Presentation on theme: "Enrolling Families and Children in Medicaid and Child Health Plan Plus"— Presentation transcript:
1 Enrolling Families and Children in Medicaid and Child Health Plan Plus
2 Department of Health Care Policy and Financing The Department of Health Care Policy andFinancing is the state department thatadministers Child Health Plan Plus (CHP+)and other medical programs for low incomefamilies, persons who are blind or personswith disabilities and the elderly.
3 What we will cover Medical Assistance (MA) Sites Presumptive Eligibility (PE) SitesCertified Application Assistance sites (CAAS)ResponsibilitiesExpectationsApplication and certificationI will give you information about becoming a CAAS, MA or PE site by covering the responsibilities, expectations, and application and certification requirements.
4 Responsibilities for all sites Must meet all Federal and State criteriaAdhere to all Department of Health Care Policy and Financing (Department) rules, regulations, and agency letters. To view these documents, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/Assist families with the completion of the Public Health Insurance for Families Application and other Medical programs
5 Responsibilities for all sites Participate in required trainingsDisplay current site location and contact information on the Department Web siteInform the Department of any changes made to the primary site contact in a timely manner
6 Responsibilities for all sites Abide by all applicable HIPAA Privacy and Security requirements regarding health informationAs defined in 42 U.S.C. 1320d – 1320d-8, and implementing regulations at 45 C.F.R. Parts 160, 162 and 164
7 Responsibilities for all sites Offer voter registration at the time of initial applicationPursuant to the National Voter Registration Act of 1993, 42 U.S.C.S 1973gg-5(a)(2)(H)Track the number of voter registrations offered
8 National Voter Registration Act Congress enacted the National Voter Registration Act (NVRA) in 1993Requires voter registration opportunities to be offered at each agency that:Provides public assistance (including food stamps, Medicare and Medicaid, WIC, and Colorado Works/unemployment assistance)Provides state-funded programs primarily for persons with disabilitiesRecruits for the armed forces(also known as the "NVRA" and the "Motor Voter Act"),U.S.C. 1973gg 5(a), (b),Other federal, state, local government, or nongovernment offices may choose to provide voter registration services
9 Complying with NVRA Voter registration must be offered: Upon initial request for servicesAt service renewalUpon address changeApplicants must be:Provided a voter registration form including a declination sectionOffered assistance in completing the formsEach agency is required to transmit forms to the appropriate county clerk
11 Implementing NVRAThe Department will inform all PE and CAAS sites with requirements and implementation dates.Each site will be responsible for implementing a NVRA process to be in compliance with NVRA.
12 Voting Registration Supplies Blank agency voter registration forms, agency voter registration reporting forms and special envelopes may be ordered directly from the Secretary of State’s office or through your local county clerk.
13 Additional NVRA Information Elections Questions and Answers:Voter Information:County Elections Offices:NVRA Address:
15 Medical Assistance (MA) Site Designated site that:Accepts and processes applications for Medical Assistance ProgramsUses the Colorado Benefits Management System (CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Medicaid programsTransfers the cases to the appropriate County Department of Human/Social Services for ongoing case maintenanceThe Department is authorized to establish MA sites by Statue (CRS et seq).
16 MA Site expectations Self-funded (non-monetary contract) Have capacity and capability to process all Medical Assistance applications submitted to include: i.e., staff, workspace, equipmentProvide and maintain adequate hardware and software to access the CBMS application through the Department’s secured Web PortalPrevious Certified Application Assistance Site (CAAS) and Presumptive Eligibility (PE) experience preferred
17 MA Site expectationsProcess and authorize the eligibility determination within the processing timelines; 45 days for family and children’s applications and non-disability applications, and 90 days for disability applicationsResolve any applicant/client issues in a timely mannerRespond to requests from the Department in a timely manner
18 MA Site expectationsAccept and process all walk-in and mail-in applications in a timely mannerExplain the benefits of the programs that are administered by the DepartmentConduct internal quality improvement reviews on a monthly basis*The above is not a comprehensive list, but a representation of primary responsibilities. Details of the overall responsibilities will be included in the contract between the Department and the approved MA site.
19 MA Site expectationsRespond to any audit or Medicaid Eligibility Quality Control (MEQC) requests for case files and client informationMaintain copies of the active case files and non-active case files for three years after the discontinuation or denial of eligibility
20 How to apply to be an MA site Submit a Letter of Interest (LOI) to the DepartmentThe LOI should address the following:Why is your organization interested in becoming an MA Site?What population will benefit from your organization becoming an MA Site?What are the benefits to your organization in becoming an MA Site?What are the anticipated staffing levels and location(s) if your organization becomes an MA Site?How is your organization going to fund your ability to function as an MA site?
21 AddressHealth Care Policy and Financing (HCPF), at 1570 Grant Street, Denver, CO , Attention: Monica Owens, MA Site Contract Manager, or via to
23 Presumptive Eligibility (PE) Site Temporary health care coverage for children 18 and under and pregnant women while their eligibility is being determinedPE Coverage is no less than 45 daysPE Site list available:CHPplus.org/materials/PESiteList.pdf
24 What does a PE site offer? Immediate access to health careMedicaid PE for children: includes all Medicaid-covered servicesMedicaid PE for pregnant women: includes only outpatient servicesCHP+ PE: includes all CHP+ covered services - except dental benefits
25 PE Site qualifications Sites must meet specific federal and state criteria:• Federal CriteriaA “qualified provider” may grant Presumptive Eligibility to pregnant women if all of the following criteria is met:Be eligible to receive payments through the State;Provide outpatient hospital services, rural health services, or clinic services; andBe determined by the state agency to be capable of making PE determinations.
26 PE Site qualifications A “qualified entity” may grant presumptive eligibility to children if any one of the following criteria is met:Be eligible to receive payments through the State;Provide health care items or services; andBe determined by the State agency to be capable of making PE determinations.
27 PE Site expectations • State Criteria Have appropriate internet access that is capable of supporting the Colorado Benefit Management System (CBMS);Be a Medicaid and/or CHP+ provider OR be affiliated with a Medicaid/CHP+ provider;Routinely be able to provide pregnancy testing or assure referral to prenatal care and/or children’s routine medical care;
28 PE Site responsibilities Make necessary referrals to practitioners for continued care for normal and high-risk patients;Have client contact personnel available to determine eligibility;Accept the Colorado Public Health Insurance for Families Application and forward to the appropriate county;Maintain at least a 90% accuracy rate of eligibility determinations;
29 PE Site responsibilities Participate in initial and ongoing PE trainings;Agree to fulfill all the responsibilities of a qualified provider as stipulated by the Department; andBe capable of assisting non-English speaking clients.CAAS trained and approved
30 How to apply to be a PE site Download the application from the Department website, colorado.gov/hcpfContact Corinne Lamberson
32 Certified Application Assistance Sites Agencies that assist families in completing the “Colorado Public Health Insurance for Families Application”Certified to verify citizenship and identification documentation
33 CAAS responsibilities A certified agency must:Train all staff on the process for completing an application and how to verify citizenship and identity documents.
34 CAAS responsibilities A certified agency must also:Complete an “Certification Site Application” aka Certified Application Assistance Site Application, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/Submit completed applications and all documentation to local county within five business days.
35 What are Medicaid and CHP+? Medicaid – Low-cost health insurance for Colorado children, pregnant women, parents with dependent children, the elderly, and people with disabilitiesCHP+ – Low-cost health insurance for Colorado children and pregnant women who exceed the income guidelines for Medicaid eligibility
36 Who is eligible for Medicaid? Children who are 18 years old and underParents caring for dependent children who are enrolled in Medicaid or CHP+Pregnant womenWithin income guidelinesColorado residentsUS citizens or legal permanent residents for at least 5 yearsSome exceptions to 5 year banOkay to have another form of insurance
37 Who is eligible for CHP+ ? Children who are 18 years old and underNot eligible for MedicaidWithin income guidelinesColorado residentsNot covered by other health insuranceUS citizens or legal permanent residents for at least 5 yearsUnable to access employee health insurance through the State of Colorado
38 2010-2011 Income Guidelines for CHP+ and Medicaid Slide updated 07/13/2010 by Jeff Konrade-HelmSlide updated: 07/13/2010
40 What expenses should be listed on the application? Child care and elder care expensesMedical/prescription expensesHealth insurance premiumsOutgoing and incoming child support and alimonyExpenses must be from the same month as the income being reportedSome or all of these expenses will be deducted from the family’s income to determine eligibility
41 What is acceptable proof of income? Paycheck stubsAt least one paycheck stub with pay date in previous or current monthORSigned written document from employerExact gross income from previous month ORExact hourly wage, hours worked, how often paid, and date of last paycheck
42 What about self-employed applicants? Profit and loss statement for previous or current month must be includedORComplete self-employment section - the ledger - on the application
43 Joint Application Determines eligibility for Medicaid and CHP+ Applications are checked for Medicaid eligibility first, then CHP+Available in English and SpanishAvailable at CHPplus.org or Colorado.gov/hcpf or Department of Human/Social Services Offices or by calling toll free:
44 Points of Clarification Question 1:Use legal namesInclude mailing address if different from physical addressMust include at least 1 phone numberQuestion 3:List all members of the household even if the person is not a family memberMake a copy of this page if more than 8 people live in the household
45 Points of Clarification Question 4:This information is for any child in the familyQuestion 5:If anyone in the household is pregnant, be sure to complete this entire section
46 Points of Clarification Complete one page for each child applying; if needed, make a copy of this page for each additional childAdd child’s full name including middle initialInclude only natural or adoptive parents living in the home (don’t include step-parents in this section)Alaskan Native or Native American applicants: check box in order to receive fee exemptions
47 Points of Clarification Question 2:If applicable, write alien registration number on the line and make a copy of both sides of resident card to include with the applicationQuestion 4:Medicaid will allow up to 3 months of backdated coverage; CHP+ does not back date and enrollment begins the day an application is date-stamped and received by a CHP+ partner organization
48 Points of Clarification Question 5:Applicants who have access to Colorado State Government health benefits do not qualify for CHP+ but may qualify for MedicaidQuestion 6:Pre-existing conditions do not impact eligibilityIf yes, child may qualify for other programs
49 Points of Clarification ONLY Pregnant women and adults 19 years and older in the household applying for health insurance will complete this formPermanent legal residents must include a copy of both sides of the resident card with the application
50 Points of Clarification Questions 1 and 2:Only refer to those applying for benefitsIf anyone applying is/ was covered by other health insurance, complete ALL fields in the appropriate sectionInclude a copy of both sides of the health insurance card for question 1 if available
51 Points of Clarification List all working members of the household and their income detailsQuestion 1:Self-employed workers must complete this section OR submit a profit and loss statement showing income and expenses for either the current or previous monthQuestion 2:List all other income for all household members here
52 Points of Clarification List all allowable expenses/income deductions for each member of the householdBlue box:Applicant must include HMO choice or the State Managed Care Network depending on the county of residence (refer to application insert)
53 Medicaid Disregards The disregards run automatically in CBMS Earned Income Disregard$90/month/person whose earned income is used to determine program eligibilityChild/Spousal Support Disregard$50/month/householdDependent Care Disregard$200/person < age 2; or$175/person ≥ age 2
54 Selecting an HMO for CHP+ An HMO is a group of doctors, nurses, hospitals, and other providers who care for membersAn HMO manages the health insurance benefits that CHP+ offersApplicants must select an HMO or the State Managed Care Network, depending on the county of residenceFor a complete list of HMOs available in your county, see:CHP+ deskguide for professionalsHealth Plan Comparison Chart Insert (in application)CHPplus.org
55 Pre-HMO enrollment period All CHP+ members have a pre-HMO enrollment periodProvides medical coverage from received date of application up to HMO/Dental effective date.Provides medical care immediately so members don’t have to waitThe pre-HMO coverage is through the State Managed Care NetworkMembers will receive a temporary identification card during this timeDental services are not covered during this time
56 Points of Clarification All adults 19 or older applying for health coverage must sign hereParents or guardians applying for health coverage for their children must sign name, print name, and write the date here
57 Verification requirements Medicaid and CHP+ applicants may be asked to provide original or certified copies of documents proving the identity and citizenship of all who are applyingClients must provide the original copies to the Certified Application Assistance Site or the county to be verified
58 Verification requirements An insert explaining the documents required is included in each applicationList of documents and organizations where original documents can be verified: Colorado.gov/cs/Satellite?c=Page&cid= &pagename=HCPF%2FHCPFLayout
59 Verifying Documents for Medicaid and CHP+ For US Citizens or legal permanent residentsApplicants must present an original or certified copy, never a photocopyExemptions include: PE clients, Needy Newborns, SSI and SSDI eligible clients, current Medicare recipients, and Foster Care children
60 Citizenship and Identity Documentation A passport (current or expired) can be used to establish both citizenship and identity
61 Citizenship Documentation Examples of acceptable citizenship documents:U.S. birth certificateCertificate of birth abroadU.S. Nation ID cardNative American Tribal documentFinal adoption decreeOfficial military record of service showing a U.S. place of birthReligious/School records
62 Identity Documentation Examples of acceptable identity documents:Driver’s license or state ID card with photoID card issued by a federal, state, or local government agencyU.S. military card or draft record or U.S. Coast Guard Merchant Mariner CardSchool ID card with photoVerified school, nursery or daycare records (for children under age 16)Clinic, doctor or hospital records (for children under age 16)
63 Written AffidavitsCan only be used when other documentation is not availableCan only be used to prove either citizenship or identity, not bothAffidavits do not need to be notarized
64 Submitting Certified Documents - Option 1 A photocopy of the original or certified document, with the following information either stamped or written on each copied document:Agency nameName and signature of staff who viewed documentsAgency’s full addressAgency’s phone numberDate documents are verifiedWrite words “verified original” above stamp or agency information on each document
65 Submitting Certified Documents – Option 2 A photocopy of the original or certified documents attached to the “Citizenship and Identity Documentation Received” form
66 What happens if falsified documents are submitted? Sites are verifying that documents submitted are original or a certified copyIf doubts or reservations about a submitted document, do not certify the document; refer the client to local county officeSites should not knowingly accept documents such as a fax or photo copied birth certificate; all documents must have a visible stamp or the required certification information on it
67 Submitting Applications Applicant must sign and date thelast page of the applicationSend applications to the county Department of Human/Social Services in which the applicant resides, or:CHP+PO Box 929Denver, CO 80201
68 How does an applicant follow up? All communication is sent directly to the applicant, not the Certified Application Assistance SiteEligibility should be determined within 45 daysIf an applicant has not been notified, contact the agency to which the application was submitted
69 Appeal Process Clients can appeal an eligibility decision They will be notified by mail of their appeal rights and instructions on how to proceed if their application is deniedThey have 30 days from the date on the denial letter to appeal the decisionAppeals must be submitted in writing