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 ratesReceives matching funds from federal governmentCreates & maintains plans for delivering servicesDevelops additional programs beyond what the federal government requires
5 Application Assistance Sites Certified Application Assistance SitePresumptive Eligibility SiteMedical Assistance SiteHospital OutstationingTo provide an alternative location to process and enroll families and children into Medicaid or CHP+ To assist in decreasing the number of uninsured children and families in Colorado that are eligible for Medicaid or CHP+ To provide enrollment services at community based schools, health centers, and other approved agencies
6 Certified Application Assistance Sites (CAAS) 290+ volunteer community organizations & facilitiesNo access to CBMSPaper applications are forwarded to counties or MA sites for processingEach CAAS has their own business process:In-person assistanceSome phone assistanceDrop off applicationsPEAK kiosks/computersUtilizes PEAK & assists applicants in applying for:Medical AssistanceOther programs (at certain sites)CAAS are volunteer facilities, organizations and individuals authorized by the Department to verify the authenticity of citizenship and identity documents required of Colorado Citizens and assist community members interested in applying for medical benefits:Online through PEAKIn need of assistance completing a paper application for medical assistance/benefits
7 Presumptive eligibility Presumptive Eligibility Sites (PE)Presumptive eligibility131 clinics, health centers & community resource centersHave limited access to CBMS for temporary Medical AssistanceEach PE Site has their own business process:Site requires state certificationIn-person assistanceSome phone assistanceDrop off applicationsPEAK kiosks/computersScreens individuals for PEProgram provides immediate temporary medical coverage for outpatient services for pregnant women & childrenPresumptive Eligibility (PE) is a Medicaid and Child Health Plan Plus (CHP+) program that provides immediate temporary medical coverage for children under 19 and pregnant women. The client must complete an application and appear eligible to get the temporary health care benefits. PE sites have limited access to CBMS.
8 Hospital Outstationing 63 out of 77 hospitals that are part of the Provider Fee ProgramThrough Colorado HB , the Colorado Health Care Affordability Act, funding has been made available to support outstationing activities provided by eligible hospitalsOutstationing levels of participation:Level 1 – Basic OutstationingLevel 2 – CAASLevel 3 – PE SiteLevel 4 – MA SiteLevel 5 – MA Site SponsorHospitals 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.Hospital Outstationing - The Colorado Department of Health Care Policy and Financing has established the Hospital Outstationing Grant Program which provides funds to eligible hospitals to offset the costs of offering outstationing activities to individuals and families seeking financial assistance for health care services (Medical Assistance Applicants).
9 10 MA Sites stationed within 27 clinics & health centers & MAXIMUS Medical Assistance Sites (MA)10 MA Sites stationed within 27 clinics & health centers & MAXIMUSMAXIMUSState funded contractIn-person assistancePhone assistanceDrop off applicationsEach MA Site has their own business process:State contract requiredSome phone assistancePEAK kiosks/computersUtilizes CBMS & assists applicants in applying for:Medical AssistanceOther programs (at certain sites)A Medical Assistance (MA) Site is a designated site certified by the Department of Health Care Policy and Financing (Department) to accept and process the State authorized medical assistance application for the programs that are administered by the Department. The Department was authorized to establish MA sites by Statute (CRS et seq). MA Sites use the Colorado Benefits Management System (CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Medicaid programs.
10 QUESTIONS ABOUT HCPF OR MEDICAL ASSISTANCE SITES
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 presentationAfter 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 certifiedEach person will need to print their test results and send them to the CAAS Administrator in order to be issued a certificate of completionNow let’s get into the specifics of a CAAS.
12 CAAS Staff Expectations Review all CAAS training materialsAssist 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 daysFollow 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 completeVerify documents presented by an applicant using one of the processes identified in this presentationEnsure page 11 of the SSAp is signed prior to the applicant leaving, and if applicable, ensure the applicant has signed page 3 of WORKSHEET DNEATLY 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 lettersSubmit your site’s quarterly report on time per the submittal dates listed on each site’s excel spreadsheetRead 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 164Encrypt all containing PHI, turn documents facedown, never leave documents out when you leave your deskNotify 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 ReportHCPF staff are required to notify our security officer of any document containing PHI received via non encryptedLog 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 sitesCounties needing to contact or locate a CAAS, Presumptive Eligibility (P.E.) or Medical Assistance (M.A.) siteCounties to verify a site is authorized by the department to provide application assistance and verify citizenship and identity documents
20 What You Will Learn Today Facts to help you answer applicant & member questionsInformation to help you assist applicants through the Medical Assistance application processInformation 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 InsuranceNo monthly or annual enrollment feeMembers pay no or very low co-pay amounts depending on the populationFor example, children, pregnant women, & American Indian/Alaska Natives are some examples of populations who do not pay co-paysSo what is Colorado Medicaid?Colorado Medicaid is a public health insurance program for Coloradans who qualify; typically individuals or families with very low-income .Children, pregnant women, parents & caretakers, people with disabilities, & adults can all potentially qualify.There are no enrollment fees, & co-pays amounts range from $2 to $10.$2 being for something like an eye exam & $10 being for an overnight hospital stay.It is also important to note that while the co-pays are low, there are several populations who are not required to pay co-pays at all including:ChildrenPregnant womenAmerican Indian/Alaska Natives
24 Who Does Medical Assistance Serve? CitizensQualified Non-CitizensUnqualified non-citizens facing emergency medical situationsPeople with limited income & resourcesMedical Assistance serves people with limited income & resources including:CitizensUnqualified non-citizens facing emergency medical situationsQualified non-citizens, although they are usually subject to a five year waiting periodHere are some additional facts about Medical Assistance:Medical Assistance is the Largest source of medical & health related funding in the United StatesMedical Assistance Covers 60 million people in the United StatesMedical Assistance Covers over 1 million Coloradans
25 Child Health Plan Plus (CHP+) What Kinds of Colorado Medical Assistance PROGRAMS are there?And now the moment you’ve been waiting for, let’s talk about the different kinds of Medical Assistance programs available through the state. The State of Colorado administers two main types of Medical Assistance programs, they are Medicaid & Child Health Plan Plus aka CHP+.Let’s talk about Medicaid firstMedicaidChild Health Plan Plus (CHP+)MAGI (Modified Adjusted Gross Income)AndNON MAGI
26 MAGI & Non-MAGI at a Glance MAGI PopulationsAge 64 & youngerNot eligible for MedicareLow income:ChildrenAdultsPregnant WomenParents or Caretakers of a Medicaid eligible child that is under the age of 19Non-MAGI PopulationsLow-income individuals who meet any of the following:Age 65+BlindDisabled by Social Security Administration (SSA) standardsLet’s talk about some of the key differences between MAGI & non-MAGI:MAGI Populations are low income individuals who are:64 years of age and younger &Not eligible for MedicareNon-MAGI populations are low income individuals who meet any of the following criteria:Are age 65 and olderBlind orDisabled
27 What is CHP+?Public Health Insurance for children & pregnant women onlyAnnual enrollment fees range from $25 - $105 depending on income, population, & number of children enrolledMax out of pocket expenses/co-pays is 5% of gross annual incomeChild Health Plan Plus is public low-cost health insurance program for certain children and pregnant women who earn too much to qualify for Medicaid, but not enough to pay for private health insurance.Enrollment fees vary depending on the number of children enrolled, but there is no enrollment fee for Pregnant women.Similar to Medicaid, the co-pay amounts are low, and vary from $2 to $15, and American Indians/Alaskan Natives are not required to pay co-pays.
28 How are Medicaid & CHP+ Different? No enrollment feeMembers can be covered under another insurance policy at same timeIncome limits lower than those for CHP+All populations potentially eligibleAnnual enrollment feeMembers cannot be covered under another insurance policy at same timeIncome limits higher than those for MedicaidOnly covers children & pregnant women
29 So who Qualifies for Medical Assistance? ItDependsSo now you know the difference between Medicaid and CHP+, but you probably want to know more about what the specific requirements are right?You may know there are certain income guidelines, and rules to what makes up a household; but you’re eager to find out if a applicant will or won’t qualify for Medical Assistance .Well the eligibility requirements for Medical Assistance are not easy to explain or understand & there are exceptions to almost every rule.So the simple answer to who qualifies?**click**It depends
30 Applicant & Member Focused New HCPF WebsiteColorado.gov/HCPFApplicant & Member FocusedThis is the HCPF website.It’s been designed to be member focused and easy to use.We’re going to show you how to use this new website as a tool when talking to potential applicants about the Medical Assistance programs.So lets assume that Lisa here comes in and wants to get insurance through the Marketplace.Lisa has heard that she might qualify for a tax credit on the marketplace and wants to know how she finds out, because open enrollment is starting soon.You ask her if she has a Medical Assistance denial and she has no idea what you’re talking about.So You explain to Lisa that Medical Assistance is public health insurance and tell her that the benefits and co-pays vary depending on what program she’s eligible for.Lisa thinks that’s pretty neat and would like to learn more about the different programs, so you pull up the HCPF website and click on “Explore Programs & benefits”
31 About ApplyingIndividuals who are eligible for Medical Assistance are automatically enrolled in the appropriate programIf 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 MarketplaceApplicant can choose to simultaneously apply for Medical, Food, & Cash assistance on one applicationBefore Lisa applies for Medical assistance there are a few things you want to tell her:If she fills out the Medical Assistance application for her family, those found eligible for Medical Assistance will be automatically enrolled. Lisa or her family can opt out of Medical Assistance at any time, but they will not be eligible to receive a tax credit or cost sharing reductions for the Marketplace if they do. If after opting out Lisa and her family want to be re-enrolled in Medical assistance, they will need to re-apply.Another thing Lisa should know is that starting on November 9th, 2014, when she applies for Medical assistance through PEAK her information is automatically being checked to see if she qualifies for Advanced Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR) at the same time. If she isn’t eligible for Medical Assistance, when she receives her denial notice she will also be told how much financial assistance she can get through the market place.Lastly, Lisa should know that when is applying for Medical Assistance she can also choose to simultaneously apply for Food & Cash assistance, depending on how she applies.
32 What is Needed to ApplyName, address, & contact informationSocial Security numbers (or document numbers) for each member of your household to be covered by your planBirth datesIf someone in your home is pregnant, the due date & number of babies for that pregnancyInformation & policy numbers for health insurance plans currently covering members of your householdAsset & expense information for the household if anyone in the home is disabledLisa probably wants to know what information she needs to gather before applying, so you give her this list:**read list**Income information may not be needed at time of application. If applicants income information IS needed, the applicant will receive a notice in the mail. The applicant has 90 days to provide the information requested.
33 May get immediate determination (medical only) Colorado.gov/PEAKFastest method!May get immediate determination (medical only)Can simultaneously apply for Medical, Food, & Cash assistanceThere are four ways to apply for benefits.PEAK is the fastest method as it hopefully results in real time determination and at the end of the application process, the client will know if they are eligible for Medicaid or are receiving tax credits for The Marketplace.
34 Can apply in person at:County DepartmentsMedical Assistance (MA) sitesCertified Application Assistance Sites (CAAS)
35 To apply by phone call:TDD:Can only apply for Medical Assistance over the phone
36 To apply by mail or fax:Print out application onlineOr request a printed copy Colorado.gov/hcpf/form/ paper-application-request
37 Who Do I Include in an Application? ApplicantApplicant’s spouseApplicant's children under 19 who live with themAnyone on applicant’s federal income tax returnThis could include children over 19, even if they do not live with themApplicants unmarried partner who needs health coverageAnyone 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 applicantAll other members of that federal tax filing household that are claimed as dependentsAny family member living with the applicantOnly include roommates in household that are related to the applicant or listed on applicant’s federal income tax returnIf in doubt about a specific person, a good rule of thumb is to add that person to the application.County eligibility workers & CBMS will only use the appropriate individuals when calculating each persons household and income amount.
39 Program Specific Income Guidelines Specific income guidelines are available on the hcpf website, but we should warn you that these charts are not always as straight forward as they appear.For example, these are the 2014 income guidelines for MAGI programs. You will notice that the income limits for Parents & Caretaker Relatives is 107% of the FPL.**1st click**What this chart doesn’t tell you is that this 107% limit doesn’t really matter because if a parent or caretaker relative makes more than 107% of the FPL they can still qualify for…**2nd click**Medical assistance through the MAGI Adults category, so long as their income limit is less than 133% FPL.We are dealing with federal rules here people, the state of Colorado did not makes these rules up themselves.
40 COhealthinfo.com/FAQs/ Answers to Other Application QuestionsFindCOhealthinfo.com/FAQs/
41 Kinds Of Help Available To Members FAQ’s Colorado.gov/hcpf/member-faqsCall or visit your county Department of Human / Social ServicesContact Medicaid Customer Contact Center:Toll Free:TDD:Contact CHP+ Customer Service:CHPPlus.org
43 PEAK Enhancements: November 2014 This presentation has been created by the PEAK Outreach Team, an initiative committed to informing and contributing to the development of the PEAK website and supported by Boulder County, Colorado Health Foundation and the state agencies associated with the website.Today’s presentation has been informed by the work of many people and we appreciate the many staff from various state agencies, including our collaborating training colleagues from the Economic Security Staff Development Center and Connect for Health Colorado.Today’s presentation is a spotlight on the PEAK enhancements effective November 9th.PEAK Enhancements:November 2014
44 Open Enrollment and Re-Enrollment Many of the November changes to PEAK reflect an integration of public health insurance such as Medicaid and CHP+ and private health insurance financial assistance through the Connect for Health Marketplace. Because of this integration we want to highlight elements of the open enrollment and re-enrollment process.
45 Key PointsMedical 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, 2014In support of ease of access to affordable health insurance and as required by the Centers for Medicare and Medicaid Services Colorado has created a single application process to apply for insurance affordability programs.You may hear this system referenced as both Shared Eligibility System or Single Application Process. They are the same thing.
47 Key PointsSingle application and results for all insurance affordability programs: Medicaid, CHP+, APTC, CSRAccessible online via PEAK and Connect for Health Colorado websites; Single Sign-On optionNew questions added to determine Advanced Premium Tax Credits (APTC) and Cost Sharing Reduction (CSR) eligibilityAn Authorization number associates with APTC and CSRMixed eligibility households’ (e.g., APTC/CHP+) ongoing case management maintained by the MarketplaceA few high points of this new system and integration before we dive into specific application changes associated.
48 Single Application & Result States are required to provide a seamless, online experience for insurance affordability programs.System under continuous evolution and development to ease access. November changes are another step forward in our state’s effort.Other than the Early Childhood program additions, November PEAK changes are medical assistance-centric because of the efforts to streamline health coverage access.PEAK is a portal for multiple programs: food, cash and now early childhood in addition to Medical.It is a dynamic system, questions present based on programs applied for and household information.Today’s detailed content is focused on a Medical Assistance application because the questions being changed are for Medical Assistance, aka, not Food Assistance or other programs for which an applicant may apply on PEAK.
49 Shared Eligibility System We think of the Shared Eligibility System as the common street between two families who live across the street from one another. Each home is separate, yet they both travel the same street to go to work. The common street is the application for insurance affordability programs.PEAK separately provides a point of access to food/cash/early childhood programs while Connect for Health separately provides access to Marketplace insurance without financial assistance.This integrated system coordinates eligibility and movement across the associated eligibility thresholds, so that:APTC benefits may begin once Medicaid or CHP+ eligibility has ended.If an individual is Medicaid or CHP+ eligible due to 10-day noticing or continuous eligibility, they will not be approved for APTC/CSR until that coverage has discontinued.E.g., Medicaid discontinuance date is 11/2015 APTC eligibility begin date will be 12/2015.
50 Single Application & Result Single Sign On Single sign on allows a client to use one set of credentials (username & password) to access both sites.PEAK clients will be able to use their PEAK account credentials through the C4 site after they have submitted an application, change report or RRR in the new system (on or after 11/10/2014), and an eligibility determination has been made.For those who start in the Marketplace, as soon as the shared application is begun, credentials are available for use in PEAK.For those familiar with PEAK and the options available through Manage My Account, the full range of Manage My Account features is available to those with a PEAK account or those entering from Connect for Health through Single Sign On.
51 It is both a single application and a single result! So, families receive results as to all relevant eligibility from Medicaid and CHP+ to Advanced Premium Tax Credits and Cost-sharing Reductions available through the Marketplace.SCROLL! Lots of info on one page, may not see RTE until you scroll…Note Case #, Authorization number, Monthly Tax Credit Amount and Cost Sharing Reduction LevelAuthorization number only displays for those who have received APTC or CSR and ties their case to their APTC or CSRIf a client goes straight to Shop from here, it starts the end-to-end process. If SHOP is not selected here, it is important to note the Case and Authorization Numbers so that they may be provided when the shopping experience is undertaken.
52 Application Changes As of November 10, 2014 Now we will dive into the application details that associate with this single application.Again, these questions are dynamic and we are focusing on the NEW questions that display when someone has chosen to apply for Medical Assistance on PEAK.
53 Application ChangesHelping you Apply has changed. On PEAK, Brokers and Health Coverage Guides do not have a field in which to provide their credentials. Certified Application Counselors do have a place to enter their credentials.
54 Application ChangesA fantastic addition of extensive Hover Text is available throughout the application. Everywhere that a blue question mark balloon appears help desk will display if the cursor is hovered over that blue circle.
55 Application ChangesLanguage about People in the Household has been revised.
56 Application ChangesIf yes is selected the further question as to where they will live when they return is asked. This information is gathered for marketplace financial assistance as premiums are rated by geographic location.
57 Application ChangesIf an individual has passed away in the same year that the household is requesting coverage, they can count as part of the household’s FPL. In addition, information about the deceased, including tax filing status and income will be needed to properly determine eligibility for other household members.
58 Application ChangesHover Text for who is exempt from requirement to purchase insurance includes C4 phone number for further information.
59 Application ChangesChanges to Tax-filer questions are aligned with IRS and intuitive – showing both yes and no options.Head of Household is an IRS tax filing status, it is not the same as PEAK head of household.If you are allowed to file taxes jointly, you may claim Married filing jointly on this application.APTC Eligibility and Tax Filing StatusA Tax Filer, who is ineligible for APTC/CSR because he/she receives Medicare, may still receive APTC/CSR for other qualifying members of their Tax Household.To be eligible for APTC/CSR, married individuals must file taxes jointly. There is an exception for married individuals if there is a domestic violence situation.
60 Application ChangesFurther detail for entering tax filing information.
61 Application Changes SSN is entered twice now for verification. Reasonable Opportunity PeriodA Reasonable Opportunity Period (ROP) is a period in time (90+1 Calendar days) during which an individual is eligible for Medical Assistance, APTC and CSR in order to allow time to provide any requested manual verifications, such as citizenship documentation.Individuals will be eligible for ROP when interfaces are not able to verify the following (and manual verifications are then requested):Citizenship/Non-CitizenSSNIncarceration (through interfaces)AI/AN StatusReasonable Compatibility Income
62 Application ChangesFor APTC and private health insurance, premiums and amount of APTC are partially based on rating areas based on geographic location. This captures information for people who live in different locations to ensure correct calculation of APTC and premiums, if applicable.If a member of the home lives outside of Colorado, the rating is based on the Colorado address of the primary contact.Examples of when these fields would be relevant include children on the application who attend college in a different town or different state.
63 Application ChangesIncarceration status, with associated Hover Text, has been added to Med Apps.
64 Application ChangesIn PEAK anyone who is over 18 and part of the household, or an authorized representative, can be a secondary account holder.Secondary Account Holders can be removed by the primary account holder at any time. Secondary account holders can perform all of the functions as the primary account holder except removing other account holders. If a secondary account holder is removed, all authorization will be removed from that individual.For C4, primary account holders can designate a Brokers to complete MA applications and submit CRFs on their behalf. This access is not a function/feature of PEAK.
65 Application Changes: Income As of November 10, 2014Let’s look specifically at the changes or additions to application questions pertaining to income.
66 Key PointsIn 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 ChangesDeductions related to Job also, not just Self-EmploymentThe last question regarding conservator fees, etc., is new
68 Application ChangesExpenses for Self-Employment are more details and a window appears for monthly expense if that category is selected. This information is used to determine eligibility and amounts of Marketplace financial assistance.
69 Monthly vs. Annual Income A very significant revision is that there is now the opportunity to update annual income for those whose annual income is NOT monthly X 12.First, an estimated annual is generated by the system from their monthly; then there is a field wherein someone may enter their estimated actual annual income (e.g., self-employed, seasonal workers, etc.)Adjustments to Annual Income inform APTC/CSR calculations and may also affect Medicaid eligibility.In this scenario: Lori’s annual income is low, but based on her current month income, she would be denied for Medicaid. However, because her annual income is below 100% FPL, she would be approved for Medicaid starting the following month. If her annual income were between % FPL, she would be eligible for APTC/CSR.
70 Monthly vs. Annual Income Another scenario in the opposite direction:Max’s annual income is high, but based on his current month income, he would be approved for Medicaid. Although Max can input the correct annual amount, his current month income will take precedence and approve him for Medicaid. When he submits a change report for a change to his income, presumably, based on this financial scenario, his Medicaid eligibility would terminate and he would receive results that he is eligible for APTC/CSR.
71 Application ChangesSince "client statement' is valid for income, the verification checklist will not be created for MA or APTC. If there is discrepancy between IEVS and client attested income and if there is no "reason for income difference" then a IEVS letter will be sent asking for manual income verification. If a “Reason for Income Difference" is provided the letter will not be sent out.Reasonable Compatibility for IncomeAPTC/CSR reasonable compatibility is determined based on the income posted by the Income Eligibility Verification System (IEVS) interface which is a computerized information system which performs data matches against several agency data bases to verify certain types of income and/or property. These matches use the applicant’s name and Social Security Number (SSN) against such information as wages, unemployment or disability benefits, amongst others.Self-attested income is used for the initial eligibility determination and until the first IEVS interface. Information obtained through the IEVS interface is a quarter behind in timing.The earned income from IEVS is annualized to compare with the self-attested annual earned income.Discrepancies identified greater than 10% through the IEVS interface may trigger a correspondence requesting rationale for the discrepancy. Depending on information provided, a change in benefit eligibility or amount may result.(Eligibility processing for County Staff - if there is an open end-dated record in the Earned Income window, with a source other than Client Statement and the effective begin date is within the current or last month from the EDBC run date then the IEVS income will be ignored.)
72 Application ChangesNew questions have been added to gather information about other insurance which affects eligibility for Marketplace financial assistance.
73 Manage My Account As of November 10, 2014 Manage My Account is a function of PEAK with many features that allow (and empower) clients to access their benefit information, associated correspondence, ability to report changes and many other features.
74 Key PointsThe 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 IDThe process to link a PEAK account to a case remains the same.There is a new addition of a Client ID for those who do not have a State ID or Social Security Number.Clients enter either their SSN, State ID or Client ID, date of birth and 1B case number to link their case. Both primary and secondary account holders can use this function.
76 Link My Case – Client IDClients with existing cases but not SSN or State ID will be sent a speed letter (shown on the left) informing them they can create an account with this information. Newly approved clients will also receive this information on their approval notices.Note: Client ID is separate from State ID. Client IDs are assigned to all persons listed on an application, regardless of the programs they are applying for. State IDs are issued to those individuals applying for Medical Assistance.Client IDs are nine digits long.
77 Manage My AccountThe full range of My Account features are available to those with a PEAK or C4 account regardless of through which website they access the function.If a customer accesses My Account through the C4 portal, they will see the Marketplace color scheme and branding.
78 Report My ChangesMore detail has been added to the Report My Changes pages, including ability to add a SS#.
79 Application StatusView of Benefit Summary through Manage My Account.
81 ExamplesSame Sex-MarriageCitizenshipEmployer Health Insurance
82 Same-Sex Marriage Applications While the help text states that only same-sex couples that were married in other states may mark themselves as married, per the recent Supreme Court announcement, same-sex couples can legally marry in Colorado and may select married to this question.
83 Same Sex-Marriage Applications Associated hover text and tax-filing fields…
85 Citizenship StatusThis hover text informs that medical assistance for emergencies may be available for those who are not citizens or lawfully present. Please note that the PEAK application is NOT an application for Emergency Medicaid and a paper application must be used.
86 Citizenship StatusTo see a list of eligible immigration statuses, click the ? mark button on the upper right-hand side of the page.
87 Citizenship Status A list of eligible immigration statuses displays. For MAGI and Non-MAGI eligibility, an applicant must be a Lawful Permanent Resident for 5+ years, or have an eligible immigration status.To be eligible for Connect for Health Financial Assistance, an applicant must be a lawfully present immigrant (no 5 year bar) and file taxes with the IRS for the requested coverage year.
88 Employer Health Insurance Questions present asking about health coverage available through an employer and applicants provide requested information for the individual in the household who has access to employer-sponsored insurance. The person is selected and then the Add button is chosen.
91 Submit a QuestionFrom the Help Screen (?) and from ‘Contact Us’, several options display to seek additional information. The option to submit an online Medical Assistance question is available from the Click here hyperlink.An address is mandatory for this feature.
93 Instructional Guides & Recordings PEAK OutreachInstructional Guides & RecordingspeakoutreachColorado.gov/PEAK> Resources>Community Partners or Counties> TrainingMonthlySupport CallsLive WebinarsIn-person TrainingsSchedule a custom training bouldercounty.orgPEAK ViewDistributed monthly to all training attendeesProvides PEAK updates and webinar information
94 Help/ResourcesPEAK website training or questionsApplication and General Benefit InformationColorado.gov/health (>select FAQs) Colorado.gov/HCPFSubmitted Medical Assistance application statusGeneral Medical Assistance benefits information/ TDDFood or Cash application assistanceConnect for Health ColoradoConnectforHealthCO.com/ TDDPEAK technical issues such as an error messageA reminder as to the many sources of information and support for you or your clients.
97 No Wrong Door to Health Insurance PEAKConnect for Health ColoradoIn addition: Presumptive Eligibility (PE) sites; Medical Assistance (MA) sites; Certified Application Assistance Sites (CAAS) sites…Medicaid Client ServicesCounty Human ServicesApplication Assistance SitesCAAS, PE, MA and Hospital OutstationingMedicaid Client Services
98 Where can I find an application? Any Eligibility SiteDepartment Web Site (English & Spanish)CHP+ Web SiteColorado Program Eligibility Application Kit (PEAK)*Most sites have applications in English, Spanish and Large Print on site. Many sites offer assistance in other languages via a language line per request.
99 Applications by PhoneThe ACA will require states to accept electronic and telephonic signatures Requirement extends to the MarketplaceAcknowledging 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:OrPlace the applicant on hold and do a “warm” transfer to the number aboveThe Affordable Care Act envisions a single, streamlined, electronic application and verification process for health coverage that remedies many of the challenges and inefficiencies that exist in today’s public benefits system.The law ensures that individuals and families can obtain coverage in multiple ways by requiring states to accept applications online, in person, by mail, and by telephone. Effective assistance over the phone will play a key roleIn ensuring that health reform reaches the millions of Americans who will be newly eligible for coverage in 2014.
101 Components of the SSAp Standard Form Worksheet A Worksheet B Captures demographic information and information necessary to make a MAGI determinationWorksheet AHealth Coverage for JobsUsed for health coverage for purposes of the Marketplace onlyWorksheet BAmerican Indian or Alaska Native Family MemberUsed for Marketplace purposesWorksheet CAssistance with Completing this ApplicationUsed to establish an Authorized Representative & capture Certified Application Assistance Counselors/Brokers/etc.Worksheet DAdditional Information RequiredThis worksheet will be used to capture information for Non-MAGI (Aged, Blind, Disabled/LTC, MSP, Buy-Ins)Worksheet EAdditional PersonsProvides two additional worksheets for additional members (make copies if necessary)Appendix AGlossary – Provides terms and definitions from the applicationTalking point: Appendix A will have the Family relationship chart….
102 Assistance is available in the languages below and more SPANISHMANDARINVIETNAMESEKOREANRUSSIANARABICHMONGAMHARICNEPALISOMALIFRENCHGERMAN
103 Please make sure application is legible. Ask applicant to double check that home address, phone and if provided, address are correct!
104 *This refers to questions 10 & 11. For more information on Shared Responsibility Exemptions go to Appendix A (i), Glossary of Terms pg. 2 or healthcare.gov*This refers to questions 10 & 11.Long Term Care10 CCR – 8.499Please check if you have bills that you want to be considered for coverage.
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
118 If there are no additional people continue on to Appendix A (i) 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 siteCounties and medical assistance sites may be able to verify an applicants citizenship and identity via electronic interfaceCAAS 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 daysCAAS 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 verificationDEPARTMENT OF REVENUE, DIVISION OF MOTOR VEHICLES (DMV)Identification verificationINCOME AND ELIGIBILITY VERIFICATION SYSTEM (IEVS)Quarter/Year wage data that is four months prior to the run monthSVES SCHIP is the only interface that will be real time with PEAKWill 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 birthSSI and SSDI recipientsMedicare recipientsFoster childrenPE Clients
127 Acceptable documents for proof of Citizenship and Identity U. S. Passport (current or expired)Certificate of Naturalization or CitizenshipIndian Tribal DocumentNOTE: 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 CardNative American Tribal documentFinal adoption decreeOfficial military record of service showing a U.S. place of birthNOTE: 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 ListPRIMARY LIST (expired documents are not acceptable) Alien Registration Receipt/Permanent Resident CardCertificate of U.S. CitizenshipColorado Department of Corrections ID cardCO Temporary Driver’s License Form (with hole- punched Driver’s License)Employment Authorization Card (I-766)Foreign PassportPhoto Driver’s LicensePhoto ID Card (DMV)School, University or College ID Card (must be current)Temporary Resident CardUNITED STATES: B1/B2 Visa card with I-94Certificate of NaturalizationCitizenship ID Card (I-197)Military ID CardPassportSECONDARY LISTAcknowledgment of Paternity documentCourt order of adoption or name changeDD-214Hospital 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 cardMerchant mariner cardSocial Security, Medicare or Social Services Card (Medicaid, WIC)State or federal prison or corrections cardTribal ID CardWork ID, Paycheck Stub (within 3 months), or W-2UNITED STATES: Birth Certificate of Applicant Divorce Decree Marriage license Motor vehicle registration or title Selective Service Card Weapon or gun permitAny 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 documentAgency name as it appears in the Mapping ToolName and signature of staff who viewed documentsAgency addressAgency phone numberDate of document verificationWrite “verified original” above agency informationWrite PEAK tracking number on each document if application was submitted onlineSubmit 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 staffVERIFIED ORIGINAL(S) _√_ PEAK TRACKING # ________________________
132 Falsified DocumentsCAAS 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 purposesCAAS should not knowingly verify falsified documentsDo not verify documents if you have doubtsDo not verify faxes or photocopies of documentsMust only use information as provided by the applicantCannot refuse to include or eliminate information whether or not the applicant provides supporting documentation
134 CAAS RESPONSIBILITIES All pages of the application (complete or incomplete) must be forwarded to an eligibility site within 5 business daysCAAS will continue to verify citizenship and identity documents if presented, but will not hold an application for any missing information or documentationCAAS 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 changesCAAS 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
135 Best PracticesMake sure the applicant has signed page 11 of the application, and if appropriate page 3 of WORKSHEET DAttach a note identifying missing or incomplete documentationDate stamp all applications processed and forwarded by your siteDo not date stamp applications for applicants choosing to hand deliver
136 Best PracticesStamp or write your entire CAAS site name and number on all CAAS related documents and communicationsmessages 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 messagesProvide 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 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: getcoveredco.org or ConnectforHealthCo.comPhone: PLANS-4-YOU ( ) TTY/TDDMedicaid Client ServicesWebsite: colorado.gov/hcpfPhone: orFax:MedicareWebsite: medicare.govPhone: MEDICARE ( )State Health Insurance Assistance Program (SHIP)Phone:Social Security AdministrationWebsite: ssa.govPhone:State Managed Care Network (CHP+)Website: ChpPlus.orgPhone: orXerox (Medicaid Fiscal Agent)Phone: or
140 Eligibility Site Program Contacts Presumptive Eligibility (PE) Site Program:Georgann Garcia * PE Specialist *Hospital Outstationing Program:Brian Knight * Hospital Outstationing Contract Mgr *Medical Assistance Site Program:Monica Owens * M.A. Site Program Manager *
141 Certified Application Assistance Site Program Contacts Please send all CAAS related communications to: