1. Master Integrated Eligibility Presentation April 2014

2. Last Updated 04/2014 Table of Contents 2 Purpose of Document To provide resources to County Directors to help educate County Commissioners, Community Partners, and Non-MAGI County Staff on the Integrated Eligibility project. TopicPage Ohio Integrated Eligibility Overview 3 – 9 How Medicaid is Changing 10 – 14 Presumptive Eligibility 15 – 18 Medicaid Extension 19 – 21 From a County Commissioner’s Point of View 22 – 24 From a Community Partners Point of View 25 – 34 From a County Worker’s Point of View 35 – 40 From a Resident’s Point of View 41 – 48 Appendix 49 – 53

3. Last Updated 04/2014 Ohio Integrated Eligibility Overview 3

4. Last Updated 04/2014 Why is Ohio Adopting Integrated Eligibility? Current eligibility determinations for Health and Human Service programs in Ohio are fragmented, overly complex, and rely on a 30-year-old legacy technology. The Ohio Integrated Eligibility system will be implemented in phases over the next 18-24 months, improving care for Ohioans, increasing program efficiencies, and reducing costs for Ohio’s taxpayers. 4 Current health and human services eligibility policies leave gaps in coverage. Federal funding is available to eliminate the coverage gap. Federal funding is available to simplify and automate eligibility systems. Ohio law requires eligibility modernization. Applying for health and human services is confusing and time consuming. What This Means… Why Is Ohio Taking Steps to Address these Challenges Now…

5. Last Updated 04/2014 The future vision for Ohio Benefits is to be an all encompassing platform for all healthcare related programs in Ohio The Integrated Eligibility system gradually replaces the existing self-service portal (eGateway) and CRIS-E platforms Medicaid applications are the first benefit to be processed through the new Ohio Benefits self- service portal and Ohio Integrated Eligibility system with coverage starting January 1 st 2014 Other benefits programs including SNAP and TANF will continue to run through eGateway and CRIS-E, until they are incorporated in future phases of the project Eventually other income-tested Health and Human Service programs will be transitioned into Ohio Benefits and the Ohio Integrated Eligibility system 5 Ohio’s Integrated Eligibility Vision C URRENT S TATE T RANSITION F UTURE S TATE Phasing out of e-Gateway & CRIS-E Incorporation of Ohio Benefits and the Integrated Eligibility system E-Gateway & CRIS-E

6. Last Updated 04/2014 Objectives The Ohio Integrated Eligibility and Organizational Change Management project will transform the state’s health and human services benefit delivery for years to come. The projects will: Redesign business processes helping county offices gain efficiencies Transform and improve the way over 15,000 county and state workers support Ohioans Improve the efficiency of state and local services Simplify eligibility following the new guidelines through automatic-technology processes Support multiple HHS programs servicing millions of Ohioans Optimize technology used by Health and Human Services 6 Ohio’s Integrated Eligibility Objectives

7. Last Updated 04/2014 7 In Person Ohio Benefits enables residents to apply for a variety of services 24/7 through a user friendly self-service website. Phone representatives are available to assist residents with Medicaid applications through the Medicaid hotline. Residents can still visit their local county JFS office to apply for benefits. Phone Online “No Wrong Door” Policy means there should be a single seamless process of applying for health coverage – regardless of how a resident applies through the Ohio’s self-service portal, at the local county office, the federal Health Insurance Marketplace, State or Federal Call Centers, etc. Residents have three channels to help them apply for Medicaid: Residents Will Have Multiple Channels to Apply for Medicaid Services

8. Last Updated 04/2014 8 Ohio Benefits websiteIntegrated Eligibility System For ResidentsFor County Case Workers The Ohio Benefits website is secure, multi-lingual (English, Spanish, and Somali) and integrates with the Ohio Integrated Eligibility System. It allows residents to create and access cases. Determine eligibility Calculate benefits Issue Notices of Action Case intake and management for Ohio residents are handled by this system. It includes applications submitted online, through the phone and in person. Check eligibility Fill out applications Report changes Tools Used to Collect and Process Eligibility Information

9. Last Updated 04/2014 9 The State of Ohio is committed to fostering a strong county-state partnership. The state has allocated an additional $28M in their budget toward supporting county partnerships through the County Change Readiness Network, support for Super Users in each county and training for MAGI and non- MAGI case workers The state has encouraged deep involvement of county workers, JFS associations and other key county stakeholders to design and build the new integrated eligibility system The Integrated Eligibility system brings a variety of specific benefits to counties. Frees up county resources by automating the simplest cases Allows county workers to re-focus their attention on the more complicated eligibility cases Affirms that case work is best done by the individual (self-service) and at the county level Eventually will fully replace a 30-year old CRIS-E system, which requires significant manual intervention and re- work due to an outdated system and policy updates to Medicaid eligibility determination We need your support. We are operating on an aggressive timeline to meet the technical requirements, as mandated by federal law During the future phases of the project there will be a focus on organizational transformation and business process improvement in county offices; this will require the support of everyone in the county to improve how we serve Ohioans There are going to be challenges with running two systems, diverting resources and trying to provide additional support when needed. We need your understanding and support during the multiple phases of this project to achieve the end goal of integrated eligibility Integrated Eligibility Key Takeaways

10. Last Updated 04/2014 How Medicaid Is Changing 10

11. Last Updated 04/2014 11 The Affordable Care Act (ACA) significantly changes state Medicaid program: Requires online near real-time, web-based application, verifications, and determinations Delinks Medicaid from other federal entitlement programs Uses new “Modified Adjusted Gross Income (MAGI)” methodology to determine income, household composition and family size Requires states to align systems and determinations with the new federal Health Insurance Marketplace Allows states to extend Medicaid coverage to additional adults Mandated “go-live” dates: Process applications for health coverage beginning October 1, 2013 With effective dates of coverage beginning January 1, 2014 Current Medicaid enrollment Eligible for Medicaid today but not enrolled Medicaid extension estimated eligible +231k +275k How is Medicaid Eligibility Changing?

12. Last Updated 04/2014 12 The new MAGI eligibility rules are defined across the country and Ohio has worked to apply this model by incorporating the following categories: Health care coverage for residents who apply for Medicaid under the new MAGI rules have benefits starting no earlier than January 1, 2014. In January all MAGI applicants will apply through Ohio Benefits and be processed with the new Integrated Eligibility system. MAGI methodology will NOT apply to Aged, Blind and Disabled categories. Non-MAGI Aged, Blind, Disabled Long Term Care/ Waiver Medicare Cost Share Recipients \ MAGI budgeting will apply to all cases deemed Covered Families and Children Medicaid, childless adults between 19- 65, and children who aged out of foster care in Ohio and are between 18-26. MAGI & Non-MAGI Groups

13. Last Updated 04/2014 13 MAGI rules are the new method of determining eligibility for Medicaid benefits for Covered Families and Children (CFC), and the new Medicaid extension coverage groups. MAGI rules do not apply to the Aged, Blind, and Disabled, Long Term Care and other populations. Refer to the Ohio Medicaid policy details for further clarification. MAGI Medicaid changes attempt to simplify the current Medicaid program by introducing: Fewer Medicaid categories Income calculations based on tax (IRS) definitions, family size and household income are calculated using tax-filing / standard filing units, in most instances Standard 5% income disregard for all MAGI categories Self-Attestation and Electronic Verifications are accepted Elimination of Asset Test (Only Non-Fin and Income Tests) Residents who believe they may be eligible for Medicaid using the new MAGI rules may apply for Medicaid through Benefits.Ohio.gov. New MAGI Rules

14. Last Updated 04/2014 14 Open Lines of Communication Public Awareness Materials Training Telephone Representatives Legislation Email Social Media Meetings Channels that are available to offer you support In-person Representatives County Coordinators – One per county County Readiness Managers – One per region Two-way communication Weekly teleconferences with County Coordinators Monthly in-person working sessions with County Readiness Managers Training Ohio customized Web-Based Training (WBT) for MAGI and non-MAGI workers Ohio customized Instructor Led Training for MAGI workers Training Environment with exercises for ILT and training simulation practice Online help available in the new Integrated Eligibility system Help Desk Residents – Leverage existing Ohio Medicaid Consumer Hotline County Staff – Leverage existing Ohio Department of Medicaid Technical Assistance Hotline for policy and technical issues Readiness Efforts & How We Will Ensure Success

15. Last Updated 04/2014 Presumptive Eligibility 15

16. Last Updated 04/2014 Presumptive Eligibility (PE) is: Process in which certain qualified entities are able to perform a simplified eligibility review and grant immediate medical assistance to people applying for Medicaid (or CHIP, if applicable)  Residents must provide: name, household size, and estimated monthly income Those determined presumptively eligible must complete the full Medicaid application process before their presumptive eligibility coverage ends to continue Medicaid coverage Who is Eligible for PE: Pregnant women (eligible once per pregnancy) Individuals who are in a family with a gross family income of no more than 200% of the FPL Must be a resident of the State of Ohio Cannot be an inmate of a public institution Cannot be currently enrolled in Medicaid Must be a U.S. citizen or qualified alien as defined in rule 5101: 1-38-02 3 of the Administrative Code 16 What is Presumptive Eligibility?

17. Last Updated 04/2014 When does PE begin? Once eligible, PE begins immediately on the date a qualified provider determines eligibility (not the day the PE application was filed) When does PE end? 1)When the resident is determined ineligible for full Medicaid 2)If a full Medicaid application is not filed, PE ends the last day of the following month in which the individual was determined to be presumptively eligible 3)When the resident is determined eligible for full Medicaid What Groups are Eligible? Who Can Submit PE Applications? What Type of Coverage is Available Through PE? Children Pregnant Women Parent Caretaker Deemed Newborns Adults Qualified Entities as determined by the Ohio Department of Medicaid Full Medicaid Services except for the Pregnant women category *Pregnant women only qualify for ambulatory prenatal care 17 Presumptive Eligibility Details

18. Last Updated 04/2014 The benefits that both residents and providers may receive through presumptive eligibility are highlighted below Residents Reduces the time for emergency eligibility-determinations. Allows prospective Medicaid beneficiaries to receive immediate, time‐limited access to medical services Provides a gateway into full Medicaid for Ohioans who may not have known they were eligible for full Medicaid benefits Gives pregnant, uninsured mothers access to prenatal care, providing multiple health benefits for the mother and baby Meets the needs of uninsured Ohioans at the point of care and assists them through the full Medicaid application process Providers Empowers Providers to perform temporary Medicaid eligibility determinations at the point of care Improves the continuum of care by ensuring that the PE recipient completes a full Medicaid application Guarantees the reimbursement of services rendered by the Provider to the PE recipient by Medicaid 18 Benefits of Presumptive Eligibility

19. Last Updated 04/2014 Medicaid Extension 19

20. Last Updated 04/2014 Gold: Marketplace Eligibility Blue: Current Ohio Medicaid Eligibility White: Coverage gap that will be covered by the extension of Medicaid Diagonal lines: Eligible for Ohio Medicaid Spenddown 20 Visual Medicaid Extension Population Information

21. Last Updated 04/2014 21 Medicaid Extension: FAQs Who? How many? Where? When? Who is newly eligible for Medicaid coverage? Adults between the ages of 19 to 64, who are between 0 – 138% FPL and are not eligible under another category of Medicaid. This new group includes parents between 91-138% of the FPL. How many Ohioans will be newly eligible under Medicaid extension? Through the recent eligibility change, Ohio is expected to see an additional 275,000 low-income residents come onto the Medicaid rolls. **Based on a monthly average through 2015 Where should the newly covered Medicaid population apply for benefits? Benefits.Ohio.Gov is accepting Medicaid applications for newly eligible adults. When can the group newly eligible for Medicaid coverage apply? Now! Residents can go to Benefits.Ohio.Gov to begin applying for Medicaid.

22. From a County Commissioner’s Point of View

23. Last Updated 04/2014 OCM Stakeholders To ensure counties are getting the information they need regarding the Ohio Integrated Eligibility project, the Organizational Change Management (OCM) team has been working directly and collaboratively with designated county personnel and other agencies. The change management activities outlined below highlight the type of work that has started and what will be executed to support county staff, community partners, and residents of Ohio. Communications and Readiness Stakeholder Engagement Change Network Management Business Process Re-Engineering Business Process Training Business Readiness, Organization Design, and Solution Alignment Project Stakeholders

24. 24 Increased Funds to Support Counties The Ohio Office of Health Transformation has worked hard to allocate increased funding to support counties through the Medicaid Enhanced Eligibility Allocation. Online Applications Reducing County Burden The launch of Ohio Benefits has increased the percentage of Medicaid applications that are received and verified electronically, reducing county workloads. Increased Support for County Training Policy clarifications have recently been issued that training expenses are not limited to those occurring prior to implementation; ongoing Integrated Eligibility expenses are reimbursable at an enhanced rate and are not limited to the transition period. Next Project Phase The next phase of the Integrated Eligibility project will incorporate Ohio’s Food Assistance Program (SNAP) and Cash Assistance (TANF) into the system. 1 2 3 4 Integrated Eligibility Project Partnerships Last Updated 03/2014

25. From a Community Partner’s Point of View

26. Last Updated 04/2014 Ohio Benefits and Federal Marketplace Overviews Applications Best Practices Resources for Community Partners Overview of the new Ohio Benefits self-service portal for the Integrated Eligibility system. Overview of the federal Health Insurance Marketplace and how the Integrated Eligibility system interfaces with the Marketplace. FAQs related to Benefits.Ohio.gov Automatic Application Processing section dedicated to the information that is needed for an online Medicaid application to receive a near real time benefits determination. List of existing resources available to Community Partners and the Ohio residents to steer them through the application process. The Integrated Eligibility system offers Community Partners a new way to help Ohio residents access health insurance. Below is an overview of what Community Partners will find in this section. Overview – How Can Community Partners Help Residents

27. Last Updated 04/2014 Ohio Benefits was created to help navigate residents to the correct online application using simple questions about a family’s income, household size, and demographics. 27 Based on the answers to these questions, residents will be directed to either an Ohio Medicaid application or the federal Health Insurance Marketplace. All Ohioans should begin the application process utilizing the Ohio Benefits portal at www.Benefits.Ohio.gov Ohio Benefits Overview

28. Last Updated 04/2014 28 The Affordable Care Act requires individuals to have health coverage starting January 1, 2014 (commonly referred to as the Individual Mandate). Ohio is working with the federal government to implement the changes but HealthCare.Gov is not run or operated by Ohio. The federal Health Insurance Marketplace is an online site for individuals to shop for private health insurance based on price and quality. Navigators may assist residents applying for private insurance, or apply on behalf of residents, through the Marketplace. Navigators are funded by the federal government Are not regulated by the state of Ohio Application Transfer Functionality Marketplace  Ohio Medicaid eligible Ohioans who submit applications to the marketplace will have their applications transferred to the Ohio Integrated Eligibility system Ohio  Marketplace Ohioans who apply through the Integrated Eligibility system and are not Medicaid eligible will have their applications transferred to the Marketplace Federal Health Insurance Marketplace Federal Health Insurance Marketplace Overview

29. Last Updated 04/2014 29 What internet browser should be used when applying online? The initial launch of Benefits.Ohio.gov provided limited browser support. However, a recent system upgrade has provided improved browser compatibility. The following browsers are now supported: Additional browsers will be supported with a planned release later this spring. What can make the application process faster? Applications Best Practices – Benefits.Ohio.gov FAQs 1 2 3 When a resident applies online through Ohio Benefits their application can go through automatic application processing if all the information necessary for this process is provided. The next slides highlight the automatic application processing required fields. The system’s required fields are highlighted in the application by an *. Individuals or organizations helping Ohioans apply for Medicaid should encourage them to provide as much information as possible in Ohio Benefits to expedite the eligibility determination process. Versions 8, 9, 10 & 11 Version 832.0.1700.76 m Versions 26

30. Last Updated 04/2014 30 Tip: Always encourage residents to answer all questions and enter the maximum amount of information into their application. This increases the likelihood for an online eligibility determination. What happens after submitting an application online? Online Eligibility Determination If the resident provided all the information needed for online processing and their information was successfully verified, they will receive a message in their Ohio Benefits message center on their eligibility determination in a matter of minutes. The resident will also receive a Notice of Action on their determination mailed to their identified mailing address. If the resident provided an email address, their eligibility determination is also emailed. Manual Eligibility Determination If the resident did not provide all the information needed for an online eligibility determination or there was an issue with online verifications, the resident should expect a mailed letter in a matter of weeks requesting additional information or notifying them of their Medicaid eligibility determination. Reducing Processing Time for Online Applications New Applications that are submitted through Ohio Benefits have the potential to be processed entirely online!

31. Last Updated 04/2014 31 Can navigators, certified application counselors (CACs), or residents helping others use one user account to submit multiple Medicaid applications? No, the primary applicant on the application needs to have their own user account. The purpose of the user account is to provide a secure communications channel with the resident. Community partners should follow these steps: Applying Online Best Practices 3 Navigators CACs Residents 1 2 3 Help the primary applicant create their own user accounts: Navigators, CACs and residents helping others through the application process should help the primary applicant to create a profile with a personal usernames and passwords. Use the Ohio Benefits tips found on the next slides: These tips provide information about the application fields that need to be completed in order for the application to possibly go through automatic Application Processing.. Provide further information about the Medicaid application process: Talk to the primary applicant about what to expect from the application process, Medicaid re-certification and other Medicaid eligibility factors..

32. Last Updated 04/2014 32 TitleSpecific QuestionsHelpful Notes First Name Last Name N/A DOBN/A Social Security Number Q: Do you have a Social Security Number? A: Yes or No If you select Yes, you are required to enter a SSN. Tip: Collect all SSN for applicants before applying. Tip: If a resident does not know their SSN but has one, select No to ‘Do you have a SSN?’ to proceed with the application online. Address (City, State, and Zip Code) Q: Do you have a home address? A: Yes or No If Yes, enter home address If No, enter only the mailing address You are required to enter a mailing address. If a resident is homeless or does not have a mailing address, enter the mailing address where the individual would receive mail. (Local county JFS office or homeless shelter) GenderSelect genderEnter the gender indicated on your birth certificate. Citizenship StatusQ: Were you born in the U.S.? A: Yes or No If Yes, US Citizen If No, Q: Do you have immigration documentation? A: Yes or No If Yes, What is your immigration status? N/A The table below highlights the required fields for an application to go through the Automatic Application Processing process and receive their eligibility determination in near real-time. Automatic Application Processing Tips

33. Last Updated 04/2014 33 TitleSpecific QuestionsHelpful Notes Marital StatusWhat is your marital status?Drop-down list of all marital status options. IncomeMultiple employment questions (Employer based and self-employed) Other income sources and details Financial deductions Complete all questions and fields relating to any source of income. Tip: For an individual with an income of 0, enter $1 for faster processing. School RecordQ: Is anyone going to school?If Yes, complete the details of full or part time and in college/ training or not. Tax Details: Filing status Tax dependents Tax deductions Q: Will this person file a tax return next year? Q: What filing status will be used on this tax return? Q: Will anyone in the household file a tax return next year? Q: Will anyone in the household be claimed as a dependent on a tax return next year? Tip: Collect all tax information for a resident before applying online, including tax filing status (i.e. filing this year), whether or not the individual has dependents, and any tax deductions. Note: An individual’s overall tax information must be similar to the previous tax years tax information received as verified with the IRS, to go through the online eligibility determination process. Relationship details Fill out the relationship between all individuals on the application: [Primary Applicant Name] is the [Select relationship] to the [Secondary Applicant Name] and Start Date Does the individual have parental control? Selecting the correct relationship between two individuals is very important. *Researching policy on what priority to choose for individuals with more than one relationship Required Fields Keep in mind that the fields listed on these tables are for Automatic Application Processing required field but do not include all the additional application required fields that are indicated with a red asterisk (*). Automatic Application Processing Tips Contd.

34. Last Updated 04/2014 34 Benefits.Ohio.gov allows residents to submit Medicaid applications online and determine their Medicaid eligibility. The following resources are available for Community Partners and residents to help with Ohio Benefits and the Integrated Eligibility system. Text Residents can use the existing Ohio Medicaid Consumer Hotline for questions or concerns with the new system 1-800-324-8680. Visit Medicaid.Ohio.gov for information about Medicaid policy, answers to Frequently Asked Questions (FAQs) and other Medicaid resources. Navigators CACs Residents Text Visit your county Department of Jobs and Family Services for questions or to submit an application. To find your county office please visit: http://jfs.ohio.gov/County/County_Directory.pdf http://jfs.ohio.gov/County/County_Directory.pdf Resources for Community Partners

35. From a County Worker’s Point of View

36. Last Updated 04/2014 The Directors’ Corner The Integrated Eligibility project is a partnership between Ohio’s 88 Counties, the Department of Medicaid and the Department of Jobs and Family Services. Directors Dungy and McCarthy recognize the outstanding performance of all Counties during the Medicaid phase of the project. 36 “Thank you, your efforts have been recognized across our state and your expertise is helping Ohio to push forward into the future.” “Your Hard Work has already made life better for tens of thousands of Ohioans.” Director John McCarthy Ohio Department of Medicaid Director Cynthia C. Dungey Ohio Department of Jobs and Family Services “Feedback from county staff is helping us to improve the new system and open additional avenues for residents to acquire assistance. Your ability to quickly address any issues that may arise during the application process has helped to advance Ohio’s renewed commitment to innovation and reform.” “In each of Ohio's 88 counties, our local departments of Job and Family Services have long served as the critical bridge that connects our residents with the assistance that is often required in times of need. That statement has certainly proven true in the early months of 2014. The commitment and service displayed by each of you is having an immediate impact on our neighbors’ ability to get back on their feet and live more stable lives.

37. Last Updated 04/2014 37 Director’s Letter to Counties

38. Last Updated 04/2014 38 Your Role Understanding the Ohio Benefits Routing Logic Ohio Benefits was created to help navigate residents to the correct online application using simple questions about a family’s income, household size, and demographics. Ohio Benefits routing logic was built as a guide to direct residents to the right application up front, therefore it is not an exact eligibility calculation. FPLs that determine which application (Ohio Benefits, e-Gateway, or the Federal site)have a built in buffer and do not reflect final Medicaid eligibility policy. For additional details on this routing logic refer to the Application Routing Logic Job Aid posted on the project website.Application Routing Logic Job Aid Ohio Benefits All individuals and families at or below FPL 145% All families with a potential MAGI category individual (individual under FPL 145%, pregnant women, children) Individuals who aged out of foster care in Ohio at age 18 and are under 26 years old eGateway Individuals who self identify as receiving Medicare or are age 65 or older, above 145% FPL and identify no other demographics (not pregnant) Individuals who self identify as seeking Long Term Care and no other demographics (Above 145% FPL) Resident Option: Federal Health Insurance Marketplace or Ohio Benefits Individuals who self identify as blind or disabled and no other demographics (FPL between 146% and 410%) Federal Health Insurance Marketplace Adults with FPL above 145% and no other demographics Pregnant women with FPL above 210% and no other demographics Children with FPL above 210% and no other demographics.

39. Last Updated 04/2014 39 CRIS-E During the transition to the new Ohio Integrated Eligibility system the current CRIS-E eligibility system will continue to be used for Non-MAGI applications such as individuals seeking Long Term Care, or who are blind or disabled. SNAP and TANF will continue to be determined in CRIS-E as well. NEW Ohio Integrated Eligibility System Determine eligibility Calculate benefits Issue Notices of Actions Case intake and management for all potential MAGI residents and households will be handled by this new system. Current Case Worker Tools to Process Medicaid

40. Last Updated 04/2014 40 Your Role Your role: Non-MAGI case workers will continue to process non-MAGI eligible residents in the eGateway/CRIS-E system online, over the phone and/or in person. All county workers will continue to be a vital role in delivering coverage to Ohio residents. Why this is helpful: Allow time for integration and learning. Make all county workers aware of the changes that took place October 1, 2013 and coverage that went into effect January 2014. County Workers Continued Role

41. From a Resident’s Point of View

42. Last Updated 04/2014 42 Resident’s Impacted by Changes to Medicaid Impacted GroupMajor Impacts Ohio Food Assistance Program (SNAP) Recipients All current SNAP recipients are now potentially eligible for Medicaid coverage. Medicaid Spend down RecipientsCurrent Medicaid spend down recipients under 65 years of age, below 138% FPL, and not on Medicare may be eligible for Medicaid coverage. Family Planning Services RecipientsCurrent Family Planning Services recipients below 138% FPL may be eligible for Medicaid coverage. Parents/Caretakers of dependents on Healthy Start Current Healthy Start recipients below 138% FPL may be eligible for Medicaid coverage. 19 and 20 year oldsCurrent 19 and 20 years olds below 138% FPL may be eligible for Medicaid coverage. DDA (Disability Determination Area) pending without MA C Disability Individuals who have Medicaid pending because they are waiting on a disability determination and are below 138% FPL may be eligible for Medicaid coverage. What’s next? Residents should submit their Medicaid applications online using: Benefits.Ohio.Gov.

43. Last Updated 04/2014 43 Attention All SNAP Recipients! Are you receiving SNAP? All current SNAP recipients are potentially eligible for Medicaid coverage as of January 1, 2014.* Specific Individuals Impacted: 59 and Under: If you are 59 years of age or below, on SNAP, and not on Medicare, you most likely qualify for coverage under Medicaid extension. *60 – 65: If you are 60 to 65 years of age, on SNAP, and not on Medicare you most likely qualify for coverage under Medicaid extension if your income falls below 138% FPL. *65 and older: If you are 65 years of age or older and pregnant you are likely eligible under the new Medicaid extension category. What do I do next? SNAP recipients are encouraged to apply for Medicaid benefits at: Benefits.Ohio.Gov. Benefits.Ohio.Gov If your yearly income falls within this table for your household size you are most likely eligible for Medicaid. Eligible for SNAP and Medicaid Eligible for Medicaid Household Size Annual Household Income at 130% FPL Annual Household Income at 138% FPL 1$0 - 14,940$14,941 - 15,856 2$0 - 20,172$20,173- 21,404 3$0 - 25,392 $25,393 - 26,951 4$0 - 30,624$30,625 - 32,499 5$0 - 35,844$35,845 - 38,047 6$0 - 41,076$41,077 - 43,594 7$0 - 46,296$46,297 - 49,142 8$0 - 51,528$51,529 - 54,689

44. Last Updated 04/2014 44 Attention Medicaid Spend Down Recipients! Are you on Medicaid spend down? Residents who are currently on Medicaid spend down, are under 65 years of age, and do not have Medicare coverage may be potentially eligible for full Medicaid coverage if your gross income is below 138% Federal Poverty Level (FPL). Household Size Annual Household Income at 138% FPL 1$0 - 15,856 2$0 - 21,404 3 $0 - 26,951 4$0 - 32,499 5$0 - 38,047 6$0 - 43,594 7$0 - 49,142 8$0 - 54,689 FPL Above 138%? As a spend down recipient you may also visit the federal Health Insurance Marketplace to apply to receive a federal tax subsidy to help pay for private health insurance: https://www.healthcare.gov/.https://www.healthcare.gov/ What do I do next? Medicaid spend down recipients are encouraged to re- apply for Medicaid benefits at: Benefits.Ohio.Gov.Benefits.Ohio.Gov If your yearly income is below the amount listed for your household size you are most likely eligible for Medicaid.

45. Last Updated 04/2014 Specific Individuals Impacted: If you are receiving Family Planning Services, and not on Medicaid you will most likely qualify for coverage under the new Medicaid extension Category if your income falls below 138% FPL. What do I do next? Family planning recipients are encouraged to apply for Medicaid benefits at: Benefits.Ohio.Gov.Benefits.Ohio.Gov 45 Attention Family Planning Recipients! Are you receiving Family Planning Services? Residents who are currently receiving Family Planning Services may be eligible for Medicaid coverage if your gross income is below 138% Federal Poverty Level (FPL). If your yearly income is below the amount listed for your household size you are most likely eligible for Medicaid. Household Size Annual Household Income at 138% FPL 1$0 - 15,856 2$0 - 21,404 3 $0 - 26,951 4$0 - 32,499 5$0 - 38,047 6$0 - 43,594 7$0 - 49,142 8$0 - 54,689

46. Last Updated 04/2014 46 Attention Families with Healthy Start Recipients! Is your child on Healthy Start? Parents or caretakers who have children receiving Healthy Start benefits may be potentially eligible for Medicaid coverage if your gross income is below 138% Federal Poverty Level (FPL). Specific Individuals Impacted: If you are an adult under 138% FPL you may now qualify for coverage under the new Medicaid extension category. Before January 1, 2014, you could not receive Medicaid with an FPL above 91% as a parent or caretaker. What do I do next? Parents or caretakers of children receiving Healthy Start are encouraged to apply for Medicaid benefits at: Benefits.Ohio.Gov.Benefits.Ohio.Gov If your yearly income is below the amount listed for your household size you are most likely eligible for Medicaid. Adults & Children Eligible for Medicaid Only Children (under 19) Eligible for Medicaid Household Size Annual Household Income at 138% FPL Annual Household Income at 200% FPL 1$0 - 15,856$15,857 - 22,980 2$0 - 21,404$21,405 - 31,020 3$0 - 26,951$26,952 - 39,060 4$0 - 32,499$32,500 - 47,100 5$0 - 38,047$38,048 - 55,140 6$0 - 43,594$43,595 - 63,180 7$0 - 49,142$49,143 - 71,220 8$0 - 54,689$54,690 - 79,260

47. Last Updated 04/2014 47 Attention 19 and 20 Year Old Recipients! Are you 19 to 20 years old? When children receiving Medicaid turn 21 he or she may be potentially eligible for Medicaid coverage if your gross income is below 138% Federal Poverty Level (FPL). Specific Individuals Impacted: If you are 19 – 20 years of age and your parent’s income is below 138% FPL you will most likely qualify for coverage under the new Medicaid extension. When you turn 21 you may still be eligible under Medicaid extension if your household income is below 138% FPL. What do I do next? If you are currently enrolled in Medicaid and will soon turn 21 the CDJFS will check to see if your Medicaid eligibility will continue. At this point you may be contacted to provide more information or with a eligibility determination. If your yearly income is below the amount listed for your household size you are most likely eligible for Medicaid. Household Size Annual Household Income at 138% FPL 1$0 - 15,856 2$0 - 21,404 3 $0 - 26,951 4$0 - 32,499 5$0 - 38,047 6$0 - 43,594 7$0 - 49,142 8$0 - 54,689

48. Last Updated 04/2014 48 Attention Residents with a Pending DDA Status! If your yearly income is below the amount listed for your household size you are most likely eligible for Medicaid. Are you still waiting on your disability determination from the Social Security Administration? Residents who are currently pending DDA approval may be potentially eligible for Medicaid coverage if your gross income is below 138% Federal Poverty Level (FPL). Specifics: Adults between the ages of 19 to 64, who are between 0 – 138% FPL and are not eligible under another category of Medicaid. What do I do next? While waiting for your SSA determination you may qualify for Medicaid coverage as a single adult. You are encouraged to apply for Medicaid benefits at: Benefits.Ohio.Gov.Benefits.Ohio.Gov Household Size Annual Household Income at 138% FPL 1$0 - 15,856 2$0 - 21,404 3 $0 - 26,951 4$0 - 32,499 5$0 - 38,047 6$0 - 43,594 7$0 - 49,142 8$0 - 54,689

49. Last Updated 04/2014 Appendix 49

50. Last Updated 04/2014 The Ohio Integrated Eligibility project is one of many initiatives taking place within Ohio. To learn more about the Integrated Eligibility project, or other Ohio Health Transformation initiatives taking place, please visit Ohio’s Health Transformation website at: Healthtransformation.Ohio.gov Community Partners can learn more information about the federal Health Insurance Marketplace and how to assist Ohio residents in applying for private health insurance through: HealthCare.Gov 50 Additional Resources

51. Last Updated 04/2014 CMS - Center for Medicare and Medicaid Services DAS - Department of Administrative Service HHS - Health and Human Services IE&BI - Integrated Eligibility and Business Intelligence MAGI - Modified Adjust Gross Income OBM - Office of Budget and Management OCM - Organizational Change Management ODJFS - Ohio Department of Job and Family Services OHT - Office of Health Transformation SOA - System Oriented Architecture ODM - Ohio Department of Medicaid MAGI Standard – Modified Adjusted Gross Income – an income standard used to determine financial eligibility, and based on the Primary Tax Filer, certain defined relationships (spouse, parent, stepparent) and any claimed tax dependents. Streamlines and standardizes the type of income used for eligibility determination and the manner in which it is counted. Medicaid Extension– The ACA legislation introduced the ability for each state to expand Medicaid coverage to childless adults below the age of 65 with a household income at or below 133% FPL – the Supreme Court upheld this extension, but limited the ability for the Federal Government to penalize States who do not comply with the extension. “No Wrong Door” – An application for assistance should be simple and seamless, regardless of the application method (paper, phone, online) and process (Self-Service Portal, Marketplace, state agency) and should be able to submitted through a variety of channels “No Touch” Automatic Application Processing – The concept that an application for assistance should be accepted and processed without a single worker intervention (if all required data is present and verifiable) in “real time” (real time has not been defined, but is assumed by clients to be within minutes) 51 Key Terms & Definitions

52. Last Updated 04/2014 Reasonable Compatibility – A standard applied for determining if client attested value (e.g. income) can be considered verified by another source within a defined parameter or threshold. Reasonable Opportunity – To avoid unnecessary reapplication processing and burden on the consumer, an application for renewal will be accepted within 90 days of the date it is due. Single Streamlined Application – An application for assistance should be easily available to the consumer (paper, online, in person, phone) and only ask those questions that are relevant for a MAGI determination inclusive of both Medicaid and Marketplace eligibility. Alternative Application – States have the option to utilize an alternative application for assistance that must be approved by CMS, and may collect additional data beyond that required on the streamlined application, but not prohibit an application from being processed if the additional data is missing. Electronic Verifications – Each state must submit a State Verification Plan highlighting their plan to verify each required MAGI eligibility data element. Electronic verifications should be used as much as possible. Federal Data HUB – A composite of multiple interfaces allowing an agency to access Federal data to verify applicant eligibility data such as income, citizenship, identity. Identity Proofing – All states using the trusted data sources made available through the hub for real-time verifications for the online application or a telephone application that is enabled by real-time hub services must prove identity prior to processing the application via a federally-facilitated service. State Based Marketplace (SBE) – A State-based health insurance marketplace where individuals and small businesses will be able to shop for coverage. States planning to operate an SBE were required to submit an Marketplace blueprint to the Federal DHHS in December 2012. 52 Key Terms & Definitions

53. Last Updated 04/2014 Federal Health Insurance Marketplace – If a state did not indicate their intentions for either an SBE or a Partnership Marketplace model, they will default to using the federal Health Insurance Marketplace, which will coordinate eligibility and enrollment determinations for non-Medicaid coverage, and potentially also Medicaid coverage depending on state decision (assessment versus determination model). Advance Payment Tax Credit (APTC) – MAGI eligible persons between 133-400% FPL qualify for a tax credit, payable in advance on a monthly basis, that can be used to offset the premium cost for insurance coverage purchased on an exchange. The tax credit amount is pegged to a sliding scale affordability standard and the cost of health plans offered in the applicant’s region. MAGI Non-Financial Eligibility Citizenship/Qualified Alien Status Lawful Permanent Residency Incarceration Status Relationship Tax Household Information Living Arrangement Aged, Blind, Disabled (Long Term Care) Requesting Financial Assistance for Medical Coverage Not receiving other financial assistance (Foster Care, Other Health Insurance) MAGI Financial Eligibility Tax Household Income against Federal Poverty Limit Financial Test. 53 Key Terms & Definitions