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CORPORATE OFFICE 425 E. Colorado St., Suite 410, Glendale, CA 91205 800-543-3003 with Satellite offices in Northern and Southern California 1.

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Presentation on theme: "CORPORATE OFFICE 425 E. Colorado St., Suite 410, Glendale, CA 91205 800-543-3003 with Satellite offices in Northern and Southern California 1."— Presentation transcript:

1 CORPORATE OFFICE 425 E. Colorado St., Suite 410, Glendale, CA 91205 800-543-3003 with Satellite offices in Northern and Southern California 1

2 Agenda  HPE (Hospital Presumptive Eligibility)  HPE Application  Non-MAGI (Non-Modified Adjusted Gross Income)  MAGI (Modified Adjusted Gross Income)  Completing the Medi-Cal / Streamline application to ensure:  Compliance  Continuity of Eligibility  Retro Coverage  HPE’s Effects on the Revenue Cycle Goals 2

3 Hospital Presumptive Eligibility (HPE) The Hospital Presumptive Eligibility (HPE) program provides individuals with temporary, no cost, Medi-Cal benefits for up to 60 days. Those potentially eligible for HPE benefits are:  Children (ages 0 – 19)  Parent(s), caretaker relatives  Pregnant women  New adult group (ages 19 – 64)  Former foster care children between the ages of 18 – 26 3

4 Hospital Presumptive Eligibility (HPE) Eligibility timeframe:  HPE period lasts up to 60 days  HPE does not go retroactive  HPE begins the first day of the month the HPE application is approved and ends the last day of the following month  To extend Medi-Cal benefits, applicant must submit a full Medi-Cal application prior to HPE termination 4

5 Hospital Presumptive Eligibility Program PROS AND CONS 5

6 HPE PROGRAM PROS  HPE Medi-Cal determination will be conducted in real-time  HPE Medi-Cal provides benefits up to a two month period  HPE Medi-Cal minimizes the financial liability for difficult patients types such as homeless and mental health patients  HPE Medi-Cal offers immediate coverage to those services that yield higher medical costs such as Trauma patients and NICU 6

7 HPE PROGRAM CONS  HPE Medi-Cal offers no retroactive coverage  HPE Medi-Cal can only be processed once every 12 consecutive months with the exception of children between the ages of 0 – 19, CHDP patient and pregnant women  HPE Medi-Cal cannot be performed if there is a pending application 7

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10 NON - MAGI Non-MAGI (Traditional Medi-Cal)  Linkage  Under 21 years old  Over 65 years old  Pregnancy  Minors in the home with deprivation (absent or deceased parent, unemployed or underemployed parent or incapacitated parent)  A disability that will last a minimum of 12 consecutive months  Income  Assets 10

11 MAGI Medi-Cal  Eligibility  Ages 19 to 64  Income based on Federal Poverty Level (FPL) – Under 138% of the FPL  Residency  Citizenship  No Asset Test 11

12 MAGI Medi-Cal 12 2015 Federal Poverty Level Family Size 100% FPL 138% FPL 150% FPL 250% FPL 300% FPL 350% FPL 400% FPL 1$11,670$16,105$17,505$29,175$35,010$40,845$46,680 2$15,730$21,707$23,595$39,325$47,190$55,055$62,920 3$19,790$27,310$29,685$49,475$59,370$69,265$79,160 4$23,850$32,913$35,775$59,625$71,550$83,475$95,400 5$27,910$38,516$41,865$69,775$83,730$97,685$111,640 6$31,970$44,119$47,955$79,925$95,910$111,895$127,880 7$36,030$49,721$54,045$90,075$108,090$126,105$144,120 8$40,090$55,324$60,135$100,225$120,270$140,315$160,360 For families/households with more than 8 persons, add $4,020 for each additional person

13 HPE’s Effect on the Revenue Cycle Goals  Increase in eligible patients  Increase in revenue  Reduction in uninsured visits and charity write-off’s  Reduction in ER services and an increase in primary care clinics 13

14 CAN WE BE OF FURTHER ASSISTANCE? Bill Haddad President/CEO COMPSPEC, Inc. 425 E. Colorado Street Ste. 410 Glendale, California 91205 Office#: (818) 638-6200 E-Mail: BHaddad@compspec.com Shelle Murph-Mitchell Director COMPSPEC, Inc. 425 E. Colorado Street Ste. 410 Glendale, California 91205 Office#: (818) 638-6133 Cell #: (818) 530-8533 Fax#:(818) 638-6233 E-Mail: SMurph@compspec.com 14

15 C OMP S PEC, Inc. Questions? 15

16 COMPSPEC, Inc. Thank You. 16


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