Presentation is loading. Please wait.

Presentation is loading. Please wait.

Enrolling Families and Children in Medicaid and Child Health Plan Plus

Similar presentations

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 and Financing is the state department that administers Child Health Plan Plus (CHP+) and other medical programs for low income families, persons who are blind or persons with disabilities and the elderly.

3 What we will cover Medical Assistance (MA) Sites
Presumptive Eligibility (PE) Sites Certified Application Assistance sites (CAAS) Responsibilities Expectations Application and certification I 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 criteria Adhere to all Department of Health Care Policy and Financing (Department) rules, regulations, and agency letters. To view these documents, visit: 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 trainings Display current site location and contact information on the Department Web site Inform 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 information As 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 application Pursuant 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 1993 Requires 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 disabilities Recruits 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 services At service renewal Upon address change Applicants must be: Provided a voter registration form including a declination section Offered assistance in completing the forms Each agency is required to transmit forms to the appropriate county clerk

10 Agency-Based Voter Application

11 Implementing NVRA The 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:

14 Medical Assistance Sites (MA)

15 Medical Assistance (MA) Site
Designated site that: Accepts and processes applications for Medical Assistance Programs Uses the Colorado Benefits Management System (CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Medicaid programs Transfers the cases to the appropriate County Department of Human/Social Services for ongoing case maintenance The 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, equipment Provide and maintain adequate hardware and software to access the CBMS application through the Department’s secured Web Portal Previous Certified Application Assistance Site (CAAS) and Presumptive Eligibility (PE) experience preferred

17 MA Site expectations Process 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 applications Resolve any applicant/client issues in a timely manner Respond to requests from the Department in a timely manner

18 MA Site expectations Accept and process all walk-in and mail-in applications in a timely manner Explain the benefits of the programs that are administered by the Department Conduct 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 expectations Respond to any audit or Medicaid Eligibility Quality Control (MEQC) requests for case files and client information Maintain 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 Department The 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 Address Health Care Policy and Financing (HCPF), at 1570 Grant Street, Denver, CO , Attention: Monica Owens, MA Site Contract Manager, or via to

22 Presumptive Eligibility (PE) Sites

23 Presumptive Eligibility (PE) Site
Temporary health care coverage for children 18 and under and pregnant women while their eligibility is being determined PE Coverage is no less than 45 days PE Site list available:

24 What does a PE site offer?
Immediate access to health care Medicaid PE for children: includes all Medicaid-covered services Medicaid PE for pregnant women: includes only outpatient services CHP+ PE: includes all CHP+ covered services - except dental benefits

25 PE Site qualifications
Sites must meet specific federal and state criteria: • Federal Criteria A “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; and Be 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; and Be 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; and Be 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, Contact Corinne Lamberson

31 Certified Application Assistance Sites (CAAS)

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: 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 disabilities CHP+ – 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 under Parents caring for dependent children who are enrolled in Medicaid or CHP+ Pregnant women Within income guidelines Colorado residents US citizens or legal permanent residents for at least 5 years Some exceptions to 5 year ban Okay to have another form of insurance

37 Who is eligible for CHP+ ?
Children who are 18 years old and under Not eligible for Medicaid Within income guidelines Colorado residents Not covered by other health insurance US citizens or legal permanent residents for at least 5 years Unable 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-Helm Slide updated: 07/13/2010

39 Financial Responsibility
Self Self Spouse Spouse Parent Child Sibling Sibling Child Parent Others Child

40 What expenses should be listed on the application?
Child care and elder care expenses Medical/prescription expenses Health insurance premiums Outgoing and incoming child support and alimony Expenses must be from the same month as the income being reported Some or all of these expenses will be deducted from the family’s income to determine eligibility

41 What is acceptable proof of income?
Paycheck stubs At least one paycheck stub with pay date in previous or current month OR Signed written document from employer Exact gross income from previous month OR Exact 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 included OR Complete 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 Spanish Available at or or Department of Human/Social Services Offices or by calling toll free:

44 Points of Clarification
Question 1: Use legal names Include mailing address if different from physical address Must include at least 1 phone number Question 3: List all members of the household even if the person is not a family member Make 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 family Question 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 child Add child’s full name including middle initial Include 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 application Question 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 Medicaid Question 6: Pre-existing conditions do not impact eligibility If 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 form Permanent 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 benefits If anyone applying is/ was covered by other health insurance, complete ALL fields in the appropriate section Include 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 details Question 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 month Question 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 household Blue 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 eligibility Child/Spousal Support Disregard $50/month/household Dependent 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 members An HMO manages the health insurance benefits that CHP+ offers Applicants must select an HMO or the State Managed Care Network, depending on the county of residence For a complete list of HMOs available in your county, see: CHP+ deskguide for professionals Health Plan Comparison Chart Insert (in application)

55 Pre-HMO enrollment period
All CHP+ members have a pre-HMO enrollment period Provides medical coverage from received date of application up to HMO/Dental effective date. Provides medical care immediately so members don’t have to wait The pre-HMO coverage is through the State Managed Care Network Members will receive a temporary identification card during this time Dental services are not covered during this time

56 Points of Clarification
All adults 19 or older applying for health coverage must sign here Parents 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 applying Clients 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 application List of documents and organizations where original documents can be verified: &pagename=HCPF%2FHCPFLayout

59 Verifying Documents for Medicaid and CHP+
For US Citizens or legal permanent residents Applicants must present an original or certified copy, never a photocopy Exemptions 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 certificate Certificate of birth abroad U.S. Nation ID card Native American Tribal document Final adoption decree Official military record of service showing a U.S. place of birth Religious/School records

62 Identity Documentation
Examples of acceptable identity documents: Driver’s license or state ID card with photo ID card issued by a federal, state, or local government agency U.S. military card or draft record or U.S. Coast Guard Merchant Mariner Card School ID card with photo Verified school, nursery or daycare records (for children under age 16) Clinic, doctor or hospital records (for children under age 16)

63 Written Affidavits Can only be used when other documentation is not available Can only be used to prove either citizenship or identity, not both Affidavits 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 name Name and signature of staff who viewed documents Agency’s full address Agency’s phone number Date documents are verified Write 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 copy If doubts or reservations about a submitted document, do not certify the document; refer the client to local county office Sites 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 the last page of the application Send applications to the county Department of Human/Social Services in which the applicant resides, or: CHP+ PO Box 929 Denver, CO 80201

68 How does an applicant follow up?
All communication is sent directly to the applicant, not the Certified Application Assistance Site Eligibility should be determined within 45 days If 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 denied They have 30 days from the date on the denial letter to appeal the decision Appeals must be submitted in writing

70 Resources
CHP+ Customer Service: Medicaid Customer Service Denver Metro: Toll free:

Download ppt "Enrolling Families and Children in Medicaid and Child Health Plan Plus"

Similar presentations

Ads by Google