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Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 1 CHP+ 201 Created for Building Better Health.

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Presentation on theme: "Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 1 CHP+ 201 Created for Building Better Health."— Presentation transcript:

1 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 1 CHP+ 201 Created for Building Better Health – October 14 & 15, 2014 by the Colorado Department of Health Care Policy and Financing Presented by the Training Specialists from the Denver Department of Human Services

2 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Our Mission: 2

3 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 3 What You Will Learn Today You will learn about the services covered by CHP+ to help you answer customer questions You will learn about the many resources available to help members gain the services they need

4 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing \ \ 4 Medicaid Child Health Plan Plus (CHP+) What Kinds of Colorado Medical Assistance Programs are There? MAGI Non- MAGI

5 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 5 Federal Medical Assistance Structure Agriculture Commerce Defense Education Energy Health & Human Services Housing and Urban Development The InteriorJustice Labor State Transportation Treasury Veterans Affairs Independent Establishments & Government Corporations United States Department of Center for Medicare & Medicaid Services (CMS)

6 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 6 Child Health Plan Plus Structure Center for Medicare & Medicaid Services (CMS) Presumptive Eligibility Sites Healthy Communities Sites Medical Assistance Sites Certified Application Assistance Sites County Departments of Human/Social Services Colorado Department of Health Care Policy & Financing (HCPF) Colorado Department of Health Care Policy & Financing (HCPF)

7 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 7 Colorado Department of Health Care Policy & Financing Sets payment rates Receives matching funds from federal government Creates & maintains plans for delivering services Develops additional programs beyond what the federal government requires

8 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 8 County Departments of Human/Social Services 64 County Human Services Offices First step in Medicaid appeals process Receive state funding Each county has their own business process: In person assistance Some phone assistance Drop off applications PEAK kiosks/computers Utilizes CBMS & assists applicants in applying for: Medical Assistance Food Assistance Cash Assistance Other public programs

9 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 9 Medical Assistance Sites (MA) 9 MA Sites stationed within 27 clinics & health centers & MAXIMUS MAXIMUS State funded contract In person assistance Phone assistance Drop off applications Each MA Site has their own business process: State contract required In person assistance Some phone assistance Drop off applications PEAK kiosks/computers Utilizes CBMS & assists applicants in applying for: Medical Assistance Other programs (at certain sites)

10 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 10 Certified Application Assistance Sites (CAAS) 310+ volunteer community organizations & facilities Some CAAS receive state funding No access to CBMS Paper applications are forwarded to counties or MA sites for processing Each CAAS has their own business process: In person assistance Some phone assistance Drop off applications PEAK kiosks/computers Utilizes PEAK & assists applicants in applying for: Medical Assistance Other programs (at certain sites)

11 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 11 Healthy Communities Sites Receive state funding 64 counties served by 25 community organizations Family Health Coordinators: promote preventive & wellness services for children & pregnant women Each Healthy Communities site has its own business process: In person assistance Phone assistance Drop off applications PEAK kiosks/computers Utilizes CBMS & assists applicants in applying for: Medical Assistance Other programs (at certain sites)

12 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 12 Presumptive Eligibility Sites (PE) 131 clinics, health centers and community resource centers Have limited access to CBMS for temporary Medical Assistance Some PE Sites receive state funding Each PE Site has their own business process: Site requires state certification In person assistance Some phone assistance Drop off applications PEAK kiosks/computers Screens individuals for PE Program provides immediate temporary medical coverage for outpatient services for pregnant women & children

13 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 13 Who Does CHP+ Serve? Citizens People with limited income & resources

14 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 14 What is CHP+? Public Health Insurance for children & pregnant women only Annual enrollment fees range from $25 - $105 depending on income, population, & number of children enrolled Max out of pocket expenses/co-pays is 5% of gross annual income

15 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 15 What’s Covered? CHP+ Benefits

16 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Dental Benefits 16

17 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Emergency & Urgent Care 17

18 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Over the Counter Vitamins 18

19 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Hospital Services 19

20 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Behavioral Health Services 20

21 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Gym Membership 21

22 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Maternity Care 22

23 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Prescription Drugs 23

24 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing School Supplies 24

25 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Immunizations 25

26 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Primary Care 26

27 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 27 Dental services (for children only) Emergency & urgent care Hospital servicesBehavioral health Maternity care (Prenatal, delivery, postpartum) Prescription drugs ImmunizationsPrimary care CHP+ Benefits

28 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 28 Let’s Talk About MAGI & Non-MAGI What is MAGI? Methodology for: how income is counted how household composition & family size are determined What is Non-MAGI? Medicaid categories exempt from applying the MAGI methodology​

29 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 29 MAGI at a Glance MAGI Populations Age 64 & younger Not eligible for Medicare Low income: – Children – Adults – Pregnant Women – Parents or Caretakers of a Medicaid eligible child that is under the age of 19

30 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 30 Who May Qualify? State of Colorado Residents Pregnant women age 19 & over Children under age 19 Must meet income guidelines

31 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 31 How is CHP+ Income Calculated? Does the individual meet any of the following exceptions: The individual expects to be claimed as a tax dependent of someone other than a spouse, biological, adopted or step parent The individual is under 19 living with both parents, but parents do not expect to file a joint tax return The individual under 19 & expects to be claimed by non-custodial parent Start Does the individual expect to file taxes? Does the individual expect to be claimed as a tax dependent? yes no Use Tax Filer RulesUse Non-Filer Rules Use Tax Dependent Rules no yes no yes

32 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 32 The Income Rules Tax Filer RulesTax Dependent RulesNon-Filer Rules The household consists of the taxpayer and if living with the taxpayer:  The taxpayer’s spouse  All the persons whom the taxpayer expects to claim as a tax dependent The household consists of the tax dependent :  The taxpayer claiming him/her as a tax dependent  The tax dependent is not required to reside with the taxpayer  All other tax dependents of that taxpayer  The tax dependent’s spouse if married & living with tax dependent The household consists of the individual and if living with the individual:  The individual’s spouse  The individual’s natural, adoptive, and step children under the age of 19  And in the case of individuals under the age of 19:  The individual’s natural, adoptive, & step parents  The individual’s natural, adoptive, & step siblings under the age of 19

33 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 33 CHP+ Countable Income Taxable income: Salaries, Wages, Tips Capital Gains Unemployment Benefits Countable Income for MAGI Programs (including CHP+) equals

34 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 34 Federal Poverty Level Measure of income level issued annually by the Department of Health and Human Services Monthly FPR Guidelines 2014 Family Size 100%120%133%135%150%175%185%200%250% ,1671,2931,3131,4591,7021,7991,9452, ,3111,5731,7431,7701,9662,2942,4252,6223, ,6491,9792,1932,2262,4742,8863,0513,2984, ,9882,3852,6432,6832,9813,4783,6773,9754, ,3262,7913,0933,1403,4894,0704,3034,6525, ,6643,1973,5433,5973,9964,6624,9295,3286, ,0033,6033,9934,0534,5045,2545,5556,0057, ,3414,0094,4434,5105,0115,8466,1816,6828,352 Find aspe.HHS.gov/ poverty/14poverty.cfm

35 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 35 Program Specific Income Guidelines

36 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 36 CHP+ Countable Income Disregard Taxable income: Salaries, Wages, Tips Capital Gains Unemployment Benefits 5% Income Disregard Countable Income for MAGI Programs (Including CHP+) minus equals

37 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 37 Program Specific Income Guidelines

38 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 38 Income Disregard (starting Jan 1, 2015) 5% across the board (only if the disregard drops the applicants to a lower FPL category) Income Disregard for MAGI Programs equals

39 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 39 Enrollment Fees Annual enrollment fees (157% - 213% FPL) No enrollment fees for Pregnant Women, Native Americans & Alaskan Natives Annual enrollment fees (214% - 260% FPL) $0 for pregnant woman $75 for 1 child $25 for 1 child $105 for 2 or more children $35 for 2 or more children $0 for pregnant woman

40 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 40 CHP+ Co-pay Exemptions Preventive Care Native Americans & Alaskan Natives

41 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Child Health Plan Plus (CHP+) CHP+ Children CHP+ Prenatal CHP+ Needy Newborns CHP+ PE 41

42 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CHP+ Children Between 143% and 260% of FPL Covers children under the age of 19 Enrollment fee applies between 157% and 260% of FPL Receive CHP+ Benefits and participate in the Early Intervention Program. 42

43 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 43 Healthy Communities Family Health Coordinators (case managers) help with: Informing families where to submit applications Educating families on the value of preventive health care services Linking members to providers Providing clients with information and referrals to other community programs and resources Explaining the re-enrollment process to families who continue to be eligible for Colorado Medicaid and CHP+ to eliminate gaps in coverage

44 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CHP+ Prenatal Between 195% and 260% of FPL Covers pregnant women age 19 and over – Pregnant women under age 19 will be covered in the CHP+ Children category – No enrollment fee for pregnant woman and her household 44

45 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 45 How long does coverage last after delivery? At least 60 days after last day of the month pregnancy ended Example: Give birth June 26 th, coverage lasts until August 31 st

46 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CHP+ Newborn Babies age 0-12 months who were born to a mother on CHP+ 46

47 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing For kids under the age of 19 Continuous enrollment regardless of changes in household income or size 47 Continuous Coverage

48 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Presumptive Eligibility PE is a Medicaid and CHP+ program Provides temporary medical coverage to children under 19 and pregnant women Allows for immediate access to medical care Provides at least 45 days of coverage while waiting for a full eligibility determination to be made 48

49 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing CHP+ PE for Pregnant Women Outpatient Services Prenatal Care CHP+ PE for Children Doctor visitsHospitalizationMental health servicesGlasses & hearing aidsPrescriptions The Need to Know: PE Benefits Inpatient (hospital) care, labor and delivery are covered for pregnant women under PE. Dental services are NOT Covered under CHP+ PE. 49

50 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 50 Methods to Apply Find all of this Colorado.gov/ HCPF/how-to-apply Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing

51 51 Verification of Pregnancy The Affordable Care Act (ACA) allows for almost all factors of eligibility (including pregnancy) to be verified through self- attestation. Self- Attestation is a client’s statement or declaration of information.

52 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 52 Verifying Income Eligibility sites can accept Self-Attestation of income if: – applicant supplies SSN, – Applicant is assumed to be working under that SSN, and – employer is within State of Colorado Individuals not meeting above criteria must provide income documentation

53 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 53 Rocky Mountain Health Plans The Different HMOs Colorado Access State Managed Care Network Colorado Choice Health Plans | Denver Health Medical Plan Kaiser Permanente

54 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 54 CHP+ Health Maintenance Organizations (HMOs) Find this map, a comparison chart, & CHPplus.org

55 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 55

56 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 56 When Do Services Start? Benefits start as soon as a member is determined eligible for CHP+ – May take a few days after enrollment for a health care provider to confirm in their system – It is important to call a provider before you go to the office to make sure they are able to see you

57 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 57 How to Find Providers Contact the HMO Contact CHP+ Customer Service – (800) Find a Doctor on HCPF’s website Find a Doctor

58 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Medical Assistance providers are regular: Doctors Dentists Pharmacies Specialists Durable Medical Equipment Providers Medical Assistance Providers 58 … who provide services at a special rate

59 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 59 Reporting Income & Household Changes Can report changes Colorado.gov/PEAKColorado.gov/PEAK Call or visit local county Departments of Human/Social Services – Visit Colorado.gov/CDHS then click “Services by County” on right hand side – Or visit Colorado.gov/PEAK then click “Services by County” at the bottom of the screen Contact CHP+ Customer Service – (800)

60 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 60 Prior Authorization Requests (PARs) If a PAR is Required

61 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 61 What if Child Qualifies for CHP+ but Parents Don’t Leave the child on CHP+ while the adults go through the marketplace to get coverage – Parents may still qualify for Tax Credit or Cost Sharing Reduction Pull the child from CHP+ and go through the marketplace to get coverage for the entire family – Parents may still qualify for tax credit of cost sharing reduction, but the child will not

62 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 62 Kinds Of Help Available To Members FAQ’s Colorado.gov/hcpf/member-faqsColorado.gov/hcpf/member-faqs Call or visit your county Department of Human / Social Services Contact CHP+ Customer Service: – – CHPPlus.org

63 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 63 Staying Up-to-Date Visit HCPF Colorado.gov/HCPFColorado.gov/HCPF Sign up for different Colorado.gov/HCPf/publications Colorado.gov/HCPf/publications Find public Colorado.gov/hcpf/communication Colorado.gov/hcpf/communication

64 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 64 Learn More Today Session NameDate & Time What to Expect after a Medicaid or CHP+ Approval Today at 1:45pm

65 Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resourcesImproving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Colorado Department of Health Care Policy and FinancingColorado Department of Health Care Policy and Financing 65 Thank You!


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