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Mandatory Training Presentation for Certified Application Assistance Sites (CAAS) Marcy Dean Certified Application Assistance Sites’ Administrator.

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Presentation on theme: "Mandatory Training Presentation for Certified Application Assistance Sites (CAAS) Marcy Dean Certified Application Assistance Sites’ Administrator."— Presentation transcript:

1 Mandatory Training Presentation for Certified Application Assistance Sites (CAAS) Marcy Dean Certified Application Assistance Sites’ Administrator

2 Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources Our Mission

3 What will you learn? √What are Medical Assistance Sites? √Certified Application Assistance Sites information √Medical Assistance 101 √PEAK Online Application √SES (Single Eligibility System) Application √Verification Processes √Additional Misc. Information

4 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

5 Application Assistance Sites  Certified Application Assistance Site  Presumptive Eligibility Site  Medical Assistance Site  Hospital Outstationing

6 Certified Application Assistance Sites (CAAS) 290+ volunteer community organizations & facilities 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)

7 Presumptive Eligibility Sites (PE) 131 clinics, health centers & community resource centers Have limited access to CBMS for temporary Medical Assistance 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

8 Hospital Outstationing 63 out of 77 hospitals that are part of the Provider Fee Program Through Colorado HB 09-1293, the Colorado Health Care Affordability Act, funding has been made available to support outstationing activities provided by eligible hospitals Outstationing levels of participation: Level 1 – Basic Outstationing Level 2 – CAAS Level 3 – PE Site Level 4 – MA Site Level 5 – MA Site Sponsor Hospitals select an outstationing level of participation for providing outstationing activities and are approved at that level of participation or a higher level at the time of application.

9 10 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) Medical Assistance Sites (MA)


11 CAAS Mandatory Training Process  Each staff member that will be providing application assistance or verifying citizenship and identity documents on behalf of the department is expected to view this entire training presentation  After viewing this presentation, each staff member must take the test included in the interactive CAAS Training presentation and score 95% or higher in order to be certified  Each person will need to print their test results and send them to the CAAS Administrator in order to be issued a certificate of completion

12 CAAS Staff Expectations  Review all CAAS training materials  Assist all members of the community*  Process and forward all medical applications to a county, eligibility site or the Enrollment Medical Assistance Program (EEMAP aka MAXIMUS) vendor within 5 business days  Follow the application processes and guidelines as detailed in this training presentation

13 CAAS Staff Expectations  Review the application while the applicant is still present to make sure it is complete  Verify documents presented by an applicant using one of the processes identified in this presentation  Ensure page 11 of the SSAp is signed prior to the applicant leaving, and if applicable, ensure the applicant has signed page 3 of WORKSHEET D  NEATLY write or stamp your CAAS information on all applications you have assisted an applicant with and all document(s) you have verified

14 CAAS Staff Expectations  Adhere to Department rules, regulations, and agency letters  Submit your site’s quarterly report on time per the submittal dates listed on each site’s excel spreadsheet  Read and 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  Encrypt all email containing PHI, turn documents facedown, never leave documents out when you leave your desk  Notify the CAAS Administrator of concerns or issues pertaining to your site’s ability to operate as a CAAS, such as address, phone number or staffing changes

15 CAAS Quarterly Report HCPF staff are required to notify our security officer of any document containing PHI received via non encrypted email Log all CAAS activity: Applications and/ or documents verified

16 Purpose of the Mapping Tool A resource for:  Community members and partners to locate application assistance sites  Counties needing to contact or locate a CAAS, Presumptive Eligibility (P.E.) or Medical Assistance (M.A.) site  Counties to verify a site is authorized by the department to provide application assistance and verify citizenship and identity documents A resource for:  Community members and partners to locate application assistance sites  Counties needing to contact or locate a CAAS, Presumptive Eligibility (P.E.) or Medical Assistance (M.A.) site  Counties to verify a site is authorized by the department to provide application assistance and verify citizenship and identity documents

17 Mapping Tool



20 What You Will Learn Today  Facts to help you answer applicant & member questions  Information to help you assist applicants through the Medical Assistance application process  Information on resources available to help you after you return to your desks

21 Open Enrollment 2015 November 15, 2014 - February 15, 2015 If an applicant does not want to apply for Medical Assistance they don’t have to, but they would not be eligible for Cost Sharing Reductions (CSR) or Advanced Premium Tax Credits (APTC) Must have Medical Assistance denial in order to be eligible for marketplace tax credit or cost sharing reductions

22 How & When to Apply for Medical Assistance No Open Enrollment Period: Applicants can apply for Medical Assistance at any time

23 What is Colorado Medicaid? Public Health Insurance No monthly or annual enrollment fee Members pay no or very low co-pay amounts depending on the population – For example, children, pregnant women, & American Indian/Alaska Natives are some examples of populations who do not pay co-pays

24 Who Does Medical Assistance Serve?

25 What Kinds of Colorado Medical Assistance PROGRAMS are there? Medicaid Child Health Plan Plus (CHP+) MAGI (Modified Adjusted Gross Income) And NON MAGI

26 MAGI & Non-MAGI at a Glance MAGI & Non-MAGI 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 Non-MAGI Populations Low-income individuals who meet any of the following: – Age 65+ – Blind – Disabled by Social Security Administration (SSA) standards

27 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

28 How are Medicaid & CHP+ Different? No enrollment fee Members can be covered under another insurance policy at same time Income limits lower than those for CHP+ All populations potentially eligible Annual enrollment fee Members cannot be covered under another insurance policy at same time Income limits higher than those for Medicaid Only covers children & pregnant women

29 So who Qualifies for Medical Assistance? It Depends

30 Applicant & Member Focused New HCPF Website

31 About Applying 1.Individuals who are eligible for Medical Assistance are automatically enrolled in the appropriate program 2.If denied Medical Assistance, Applicant’s information is automatically used to calculate the amount of financial assistance (if any) available for use on the Connect for Health CO Marketplace 3.Applicant can choose to simultaneously apply for Medical, Food, & Cash assistance on one application

32 What is Needed to Apply Name, address, & contact information Social Security numbers (or document numbers) for each member of your household to be covered by your plan Birth dates If someone in your home is pregnant, the due date & number of babies for that pregnancy Information & policy numbers for health insurance plans currently covering members of your household Asset & expense information for the household if anyone in the home is disabled

33 Fastest method! May get immediate determination (medical only) Can simultaneously apply for Medical, Food, & Cash assistance

34 Can apply in person at: County Departments Medical Assistance (MA) sites Certified Application Assistance Sites (CAAS)

35 To apply by phone call: 1-800-221-3943 TDD: 1-800-659- 2656 Can only apply for Medical Assistance over the phone

36 To apply by mail or fax: Print out application online Or request a printed copy paper-application-request paper-application-request

37 Who Do I Include in an Application? Applicant Applicant’s spouse Applicant's children under 19 who live with them Anyone on applicant’s federal income tax return – This could include children over 19, even if they do not live with them Applicants unmarried partner who needs health coverage Anyone else under 19 who applicant takes care of & lives with applicant

38 Who Do I Include in an Application? (continued) If applicant is claimed as a dependent on someone else’s federal tax return include: – The person(s) who claims the applicant – All other members of that federal tax filing household that are claimed as dependents – Any family member living with the applicant Only include roommates in household that are related to the applicant or listed on applicant’s federal income tax return

39 Program Specific Income Guidelines

40 Answers to Other Application Questions Find this @

41 Kinds Of Help Available To Members FAQ’s Online @ Call or visit your county Department of Human / Social Services Contact Medicaid Customer Contact Center: – Toll Free: 1-800-221-3943 – TDD: 1-800-659-2656 Contact CHP+ Customer Service: – 1-800-359-1991 –


43 PEAK Enhancements: November 2014

44 Open Enrollment and Re-Enrollment

45 Key Points Medical Assistance programs have no open enrollment period Private Insurance Open Enrollment Dates are November 15, 2014 – February 15, 2015 Connect for Health Colorado sends re-enrollment eligibility notices to clients annually If clients put a new plan in their shopping cart, they will not be re-enrolled

46 Shared Eligibility System = Single Application Process As of November 10, 2014

47 Key Points Single application and results for all insurance affordability programs: Medicaid, CHP+, APTC, CSR Accessible online via PEAK and Connect for Health Colorado websites; Single Sign-On option New questions added to determine Advanced Premium Tax Credits (APTC) and Cost Sharing Reduction (CSR) eligibility An Authorization number associates with APTC and CSR Mixed eligibility households’ (e.g., APTC/CHP+) ongoing case management maintained by the Marketplace

48 Single Application & Result

49 Shared Eligibility System

50 Single Application & Result Single Sign On


52 Application Changes As of November 10, 2014

53 Application Changes












65 Application Changes: Income As of November 10, 2014

66 Key Points In order to determine insurance affordability eligibility additional detail has been added to: Wage income and expenses Self employment income and expenses Tax deductions Other health coverage Ability to adjust annual income coordinates insurance affordability program eligibility Those with adjusted annual income of 100% FPL or lower will be Medicaid eligible

67 Application Changes


69 Monthly vs. Annual Income

70 50000.00

71 Application Changes


73 Manage My Account As of November 10, 2014

74 Key Points The full range of Manage My Account features are available to those with a PEAK account or those entering from Connect for Health through Single Sign On Ability to use a Client ID to link case Report My Changes additions: Apply for Medical Assistance on a closed case Secondary Account Holders can be added Change Social Security Number Shared notices will be available for the initial notice of determination and verifications needed

75 Link My Case – Client ID


77 Manage My Account

78 Report My Changes

79 Application Status

80 Shared Notices

81 Examples Same Sex-Marriage Citizenship Employer Health Insurance

82 Same-Sex Marriage Applications

83 Same Sex-Marriage Applications

84 Same-Sex Marriage Applications

85 Citizenship Status



88 Employer Health Insurance

89 Resources and Help

90 Live Chat!

91 Submit a Question

92 Help/Resources

93 Instructional Guides & Recordings peakoutreach> Resources>Community Partners or Counties> Training Monthly Support Calls Live Webinars In-person Trainings Schedule a custom training peakoutreach@ PEAK View Distributed monthly to all training attendees Provides PEAK updates and webinar information PEAK Outreach

94 PEAK website training or questions (>select FAQs) Application and General Benefit Information 1-800-359-1991 Submitted Medical Assistance application status 1-800-221-3943/ TDD 1-800-659-2656 General Medical Assistance benefits information 1-800-536-5298 Food or Cash application assistance 1-855-752-6749/ TDD 1-855-346-3432 Connect for Health Colorado PEAK technical issues such as an error message Help/Resources


96 Single Streamlined Application (SSAp)

97 Medicaid Client Services No Wrong Door to Health Insurance County Human Services Medicaid Client Services Connect for Health Colorado Application Assistance Sites CAAS, PE, MA and Hospital Outstationing PEAK

98 Where can I find an application? Any Eligibility Site Department Web Site (English & Spanish) CHP+ Web Site Colorado Program Eligibility Application Kit (PEAK) 98

99 The ACA will require states to accept electronic and telephonic signatures  Requirement extends to the Marketplace Acknowledging the technological requirements needed to capture telephonic signatures on Day 1 are prohibitive for most organizations, please follow the process below for applicants applying by phone: Provide applicants with the HCPF Medicaid Call Center toll free number: 1-800-221-3943 Or Place the applicant on hold and do a “warm” transfer to the number above Applications by Phone


101 Components of the SSAp Captures demographic information and information necessary to make a MAGI determination Standard Form Health Coverage for Jobs Used for health coverage for purposes of the Marketplace only Worksheet A American Indian or Alaska Native Family Member Used for Marketplace purposes Worksheet B Assistance with Completing this Application Used to establish an Authorized Representative & capture Certified Application Assistance Counselors/Brokers/etc. Worksheet C Additional Information Required This worksheet will be used to capture information for Non-MAGI (Aged, Blind, Disabled/LTC, MSP, Buy-Ins) Worksheet D Additional Persons Provides two additional worksheets for additional members (make copies if necessary) Worksheet E Glossary – Provides terms and definitions from the application Appendix A

102 MANDARIN SOMALI SPANISH FRENCH VIETNAMESE GERMAN RUSSIAN KOREAN HMONG ARABIC NEPALI AMHARIC Assistance is available in the languages below and more! 1-800-221-3943 / 1-855-752-6749

103 Please make sure application is legible. Ask applicant to double check that home address, phone and if provided, email address are correct!

104 For more information on Shared Responsibility Exemptions go to Appendix A (i), Glossary of Terms pg. 2 or *This refers to questions 10 & 11. Long Term Care 10 CCR 2505-10 8.400 – 8.499 Please check if you have bills that you want to be considered for coverage.



107 If applicable, begin completing for person 2, also complete Household Relationship Table on pg. 8 (make additional copies if necessary) *otherwise go to pg. 9


109 To be answered to the best of the applicant’s ability





114 In addition to stamping or writing your CAAS information on all attached documents and on the first page of the application, CAAS must also stamp or neatly write your site name and number (as it is listed in the Mapping Tool) along with the name of the assisting staff person. 2. DO NOT check any of these boxes Unless you are also a counselor, health coverage guide or agent/broker

115 Long Term Care 10 CCR 2505-10 8.400 – 8.499

116 Signature required ONLY if WORKSHEET D Was completed


118 WORKSHEET E (pages 1-6) is for additional household members. Please make copies if necessary.* If there are no additional people continue on to Appendix A (i) *pages 4-6 are not included in this presentation because they are only duplicates of pages 1-3






124 Citizenship and Identity Requirement  Medical Assistance programs still require proof of an applicants identity, U.S. Citizenship or lawful residency for non-U.S. citizens.  Only original or certified copies of citizenship and identity documentation may be accepted and verified by a site  Counties and medical assistance sites may be able to verify an applicants citizenship and identity via electronic interface  CAAS do not have access to the electronic interfaces when providing application assistance and are still required to verify and forward citizenship and identity documents if presented by an applicant, and forward all documents (complete or incomplete) within 5 business days  CAAS can not hold an application for any reason and are required to forward all documents to a county, M.A. site, or MAXIMUS within five (5) business days

125 Electronic Interface Verification Sites CBMS/PEAK will be using data sources/interfaces to verify certain required verifications and to communicate between each other (CBMS/PEAK)  SOCIAL SECURITY ADMINISTRATION (SSA) U. S. citizenship or lawful residency for non U. S. citizens verification  DEPARTMENT OF REVENUE, DIVISION OF MOTOR VEHICLES (DMV) Identification verification  INCOME AND ELIGIBILITY VERIFICATION SYSTEM (IEVS) Quarter/Year wage data that is four months prior to the run month  SVES SCHIP is the only interface that will be real time with PEAK Will be modified so that PEAK calls real time

126 EXEMPT from Proof of U.S. Citizenship Requirement  Newborns whose mother is on Medicaid or CHP+ at time of birth  SSI and SSDI recipients  Medicare recipients  Foster children  PE Clients

127 Acceptable documents for proof of Citizenship and Identity  U. S. Passport (current or expired)  Certificate of Naturalization or Citizenship  Indian Tribal Document NOTE: Photocopies presented by the applicant to a site are not acceptable proof of citizenship or identity verification

128 Acceptable Citizenship Documents UNITED STATES:  Birth Certificate  Certificate of Birth Abroad  Nation ID Card Native American Tribal document Final adoption decree Official military record of service showing a U.S. place of birth NOTE: Photocopies presented by the applicant to a site are not acceptable proof of citizenship or identity verification

129 Acceptable Identity Documents One (1) document from Primary list OR Two (2) documents from Secondary List PRIMARY LIST (expired documents are not acceptable)  Alien Registration Receipt/Permanent Resident Card  Certificate of U.S. Citizenship  Colorado Department of Corrections ID card  CO Temporary Driver’s License Form (with hole- punched Driver’s License)  Employment Authorization Card (I-766)  Foreign Passport  Photo Driver’s License  Photo ID Card (DMV)  School, University or College ID Card (must be current)  Temporary Resident Card  UNITED STATES: B1/B2 Visa card with I-94 Certificate of Naturalization Citizenship ID Card (I-197) Military ID Card Passport SECONDARY LIST  Acknowledgment of Paternity document  Court order of adoption or name change  DD-214  Hospital birth worksheet (for infants under 6 months)  Colorado Hunting, Fishing, Craft or Trade or Pilot’s License (CURRENT)  IRS-TIN card or Mexican voter registration card  Merchant mariner card  Social Security, Medicare or Social Services Card (Medicaid, WIC)  State or federal prison or corrections card  Tribal ID Card  Work ID, Paycheck Stub (within 3 months), or W-2  UNITED STATES: Birth Certificate of ApplicantDivorce Decree Marriage license Motor vehicle registration or title Selective Service CardWeapon or gun permit  Any document listed on the PRIMARY list expired 6 months or less

130 CAAS Verification Process Option 1  Photocopy original or certified copy of document(s)  Stamp or neatly write the following CAAS information on each photocopied document Agency name as it appears in the Mapping Tool Name and signature of staff who viewed documents Agency address Agency phone number Date of document verification  Write “verified original” above agency information  Write PEAK tracking number on each document if application was submitted online  Submit application and/or all verified documents to an eligibility site with 5 business days

131 CAAS VERIFICATION PROCESS OPTION 2 Photocopy original or certified copy document(s) Complete the Citizenship and Identity Documentation Received (CIDR) form and attach photocopied document(s) Write “verified original” above agency information and if applicable, Write the PEAK tracking number on each document and CIDR form for applications submitted online and submit all verified documents to eligibility site *consider adding verified original(s), PEAK tracking #, CAAS name, number, address and phone # to the CIDR form before making copies for your staff VERIFIED ORIGINAL(S) _ √ _ PEAK TRACKING # _______________________ _

132 Falsified Documents CAAS verify they have viewed the original/certified copies of citizenship and identity documents presented by applicants and are required to maintain an activity log for auditing purposes  CAAS should not knowingly verify falsified documents  Do not verify documents if you have doubts  Do not verify faxes or photocopies of documents  Must only use information as provided by the applicant  Cannot refuse to include or eliminate information whether or not the applicant provides supporting documentation


134  All pages of the application (complete or incomplete) must be forwarded to an eligibility site within 5 business days  CAAS will continue to verify citizenship and identity documents if presented, but will not hold an application for any missing information or documentation  CAAS will be responsible for submitting a completed and signed Employee Information sheet listing all staff that will provide CAAS assistance within 30 days of CAAS enrollment or recertification or staffing changes  CAAS will submit a quarterly report detailing CAAS activity on or before the due date as identified on each spreadsheet (report must be submitted even if no CAAS assistance has been provided during the reporting quarter)  CAAS will provide information on additional potential medical benefit resources to applicants determined to be ineligible for Medicaid benefits CAAS RESPONSIBILITIES 134

135 135 Best Practices  Make sure the applicant has signed page 11 of the application, and if appropriate page 3 of WORKSHEET D  Attach a note identifying missing or incomplete documentation  Date stamp all applications processed and forwarded by your site  Do not date stamp applications for applicants choosing to hand deliver

136 Best Practices  Stamp or write your entire CAAS site name and number on all CAAS related documents and communications  Email messages informing you of important changes, updates and training opportunities that pertain to CAAS will periodically be sent out, but it is the responsibility of each site to stay informed by reading the messages  Provide at least one (1) additional back-up contact(s) in the event your sites main contact changes or is unavailable  Set a reminder to renew your CAAS certification approximately 30 days before your current certification expires

137 Best Practices  Notify CAAS Administrator of changes that may/will impact your ability to perform your CAAS responsibilities (staff, phone, address, etc.)  Before contacting the CAAS Administrator with a question review your training materials to see if the answer is included  If staff is struggling with CAAS processes have them review the training presentation and/or request in-person training from the CAAS Administrator

138 138 Best Practices  Advise applicant that all communications will be sent directly to the address they provided and the importance going into PEAK or notifying the county of address or phone number changes  Advise applicant they may provide authorization to have their communications sent to another individual or directly to the CAAS site. (This must be arranged and agreed upon by the applicant and the CAAS)  Explain timely processing expectations, provide contact information for your site and the county, eligibility site, or Eligibility and Enrollment Medical Assistance Program (EEMAP) vendor and a list of missing documents

139 Frequently Used Phone Numbers Connect for Health Colorado (C4HCO) Website: or Phone: 1-855-PLANS-4-YOU (1-855-752-6749) TTY/TDD 1-855-346-3432 Medicaid Client Services Website: Phone: 303-866-3513 or 1-800-221-3943 Fax: 303-866-4411 Medicare Website: Phone: 1-800-MEDICARE (633-4227) State Health Insurance Assistance Program (SHIP) Phone: 1-888-696-7213 Social Security Administration Website: Phone: 1-800-772-1213 Website: Phone: 303-751-9051 or 1-800-414-6198 State Managed Care Network (CHP+) Xerox (Medicaid Fiscal Agent) Phone: 1-800-237-0044 or 1-800-237-0757

140 Eligibility Site Program Contacts Presumptive Eligibility (PE) Site Program: Georgann Garcia * PE Specialist 303-866-3544 * Hospital Outstationing Program: Brian Knight * Hospital Outstationing Contract Mgr. 303-866-4221 * Medical Assistance Site Program: Monica Owens * M.A. Site Program Manager 303-866-2286 *

141 Certified Application Assistance Site Program Contacts Please send all CAAS related communications to: HCPF_ASSISTANCESITES@STATE.CO.US


143 Thank You MARCY DEAN CAAS Administrator Department of Health Care Policy & Financing 303-866-3466

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