DSHS Eligibility and Intake Processing Update
A team from the Home and Community Services (HCS) division of the Department of Social and Health Services (DSHS) recently provided an update regarding current Medicaid eligibility and Nursing Facility Level of Care (NFLOC) processing delays, staffing challenges, and steps providers can take to help reduce processing backlogs.
Statewide Team Consolidation Underway
DSHS is currently undergoing a significant organizational transition by consolidating the Intake and Financial teams across all three service regions into a single statewide team. The change is intended to improve the distribution of workload, create greater consistency across the state, and streamline processes for both staff and stakeholders.
This transition is occurring simultaneously with the implementation of a new statewide phone system and the onboarding and training of approximately 15 new employees. As a result, all regions are currently experiencing processing backlogs.
Financial Services Staffing Challenges
Financial Services continues to experience significant staffing shortages due to turnover and vacancies. While DSHS is actively recruiting and training new staff, current caseloads remain well above desired levels.
Many financial workers are currently managing between 500 and 600 clients each—nearly double the intended caseload size. Staff are also receiving more voicemail messages each day than they can reasonably return while conducting required client interviews and processing eligibility work.
DSHS notes that these circumstances are intended to provide context for delayed responses rather than serve as excuses. Supervisors continue working to address concerns as they are identified.
In Region 2, staff are presently processing documents received on or around May 13, 2026. DSHS reports that employees are working overtime and leadership continues to closely monitor workloads while focusing on stabilizing processing timelines as staffing levels improve.
Escalating Delayed Cases
Providers with concerns about delayed financial eligibility determinations or NFLOC reviews that appear to exceed normal backlog timeframes are encouraged to contact Intake Program Manager Alec Brian directly regarding specific cases. [email protected]
DSHS emphasized that Nursing Facility Intake Request Forms (IRFs) continue to be processed in date order, consistent with Chapter 4 guidance.
Provider Assistance Needed: IRFs and Notice of Action Forms
One area where providers can significantly help reduce processing delays is by ensuring Intake Request Forms (IRFs) and Notice of Action (NOA) forms are submitted only when appropriate.
According to DSHS, these forms are intended to report changes for active Medicaid clients. However, many facilities continue to submit IRFs and NOAs for every resident rather than first verifying Medicaid status through ProviderOne (P1).
This practice creates substantial additional workload for both Intake and Financial staff. DSHS is requesting assistance from providers in reinforcing proper submission procedures and ensuring staff understand when these forms are required.
Missing Documentation and Faxing Issues
DSHS also addressed concerns regarding documents that cannot be located after submission.
When providers fax IRFs to the number listed on the form, missing documents are often related to barcode indexing issues. If a client is not yet active in the system and does not have a client identification number, submitted documents may not index correctly if a case has not yet been established.
DSHS requests that providers share specific examples whenever documents appear to be missing. Case-specific information helps staff determine whether documents were incorrectly indexed, misrouted, or require additional follow-up.
Additionally, Intake offices should no longer receive faxes directly. Examples of missing documentation can help identify whether providers are still using outdated fax processes.
New Provider Inquiry Email Available
To assist providers with urgent or extenuating circumstances, DSHS has established a dedicated provider inquiry email:
While this inbox is managed by a limited number of staff and cannot provide routine statewide case updates, it can be used for:
- Requesting award letters
- Identifying an assigned financial worker
- Escalating cases when providers have been unable to obtain a response
- Addressing other urgent provider concerns
DSHS anticipates this contact information will also be incorporated into the Skilled Nursing Facility Billing Guide in the coming months.
Continued Partnership Appreciated
DSHS encourages providers to continue sharing case-specific concerns when they arise. Detailed examples help identify process breakdowns and improve system performance. Contact Lauri St. Ours at WHCA if you are experiencing ongoing challenges where WHCA can help.
