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 Program Overview 1. 2 Assembly Bills 1494 and 1468 provide for the transition of children from Healthy Families Program (HFP) to the California Medi-Cal.

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Presentation on theme: " Program Overview 1. 2 Assembly Bills 1494 and 1468 provide for the transition of children from Healthy Families Program (HFP) to the California Medi-Cal."— Presentation transcript:

1  Program Overview 1

2 2 Assembly Bills 1494 and 1468 provide for the transition of children from Healthy Families Program (HFP) to the California Medi-Cal program. Medi-Cal will cover these children under a new optional coverage group known as the Targeted Low-Income Children’s Program (TLICP). This presentation will cover the following: Targeted Low Income Children’s ProgramSPE ProcessAccess for Infants and MothersAid Codes and PremiumsCECData Reporting and Performance Standards

3 No sooner than January 1, 2013, the Department of Health Care Services (DHCS) will implement the TLICP, which covers children who would have previously been enrolled in Healthy Families. Once the TLICP is implemented, the Managed Risk Medical Insurance Board (MRMIB) will no longer enroll children into the HFP. 3

4  Increases Federal Poverty Level (FPL) limits under Medi-Cal for children ages zero to 19 years of age  Generally follows other existing FPL Program eligibility rules  Implements a premium requirement for children with income over 150% FPL ($13 per child to a maximum of $39 per family) 4 * Up to the month of the 1 st, 6 th, or 19 th birthday

5 SPE will continue to do the following:  Receive applications (paper and online via Health-e-App)  Conduct file clearance for these applications  Review the applications it receives for completeness  Screen for accelerated enrollment (8E)  Forward applications to counties 5

6 The AIM program provides coverage for pregnant mothers with income above 200% up to 300% FPL.  Counties will play a role for the first time with AIM-linked infants  AIM-linked infants (up to 2 years of age) are affected as follows: o Family income up to 250% FPL will now be eligible to TLICP o Family income above 250% up to 300% FPL will be referred back to HFP using existing Bridging processes o Identified on MEDS with prior aid code of “0C” Note: Counties will need to develop a process to identify AIM-linked infants that need to be referred back to Healthy Families if their income is, or increases above, 250% FPL. 6

7 NEW PREMIUM NEW PREMIUM 7

8 Children with family income above 150% up to 250% will have monthly premiums  County determines eligibility for TLICP with premium o H3 and H5 aid codes convey need for premium  The Medi-Cal Premium Payment Section: o Handles premium notification and collection o Informs county of non-payment of premiums  Premiums are $13 per child, with a family maximum of $39 o It is a flat amount per child, not a sliding scale 8

9 All eligibility and case maintenance for children with income up to 250% (H1-H5) County Premium collection and notification for children with income above 150%- up to 250% (H3 & H5) Premium Payment Section 9

10  Children in H1-H5 are eligible to CEC  Follow existing Medi-Cal CEC rules  When County is notified of non-payment of premium: o County must follow SB 87 rules to evaluate child for eligibility to other Medi-Cal programs and o Either place child into another program (if eligible) or discontinue with timely notice due to non-payment (if no other eligibility found)  CEC will not cover non-payment of premiums o This means that if a child in H3 or H5 becomes ineligible for another reason that is CEC eligible, they can receive coverage through CEC; o However, if they do not pay premiums, they will be discontinued 10

11  Retroactive TLICP is available following the existing retroactive Medi-Cal rules  However, retroactive eligibility to the TLICP is not available for any months prior to TLICP implementation o Counties must evaluate for other Medi-Cal programs that were in existence in the requested month(s) Example: Family applies in February 2013 and requests 3-month retroactive Medi-Cal. TLICP can only be granted for January Eligibility for November and December 2012 must be evaluated for other Medi-Cal programs – not for TLICP. 11

12 12

13  All 58 counties must report semi-annually on Performance Standards to DHCS in 2013  Counties report on those cases subject to 10-day rule: o Applications that were received from SPE, and o Were not granted accelerated enrollment, and o Did not have active Medi-Cal, and o Were complete and without client error  Both 10 and 45 day applications count from the date the county receive applications from SPE Goal: 90% processed within 10 days 13

14  Different from Performance Standards reporting  Due monthly beginning in March 2013 and continue through February 2014 o Example: March 2013 report is for January 2013 data  Include data on processing of applications submitted directly to the county and from the SPE that were not granted Accelerated Enrollment (AE) 14

15 Report ing Requirements include:  Number of children approved in each of the following aid codes: o H1 o H2 o H3 o H4 o H5  For applications received directly to the county and from the SPE that were not granted accelerated enrollment: o Total number of applications approved for aid codes H1-H5 o Average number of days it took to make the final eligibility determination  Total number of applications denied (of applications received from the SPE that were not granted accelerated enrollment) 15

16  The TLICP is incorporated in the Medi-Cal program hierarchy  Beginning January 1, 2013, the TLICP must be evaluated when applicable at any Medi-Cal eligibility determination. o Eligibility determinations include but are not limited to applications, annual redeterminations, mid year status reports, or reported changes.  Children who now have a share of cost can qualify for the TLICP with no share of cost or with a premium. 16

17  ACWDL (November 16, 2012) Targeted Low-Income Children’s Program ACWDL (November 16, 2012)  ACWDL (November 13, 2012) Data Reporting and Performance Standards for the Healthy Families Program (HFP) to Medi-Cal Transition ACWDL (November 13, 2012)  Healthy Families Program Transition To Medi-Cal Healthy Families Program Transition To Medi-Cal DHCS Transition Page 17


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