What to say, and what to send
Short, plain-language wording for the conversations that keep patients covered. Adapt the words to your own voice and your state's rules.
Talking with patients
Opening the conversation
"Medicaid has a new rule for some adults about work or other activities. Because of your cancer treatment, you may not have to meet it, but Medicaid needs the right paperwork from us. Can I ask you a few quick questions so we can make sure your coverage stays in place during treatment?"
When a patient is worried
"You are not in trouble. Let's check where your coverage stands and what Medicaid needs. Many people with cancer can be excused from this rule. Our job is to help you show that. The most important thing you can do is bring us every letter you get from Medicaid."
Explaining "medically frail"
"'Medically frail' is the term Medicaid uses for people whose health makes it hard to work. It does not mean you are weak. It is the category that can excuse you from the work rule while you are in treatment."
Teach-back
"Just so I know I explained it well, can you tell me what you will do if you get a letter from Medicaid?" Listen for: open it, bring it in or call us, and the 30-day deadline.
When a patient brings a notice
"Thank you for bringing this in. These letters have a deadline, so I'm going to connect you with [social worker / navigator] today. Can I make a copy for your chart?"
Messages within the care team
Asking the oncologist for a frailty letter
"[Patient], DOB [date], has Medicaid and is subject to the new work requirement. Please complete a medical frailty letter documenting diagnosis, treatment, expected duration and how treatment limits work. Template: cancerpolicylab.org/coverage-watch/toolkit/letter. Needed by [date] (renewal or notice deadline). I will send it to the state and confirm receipt."
Flagging a coverage problem before a visit
"Eligibility check shows Medicaid for [patient] is [pending / ending on date] before [infusion / surgery] on [date]. Please do not cancel the visit; social work is working the case. Reason on file: [reason]."
A chart note for the clinician
"Medicaid community engagement: patient has [diagnosis, stage] and is receiving [treatment, frequency], expected through [date]. Treatment causes [limits]. In my judgment these significantly impair the patient's ability to work or do other qualifying activity for 80 hours per month through at least [date]. Frailty letter sent [date]."
Calling the Medicaid agency
Call with the patient, or with their written permission. Write down the date, the name of the person you spoke to, and any reference number.
- Is [patient] subject to the community engagement requirement, and which months are being checked?
- What does your record show: an exclusion, compliance, or nothing yet?
- Is [patient] already recognized as medically frail? Until when?
- What documents do you need, and how can we send them: portal, fax, mail or in person?
- Do you accept a clinician letter, or must we use a state form?
- Does the state accept self-attestation of medical frailty?
- Does the state offer the short-term hardship exception for hospital stays or travel for treatment? How do we request it?
- Can you confirm you received what we sent on [date]?