Child Health Plan Plus (CHP+) Colorado Community Partners… Keeping Colorado Kids Healthy

Department of Health Care Policy and Financing The Department of Health Care Policy and Financing is the state department that administers Child Health Plan Plus (CHP+) and other medical programs for low income families, persons who are blind or persons with disabilities and the elderly.

Who is MAXIMUS? The Department contracted with MAXIMUS, Inc. in January 2006 to increase CHP+ marketing, outreach, and enrollment Regional Outreach Coordinators work for MAXIMUS

What does a Regional Outreach Coordinator (ROC) do? The ROCs are employed by MAXIMUS to increase pubic awareness of CHP+ through: Education Program Resources and Referral Support Training on CHP+ and application assistance to professionals and families Participation in community events

For Marketing and Outreach Purposes Only

What is CHP+ & Medicaid? CHP+ – Low-cost health insurance for Colorado children and pregnant women who exceed the income guidelines for Medicaid eligibility Medicaid – Low-cost health insurance for Colorado children, pregnant women, parents with dependent children, the elderly, and people with disabilities

Who is eligible for CHP+ ? Children who are 18 years old and under Not eligible for Medicaid Within income guidelines Not covered by other health insurance Colorado residents US citizens or legal permanent residents for at least 5 years Unable to access health insurance as an employee or child of an employee through the State of Colorado

Who is eligible for Medicaid? Children who are 18 years old and under Parents caring for dependent children who are enrolled in Medicaid or CHP+ Pregnant women Within income guidelines Colorado residents US citizens or legal permanent residents for at least 5 years Some exceptions to 5 year ban Okay to have another form of insurance

What does CHP+ cover? Medical Services Well-child check-ups and physicals Immunizations (shots) Doctor visits Hospital services Mental health services Eye care and eye glasses Hearing aids Prescriptions (medicine) Prenatal care Dental services ($600 each calendar year for children)

What does Medicaid cover? Medical Services Well-child check-ups and physicals Immunizations (shots) Doctor visits Hospital services Mental health services Eye care and eye glasses Hearing aids Prescriptions (medicine) Prenatal care Dental services (children age 21 and younger, adults extractions only)

Who is eligible for the CHP+ Prenatal Care Program? Pregnant women who are: 19 years old and over Not eligible for Medicaid Within income guidelines Not covered by other health insurance Colorado resident US citizen or legal permanent resident for at least 5 years Unable to access health insurance as an employee or child of an employee through the State of Colorado

What does the CHP+ Prenatal Care Program cover? Prenatal care visits Other doctor visits Hospital services including delivery Medications/Prescriptions Mental health services Postpartum care (limited) Vision services Dental services are not covered

How long does CHP+ Children coverage last? -12 months from the received date of application Members receive a renewal packet in the mail up to 60 days prior to coverage ending Packet is to be returned to CHP+ with current proof of income and any required documents immediately

How long does Medicaid coverage last? 12 months from the received date of an application Members receive a renewal packet in the mail up to 60 days prior to coverage ending Packet is to be returned to Department of Human/Social Services with current proof of income and any required documents immediately

How long does CHP+ Prenatal Care coverage last? From the enrollment date at least 60 days after the pregnancy ends Baby born to a CHP+ enrolled mother is automatically guaranteed 12 months of enrollment effective as of baby’s date of birth CHP+ must be notified of the baby’s birth in order to enroll child

Income Guidelines for CHP+ & Medicaid

What expenses should be listed on the application? Child care and elder care expenses Medical/prescription expenses Health insurance premiums Outgoing and incoming child support and alimony Expenses must be from the same month as the income being reported Some or all of these expenses will be deducted from the family’s income to determine eligibility

What is acceptable proof of income? Paycheck stubs At least one paycheck stub with pay date in previous or current month OR Signed written document from employer Exact gross income from previous month OR Exact hourly wage, hours worked, how often paid, and date of last paycheck

What about self-employed applicants? Profit and loss statement for previous or current month must be included OR Complete self-employment section - the ledger - on the application

What is Presumptive Eligibility (PE)? Temporary health care insurance for children and pregnant women while their eligibility is being determined PE Coverage is no less than 45 days PE Site list available: CHPplus.org/materials/PESiteList.pdf

What is Presumptive Eligibility (PE)? Allows immediate access to health care Medicaid PE for children: includes all Medicaid-covered services Medicaid PE for pregnant women: includes only outpatient services CHP+ PE: includes all CHP+ and inpatient services - except dental benefits

Cost for CHP+ family Some families pay nothing Annual premium -$25 for 1 child, $35 for 2 or more kids $0 - $5 co-pay for each office visit $0 - $15 co-pay for emergency room and hospital visits No co-pay for check-ups No enrollment fee or co-pay for prenatal care; non-pregnancy related services may have a co-pay

Cost for Medicaid family No annual premium No co-pays for children No co-pays for pregnant women

Joint Application Determines eligibility for Medicaid and CHP+ Applications are checked for Medicaid eligibility first, then CHP+ Available in English and Spanish Available at CHPplus.org or Colorado.gov/hcpf or Department of Human/Social Services Offices or by calling toll free: 1-800-359-1991

Points of Clarification Question 1: Use legal names Include mailing address if different from physical address Must include at least 1 phone number Question 3: List all members of the household even if the person is not a family member Make a copy of this page if more than 8 people live in the household

Points of Clarification Question 4: This information is for any child in the family Question 5: If anyone in the household is pregnant, be sure to complete this entire section

Points of Clarification Complete one page for each child applying; if needed, make a copy of this page for each additional child Add child’s full name including middle initial Include only natural or adoptive parents living in the home (don’t include step-parents in this section) Alaskan Native or Native American applicants: check box in order to receive fee exemptions

Points of Clarification Question 2: If applicable, write alien registration number on the line and make a copy of both sides of resident card to include with the application Question 4: Medicaid will allow up to 3 months of backdated coverage; CHP+ does not back date and enrollment begins the day an application is received and date-stamped by a CHP+ partner organization

Points of Clarification Question 5: Applicants who have access to Colorado State Government health benefits do not qualify for CHP+ but may qualify for Medicaid Question 6: Pre-existing conditions do not impact eligibility If yes, child may qualify for other programs

Points of Clarification ONLY Pregnant women and adults 19 years and older in the household applying for health insurance will complete this form Permanent legal residents must include a copy of both sides of the resident card with the application

Points of Clarification Questions 1 and 2: Only refer to those applying for benefits If anyone applying is/ was covered by other health insurance, complete ALL fields in the appropriate section Include a copy of both sides of the health insurance card for question 1 if available

Points of Clarification List all working members of the household and their income details Question 1: Self-employed workers must complete this section OR submit a profit and loss statement showing income and expenses for either the current or previous month Question 2: List all other income for all household members here

Points of Clarification List all allowable expenses/income deductions for each member of the household Blue box: Applicant must include HMO choice or the State Managed Care Network depending on the county of residence (refer to application insert)

Selecting an HMO for CHP+ An HMO is a group of doctors, nurses, hospitals, and other providers who care for members An HMO manages the health insurance benefits that CHP+ offers Applicants must select an HMO or the State Managed Care Network, depending on the county of residence For a complete list of HMOs available in your county, see: CHP+ deskguide for professionals Health Plan Comparison Chart Insert (in application) CHPplus.org

What is the pre-HMO enrollment period? All CHP+ members have a pre-HMO enrollment period Provides medical coverage from received date of application up to HMO/Dental effective date. Provides medical care immediately so members don’t have to wait The pre-HMO coverage is through the State Managed Care Network Members will receive a temporary identification card during this time Dental services are not covered during this time

Points of Clarification All adults 19 or older applying for health coverage must sign here Parents or guardians applying for health coverage for their children must sign name, print name, and write the date here

Verification may be required by applicants Because applications are reviewed for both Medicaid and CHP+, applicants may be asked to provide original or certified copies of documents proving the identity and citizenship of all who are applying Clients must provide the original copies to the Certified Application Assistance Site or the county to be verified

Verification may be required by applicants An insert explaining the documents required is included in each application List of documents and organizations where original documents can be verified: Colorado.gov/cs/Satellite?c=Page&cid=1226307681414&pagename=HCPF%2FHCPFLayout

Verifying Documents for Medicaid For US Citizens or legal permanent residents Applicants must present an original or certified copy, never a photocopy Exemptions include: PE clients, Needy Newborns, SSI and SSDI eligible clients, current Medicare recipients, and Foster Care children

Certified Application Assistance Sites Agencies that assist families in completing the “Colorado Public Health Insurance for Families Application” Certified to verify citizenship and identification documentation

Expectations of a Certified Application Assistance Site A certified agency must: Agree to Department rules, regulations and agency letters. To view these documents, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/1226307681414 Train all staff on the process for completing an application and how to verify citizenship and identity documents.

Expectations Continued . . . A certified agency must also: Complete an “Certification Site Application” also know as Certified Application Assistance Site Application, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/1226307681414 Submit completed applications and all documentation to their local county within five business days.

Citizenship and Identity Documentation A passport (current or expired) can be used to establish both citizenship and identity

Citizenship Documentation Examples of acceptable citizenship documents: U.S. birth certificate Certificate of birth abroad U.S. Nation ID card Native American Tribal document Final adoption decree Official military record of service showing a U.S. place of birth Religious/School records

Identity Documentation Examples of acceptable identity documents: Driver’s license or state ID card with photo ID card issued by a federal, state, or local government agency U.S. military card or draft record or U.S. Coast Guard Merchant Mariner Card School ID card with photo Verified school, nursery or daycare records (for children under age 16) Clinic, doctor or hospital records (for children under age 16)

Written Affidavits Can only be used when other documentation is not available Can only be used to prove either citizenship or identity, not both Affidavits do not need to be notarized

Submitting Certified Documents - Option 1 A photocopy of the original or certified document, with the following information either stamped or written on each copied document: Agency name Name and signature of staff who viewed documents Agency’s full address Agency’s phone number Date documents are verified Write words “verified original” above stamp or agency information on each document

Submitting Certified Documents – Option 2 A photocopy of the original or certified documents attached to the “Citizenship and Identity Documentation Received” form

What happens if falsified documents are submitted? Sites are verifying that documents submitted are original or a certified copy If doubts or reservations about a submitted document, do not certify the document; refer the client to local county office Sites should not knowingly accept documents such as a fax or photo copied birth certificate; all documents must have a visible stamp or the required certification information on it

Submitting Applications Applicant must sign and date the last page of the application Send applications to the county Department of Human/Social Services in which the applicant resides, or: CHP+ PO Box 929 Denver, CO 80201

How does an applicant follow up? All communication is sent directly to the applicant, not the Certified Application Assistance Site Eligibility should be determined within 45 days If an applicant has not been notified, contact the agency to which the application was submitted

Appeal Process Clients can appeal an eligibility decision They will be notified by mail of their appeal rights and instructions on how to proceed if their application is denied They have 30 days from the date on the denial letter to appeal the decision Appeals must be submitted in writing

Resources CHPplus.org Colorado.gov/hcpf CHP+ Customer Service: 1-800-359-1991 Medicaid Customer Service Denver Metro: 303-866-3513 Toll free: 1-800-221-3943