TIHCA 2008

1. TIHCA 2008 Advanced Eligibility

2. Advanced Eligibility Rebecca Currington Hockley County Lesa Gilbert Northwest Texas Healthcare System Felix Luera University Medical Center Health System

3. Advance Eligibility Session Eligible Household/Minor Relatives College Students & Determining Residency Resource & Income Verification/Documentation Bank Accounts � Whose money is it? Referrals to QMB/SLMB/QI1 � Are you doing it? Mandated Providers/Cobra/VA Mill Bill Consent to Obtain & Release of Information Legal Separation Form Meeting Timelines

4. Minor in H/H w/o a Parent Grandchild/Niece/Nephew - Who should apply for Medicaid/TANF? - Non-related caretaker May apply and be payee for minor but may not be recipient

5. Minor in H/H w/o a Parent Related Caretaker May apply for and be payee for minor and also receive benefits Only one caretaker allowed Requirements: -Prove relationship � i.e. Birth certificates -Seek child support from parent(s) -Cooperate with �Choices Program� or have doctor�s statement of inability to work -Guardianship paperwork is NOT required CIHCP Coverage Cover or don�t cover when potentially eligible?

6. College Students Determining Residency Driver�s License Voter�s Registration Mailing Address Living on/off campus Leave during holidays/summers Employment Staying or leaving after graduation Other methods used?

7. Resources & Income Accurint � www.accurint.com � free trial Lexis Nexis - www.lexis.com Yvette V. Cleveland yvette.cleveland@lexisnexis.com 214 941-7055 (direct) 800 238-5853 x7393 (toll free) Reveal potential assets Vehicles Real Estate Address History Neighbors Professional Licenses Relatives and associates

8. Resources & Income The Work Number www.theworknumber.com The Work Number is America's leader in automated employment and income verifications. Provides pay information Ending pay period date Next pay date Gross pay

9. Resources & Income TWC (Texas Workforce Commission) � www.twc.state.tx.us Open Records Section 101 E. 15th Street, Room 266 Austin, 78778-001 512-463-2422 Income information and unemployment income information Currently charging $125/month (billed quarterly) 1-10,000 inquiries

10. Resources & Income Appraisal Districts Many are on-line www.appraisaldistrict.net Locate county appraisal districts by County, City or Zipcode Growing to include other states www.texascad.com All of the Texas Appraisal Districts that have a website can easily be found in one location You can submit web-sites if not found www.trueautomation.com Currently has about 90 county appraisal districts

11. Resources & Income Vehicles �Request for Texas Motor Vehicle Information� Obtain from County Tax Assessor Office Shows Name of Current owner Shows last time vehicle was registered - �Texas Motor Vehicle Transfer Notification� Obtain from www.txdot.gov or tax assessor�s office No cost to notify state that vehicle is no longer owned Benefit to client Gets vehicle out of their name Removes liability issues

12. Resources & Income Bank accounts Joint account, only income is from disqualified member-Do you count if spouse applies?

13. Referrals to QMB/SLMB/QI-1 CIHCP Household (Section 2 Page 3) The CIHCP household is a person living alone or two or more persons living together where legal responsibility for support exists, excluding disqualified persons. Disqualified Persons � A person who receives or is categorically eligible to receive Medicaid, � A person who receives TANF benefits, � A person who receives SSI benefits, � A person who receives Qualified Medicare Beneficiary (QMB), Medicaid Qualified Medicare Beneficiary (MQMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual-1 (QI-1); or Qualified Disabled and Working Individuals (QDWI), and � A Medicaid recipient who partially exhausts some component of his Medicaid benefits. A disqualified person is not a CIHCP household member regardless of his legal responsibility for support. SLMB paid by state/QI-1 paid by the feds

14. Referrals- Are you doing it? Why or why not? Website:www.dads.state.tx.us/handbooks/meh/ Section 3000 Determining Financial Eligibility & Payment Plans

15. Mandated Providers They refuse to see your client-now what?

16. COBRA-To pay or not to pay? Cost-savings measure for eligible clients Rita Kelley Bride Roberts

17. VA Patient Eligibility Millennium Bill Act (Mill Bill) Allows veterans to go to the nearest emergency room to receive care if they cannot reach a VA facility in time and if all of the following criteria are met: 1)You must have been seen in a VA facility within the past 24 months 2)You can not have any other insurance coverage 3)The VA must receive your bills within 90 days 4)Your care has to be emergent 5)A VA facility cannot be available Generally will just cover the emergency room portion and/or up to the point of stabilization.

18. Consent to Obtain & ROI Form 100 states The statements I have made, including my answers to all questions are true and correct to the best of my knowledge and belief. I agree to give eligibility staff and the county any information necessary to prove statements about my eligibility. I agree to report any of the following changes within 14 days: � Income � Resources � Number of people who live with me � Address � Application for or receipt of SSI, TANF, or Medicaid I have been told and understand that this application will be considered without regard to race, color, religion, creed, national origin, age, sex, disability, or political belief; that I may request a review of the decision made on my application or re-certification for assistance; and that I may request, orally or in writing, a fair hearing about actions affecting receipt or termination of health care assistance.

19. Consent to Obtain & ROI Form 100 (continued) I understand that by signing this application, I am giving the county the right to recover the cost of health care services provided by the county from any third party. I agree to give the county any information it needs to identify and locate all other sources of payment for health care services. I have been told and understand that my failure to meet the obligations set forth may be considered intentional withholding of information and can result in the recovery of any loss by repayment or by filing civil or criminal charges against me.

20. Consent to Obtain & ROI Who uses additional forms? -Hockley County -University Medical Center Health System Legal separation form -Northwest Texas Healthcare System

21. Meeting Timelines Provider Notifications Chapter 61 Section .031 & .032 (pg.14 & 15) General rule: Providers must notify you by telephone within 72 hours and by mail within 5 working days. Applies only to Counties & PH�s

22. Eligibility Determination Section 1-Pg.12; Section 3-Pg.1 The date a complete application is received is day �0� Determine eligibility within 14 days after a completed application is received Provide applicant and providers with written notice of determination (Form 109) Denial notices must include reason for denial and appeals process (Form 117) Establish an appeals process Determination can be made face to face, by telephone or with completed application

23. Case Reviews Section 1-Pg 12; Section 3-Pg.1 Review the eligibility of each household at least once every six months Review requires new Forms 100, Application for Assistance and 101 Worksheet

24. Public Notice County Secton 1-Pg. 2 Not later than the beginning of the state fiscal year (September 1), a county not covered by a public facility shall specify the procedure it will use during the fiscal year to verify eligibility and the documentation required to support a request for assistance and make a reasonable effort to notify the public of the application procedure.

25. Public Notice Public Hospitals Section 6-Pg. 7 Not later than the beginning of a hospital�s operating year, the public hospital shall specify the procedure it will use during the operating year to determine eligibility and the documentation required to support a request for assistance and make a reasonable effort to notify the public of the application procedure.

26. Public Notice Hospital Districts Section 6-Pg. 2 Not later than the beginning of a hospital district�s operating year, the hospital district shall specify the procedure it will use during the operating year to determine eligibility and the documentation required to support a request for assistance and make a reasonable effort to notify the public of the application procedure.

27. Q & A THANK YOU!!! Texas Longhorns 33 Texas Tech Red Raiders 39 GO TECH!!!!!!!