorado facility and in getting certified with Medicaid. They wanted they wanted checks. They wanted voided checks. They wanted a thing on letterhead from the bank. They wanted that to have a west signature. and they wanted all of those things and they didn't specify all of that to me. It was just a mess. Anyways, um what you want

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to do is figure out exactly what the what the Medicaid provider is going to need and make sure you provide exactly what they ask you to do and get clarification on it as well. Make sure you ask for clarification. Make sure you get everything that they need. They I I find it is best to have a letter on bank letter head that has a wet signature along with a uh a an account not not a statement but it basically is another piece of another document from your bank that's on their letterhead that says

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your account information routing number. Um your your bank account number has a picture of avoided check on it as well on their letter head and possibly even a signature on that one. If you get those things together, that will more than likely meet the needs of of the the person that is doing the credentiing process and your enrollment with Medicaid. And I want to specify everything that I'm doing here. I told you that this is your enrollment and your certification is different. You're talking to different groups. They're

00:17:03
probably going to need the exact same documents. So, this is where having a Google Drive, Google Drive folder or an One Drive folder or whatever um cloud service that you're going to use with all of these documents in one spot is going to help you out quite a bit. Then on top of all of that, there could be other state specific paperwork or requirements that they have and um you're just going to need to figure out what those are. It will be very clear in the application process what they need.

00:17:29
Um they're not going to, you know, assume that you know things. They will give you a checklist of things that you need to be submitting. Um, but you'll need those top three things for sure and then possibly other pieces of of paperwork as well as you go through it. They're also going to have you fill out in in the application process um information around um you know your contact information, your address, ownership percentage. Uh they want to get a lot of that information and that information

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that you're providing very similar to your facility license then becomes publicly available data. So, if you are doing this, you want to be careful with maybe putting out uh maybe a personal cell phone number. Maybe you just have a business one or your personal address. Maybe you get a business address. Um some of those types of things. And u so it's just something that I want you to be aware of. There are ways that you can protect your your personal information because once you put it out there, it

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can then become publicly publicly available or at least available um to um certain individuals and that can lead to angry emails, angry phone calls uh or spam. So, just want you to to be aware of that. Okay, that's the paperwork you're going to need. Next is the questions that they're going to ask you. Um, and I kind of alluded to this, but as you're going through that application process, they're going to ask you several questions. So, they're going to want to know ownership information, your

00:18:50
addresses, the population that you're going to serve. They'll ask you that. Um, you know, are you providing care to assisted living, are there specific age groups, are you offering other services like transportation or adult daycare or respbit care? They want to know that information. This is where building your business plan and go get the free business plan checklist um to help you build that. But this is where doing that work up front is going to help you answer those questions. Just make it a

00:19:15
little bit easier to answer all those questions and more importantly make it consistent throughout. Consistent in your brain, but also consistent amongst all of the different uh applications and things you're going to need to do so you can get your facility up and running. Um, and it's possible they'll need a provider identifier. Um, this could be an NPI though because you are not serving Medicare a Medicare population. You don't you don't do that. You don't necessarily need an NPI. Um, oftentimes

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when what I found is when you go through the application process and get your facility license, they'll give you uh a number. Um, they'll typically the the licensing body here, a credentiing body for Medicaid will probably want that number. They may provide you with a Medicaid number. Sometimes they call that Medicaid number an NPI. It can be really confusing. Um NPI, by the way, stands for national provider identifier. It's an 11digit number. Um and that is done at a national level. You can do it.

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It's free. It's a very simple application process. Um you can if you're interested in learning about NPIs, type in NPI down below. Something I can definitely do a video on. Uh but uh that that's something that I want you to be aware of. They may ask for some kind of provider identifier. So they may not, but it it's good to have that information. Or they may ask for it, but say that it's optional. Or they may ask for it, not say it's optional, but it really is optional. So if you have a

00:20:41
question, always ask out reach out and ask a question uh to the person that's that's helping you um you know, that's going to be processing that application. Just get more information from them. Another thing that I want you to be aware of when it comes to Medicaid is you may have multiple payers in your state. And I have spelled that correctly. I promise you. Um they are they're healthcare payers and it's O. Um some states are going to handle Medicaid internally. They will do

00:21:12
everything themselves. They have hired staff that do this. Um they process all the Medicaid claims. Sometimes they'll do it for the bulk of it and then they'll hire it out to thirdparty administrators to handle um some of the the other work. Some states, however, will just hire it out. completely to other states. So in Colorado for example, we have uh it is handled by the state but it's administered by Gainwell Technologies. Gainwell is the clearing house that the they're the company that

00:21:42
we work with when we bill. Um but they are hired directly by the state and they work um they're pretty integrated with the state and that's for Colorado. In Idaho, however, we have three different payers. We have Idaho Health and Welfare who does their own thing with it. Um that's that's one option. We have Molina Healthcare um which is another uh payer and and they're kind of regional. Uh I don't think they're nationwide but they're in a lot of states especially in

00:22:08
the western United States. Um so Molina Healthcare and there's also um Blue Cross of Idaho though that contract and this is adds more complexity was recently just sold off and Blue Cross of Idaho will not be doing it any longer and it will transition over to United Healthcare. So you have to kind of be aware of all of the things that are going on there. And when there are multiple payers, then I have to get certified with each of those payers. So I have to get enrolled for Medicaid, become a a Medicaid provider. Once I

00:22:39
have that in place, now I have to go and get certified with my different payers, which are separate application processes. So that's kind of goes back to what we were just talking about. Enrollment and certification are two different things. That's that's where they differ. Um, each of those payers are going to have their own different credentiing process, but they will ask for a lot of the same paperwork and ask for the same questions that you're going to answer when you do the enrollment process. So,

00:23:06
it just there's a lot of complexity here when it comes to Medicaid. So, like I fully acknowledge that this is why a lot of people don't do Medicaid. This is something I help you out with inside of my coaching programs though. If you're interested in Medicaid or just need help navigating this entire process, I I've done this professionally for a long time. I've worked for nonprofit uh healthcare organizations. I was uh I worked for a managed care organization which did Medicaid claims for mental

00:23:33
health um here in Salt Lake County um in in Utah. I have worked for um large nonprofit organizations that deal with government programs. I've worked for healthcare payers in the past with United Health and uh with Blue Cross and Blue Shield, I have a lot of experience professionally in in this area and so uh in addition to working with with Medicaid for my assisted living facilities, I understand how to do this. Uh for me, it's I I know how to navigate it, but it can be confusing. It's why a

00:24:03
lot of people don't uh want to get into Medicaid just because there's there's a lot of complexity to it, but I promise you it's not that bad. um you can you can definitely handle it and and learn how to get where you need to go. So, if you have questions that you need help with as you're going through this, then I would love to invite you to join our ALI basics community. So, in here, um this is where you can ask me these types of questions and get very timely answers as you're going through the process. Uh

00:24:30
we have monthly member Q&A calls. Um they're member only Q&A calls. you get priority answers on our Q&A sessions here in our lives uh for YouTube and Facebook. I have a bunch of resources in there, webinar recordings, Q&A recordings as well um that are very short like bite-sized uh Q&A type recordings so it's easy for you to find answers that you need help to and we're adding to those con consistently. Uh we have active community with weekly tips and tricks and peer-to-p peer networking

00:24:58
and you get your questions answered uh from me uh to help you out as you're going through this. No application process at all for this. Go check it out.littinginvesting.net/basics. Uh there's a special uh code on there for you so you can get your first month at a discount. Would love to have you in there. Love uh helping and coaching people like you as they're trying to launch their assisted living business and going through the process of something like this with Medicaid to help you navigate it and understand what

00:25:22
you're getting into. So again, go check that out. Assisted livinginvesting.net/basics. Would love to see you see you inside of the community. With that, let's hop over and answer some questions that you have. So, those of you that are here live, make sure you go in and type your questions. Um, we got a few of you in here right now, so that's great. Um, and while you're typing those questions, want to remind people to like the video, subscribe, and ring the bell as well, so you get notified every time we put out

00:25:48
content like this. We go live on Tuesdays and we put out content on Thursdays as well along with all of our social media stuff that's getting out there to make sure you're getting the answers that you need to your questions as you're trying to just navigate um things and and make some progress towards launching your assisted living business. Uh it's one of my favorite things to do is help people like you um as you're as you're moving along. So um with that I I've stalled as about as

00:26:15
long as I can and I'm not getting questions here. Um, so I'm going to shift over uh and make sure I don't have anything inside of our uh ALI basics community um to make sure that I didn't miss any questions that that are relevant to kind of the larger group here. I did I had one um it wasn't they didn't put it in the community. It was an email and I am not going to be able to find it um super fast. Um and I cannot remember exactly what it was. Uh, I'm blanking on it. That's all

00:26:49
right. We're not going to do dead air on here. So, with that, um, we're not getting people typing in questions, so we're just going to close it out. I want to thank everybody for watching. Thanks for being here. Make sure you go and grab that free business plan checklist at assisted livinginvesting.net/vp checklist. Hope you like this video and found it was helpful. this pretty technical um and and probably very specific to some of you that need this, but for those of you that need it, this is going to be a

00:27:14
lifesaver for you. So, make sure you like the video uh like you know, comment down below. This was a greatest thing ever. Uh would love to hear that. And um yeah, thanks for watching. Grab the free business plan checklist, assisted living investing.net/bp checklist. And you know, does residential assisted living sound interesting to you, but you don't know how to get started at assisted living investing. I'm here to help beginners like you launch their assisted living business in the next 12 months. I

00:27:37
love helping and coaching people. It's one of my favorite things to do. So, go check out the ALI basics community, assisted livinginvesting.net/basics. And remember, it doesn't take a lot, just a little bit. Just keep going step by step by step. And I promise you, if you do and you're consistent and persistent, you're going to be successful. Thanks for watching and have a great day.