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DMA Update

DMA Update. Division of Medical Assistance July 2013. ACA Impact. Will affect most Family & Children’s Medicaid programs and NCHC Budgeting methodology will totally change Coverage for groups will remain the same

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DMA Update

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  1. DMA Update Division of Medical Assistance July 2013

  2. ACA Impact • Will affect most Family & Children’s Medicaid programs and NCHC • Budgeting methodology will totally change • Coverage for groups will remain the same • Children on NCHC, age 6-18, whose income is less than 133% fpl (or new converted amount) will move to Medicaid • Former NC foster care children up to age 26 will have coverage without regard to income • Current expanded foster care is different group under different federal regulations

  3. What is MAGI? • Modified Adjusted Gross Income – term used in income tax and adjusted for certain items per ACA • Is budgeting methodology, not just an amount • Will utilize tax household concept in most cases • No longer allow disregards and deductions allowed today, such as earned income disregard, child care, etc. • Current Income limits are converted to MAGI equivalent numbers to account for not allowing disregards • For example: MPW is currently 185% fpl – this could change to 196% - (still finalizing the numbers)

  4. MAGI, cont’d • No longer count child support, but continue to count spousal support • SSA is normally non-countable, but Congress amended law to include SSA • Income of children and other tax dependents in household may not be countable unless they file or plan to file tax return • For all individuals, must now ask if they file or plan to file tax return, and if they will be claimed as tax dependent by someone else

  5. MAGI, cont’d • Constructing household for each individual will be very similar to process of determining au, bu, nu for F&C • Will need to set aside what you think will happen and work through the steps • Is not limited to spouse for spouse and parent for child • Household may be very different from current policy • No resource limit/test for MAGI groups (MAF)

  6. Presumptive Eligibility – Hospitals • Hospitals may opt to do presumptive eligibility for most MAGI groups • Must develop policy for hospitals on presumptive • State must provide training and set qualifications • State must set thresholds, such as % of individuals who file apps by deadline, % of individuals who are eligible for Medicaid • Will not otherwise expand presumptive at this time

  7. Presumptive Eligibility - Hospitals • Presumptive for pregnant women still limited to ambulatory prenatal care • For programs other than pregnant woman, coverage determined by program category (FPW, MIC, etc)

  8. Federal Contact Center & FFM

  9. Federal Contact Center Inquiries • June – September 2013: • –The contact center will launch in conjunction with the new look and feel of HealthCare.gov • –The contact center will respond to general inquiries about the program, educational, primarily related to: • •Health Insurance (“What’s a premium?” “What’s a deductible?”) • •Program (“I have insurance, will I be impacted?”) • •Preparation (“Where can I go to get additional information?” “When will I need to make a decision?) • •October 2013 – March 2014 : • –The contact center will assist with completing an enrollment application and eligibility determination, performing a plan compare to assist callers with selecting their insurance options, addressing issues related to premium information (based on adjusted gross income), determining tax credit eligibility, and issuers complaints. • •January 2014 – beyond: • –The contact center will be available to assist with additional questions as coverage begins such as income adjustments, referrals and complaints to the insurance plans

  10. Assessing Eligibility - FFM • NC has opted for the FFM to assess eligibility for Medicaid/NCHC, not determine eligibility • NC is sending eligibility information to the FFM so they can program our converted income limits, programs, and options • FFM will use NC info to screen for Medicaid/NCHC eligibility • If appears eligible, FFM will transfer account to NC • If appears ineligible for MA/NCHC, FFM will transfer if individual requests full Medicaid determination • May still enroll in APTC or reduced cost sharing, if eligible, while Medicaid determination made (disability, deductible, etc)

  11. Questions?? Stay tuned for lots more information/policy in the next couple of months!!!

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