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

1  Training Overview 1

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: Transition Phases & Managed CareTransition Aid CodesProcess & How to Continue Premium PaymentWhen to Complete Medi-Cal DeterminationsContinuous EligibilityTransition Notices 2

3 1A Enrolled in a HFP health plan that is a Medi-Cal Managed Care plan 1B Enrolled in a HFP health plan that is a Medi-Cal Managed Care plan 2 Enrolled in a HFP health plan that is a subcontractor of a Medi-Cal Managed Care plan 3 Enrolled in a HFP plan that is NOT a Medi-Cal Managed Care plan & does not contract/subcontract with a Medi-Cal Managed Care Plan 4 In a county that has not implemented Medi-Cal Managed Care Phases will include HFP children currently: 3

4 Phase 1a & 1b Will be enrolled in the same plan, unless they choose a different Medi-Cal Managed Care plan Phase 2 Will be enrolled in a Medi-Cal Managed Care plan that includes the individuals current provider Phase 3 Will be enrolled in a new Medi-Cal Managed Care plan in the county 4

5 NOTE: HFP children in 9H and AIM-linked infants in 0C remain in their HFP/AIM aid code until their transition phase. Provides no-cost, full scope Medi-Cal coverage with no premium payment 5C Provides full scope Medi- Cal coverage with a premium payment. 5D 5 The Healthy Families contractor will use these codes:

6 Families with income …Will be placed in aid code … at or below 150% FPL5C between 151% FPL and 250% FPL5D NOTE: AIM infants (ages 0 – 2 yrs of age) with income above the 250% FPL will continue as HFP enrolled infants in the AIM program in aid code 0C.  The HFP contractor will move children into the proper code  Transition aid codes will be assigned as follows: 6

7 HFP Contractor sends transaction to MEDS Aid code 5C or 5D appears on Special Program Screen of MEDS Maximus sends electronic transfer to CountyCounty receives electronic file 7

8  If the electronic transfer process is not fully automated on your county’s transition date, the HFP contractor will send case information to counties using the current paper-based transmittal process used for Single Point of Entry applications. o This would be a temporary work-around until the case information can be transmitted electronically.  The date by which electronic information can be received will vary based on which computer system your county uses. 8

9 9 Counties will not collect premium payments from customers.

10  The timing of the Medi-Cal determination depends upon the individual circumstances of the child transitioning from HFP.  In general Medi-Cal eligibility determinations must be completed by the county of residence as follows: When there is a change in circumstances that warrants a Medi-Cal review of eligibility If there is an existing Medi-Cal case with an RV that occurs sooner than the child’s HFP AER month No later than the AER Date 10 or but

11 If the Medi-Cal RV occurs …Then the county should… prior to the child’s HFP AER date,determine the Medi-Cal eligibility of the case and include the HFP child without waiting until the HFP AER. after the HFP AER,add the child and determine the child’s Medi-Cal eligibility. This action does not change the Medi-Cal RV date on the case  Transitioned HFP children in an open Medi-Cal Case with other family members will have their Medi-Cal determination completed as follows: 11

12  Transitioned HFP children who do not have a Medi-Cal case will have: o Medi-Cal eligibility determined by the county at their HFP AER date, and o A new Medi-Cal case opened at that time by the county. 12

13 If the child has …Then the county … SSI/SSP and no other family member has Medi-Cal, terminates the transition aid code. no-cost Medi-Cal thru CalWORKs,determine Medi-Cal eligibility at appropriate phase.  In situations where Medi-Cal eligibility is being determined by Social Security Administration for SSI/SSP or the CalWORKs program, counties may address these scenarios as follows: 13

14  If the family Medi-Cal RV, or adding the child to the Medi-Cal case as an “add a child”, results in a change that would otherwise move the HFP child to: o a Medi-Cal share-of-cost (SOC); o premium payment; or o program ineligibility.  The child continues with no SOC Medi-Cal (via CEC) until his/her AER. 14

15  Continuous eligibility also protects the child from nonfinancial reasons for discontinuance, even if those changes adversely affect other family members, except for: o Death; o when child reaches the age limit; o loses California residency; or o the child/guardian or representative of the child requests disenrollment;  Continuous eligibility ends with the earlier of the time the individual reaches age 19 or the end of a period following initial eligibility or annual RV (not to exceed 12 months).  Non-payment of premium is not a reason for CEC. 15

16 Those transitioning in phase …Will receive notification … 1A and 1BAt least 60 days prior to transitioning and a reminder notice (within 30 days) before the transition 2, 3, and 4At least 90 days prior to transitioning, with two reminders (within 60 and within 30 days) prior to the transition  Prior to each phase of the transition, the state will mail notifications to the affected families. 16

17  Transitioning children will receive the Medi-Cal Welcome Packets and Beneficiary Identification Cards (BICs) in the month prior to each transition. Those individuals in a managed care health or dental plan will also receive information from these plans.  Proposed contents of the Welcome Packet: o Medi-Cal What It Means To You (PUB 68) o EPSDT Program information (MC 003) o Important Information for Persons Requesting Medi-Cal (MC 219) o Multilingual Notice – Request for Assistance o Important Information About Dental Benefits o List of Counties with telephone contact information for Medi-Cal inquiries.  BIC will be sent separate from, and after, Welcome Packet 17

18  ACWDL (October 31, 2012) Healthy Families Program Transition To Medi-Cal ACWDL (October 31, 2012)  Healthy Families Program Transition To Medi-Cal Healthy Families Program Transition To Medi-Cal DHCS Transition Page 18


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