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Medical Assistance 101

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  1. Medical Assistance 101 Created for Building Better Health – October 14 & 15, 2014 by the Colorado Department of Health Care Policy and Financing Presented by the Training Specialists from the Denver Department of Human Services

  2. What You Will Learn Today • Facts to help you answer applicant & member questions • Information to help you assist applicants through the Medical Assistance application process • Information on resources available to help you after you return to your desks

  3. Affordable Care Act (ACA) or FACT FICTION

  4. Statement # 1 ObamaCare & the Affordable Care Act are different laws

  5. Statement # 2 The ACA prevents health insurance companies from denying people because of pre-existing conditions

  6. Statement # 3 Connect for Health Colorado is the same as the Federal marketplace or Healthcare.gov?

  7. Statement # 4 Insurance Plans (regardless of whether they’re public or private) are now required to cover certain preventative services at no charge to members

  8. The Affordable Care Act (ACA) Image from: www.hhs.gov/healthcare

  9. Public & Private Health Insurance Private Health Insurance • CSR & APTC to buy Private Health Insurance Public Health Insurance And more!!!

  10. Open Enrollment 2015 • November 15, 2014 - February 15, 2015 • If an applicant does not want to apply for Medical Assistance they don’t have to, but they would not be eligible for Cost Sharing Reductions (CSR) or Advanced Premium Tax Credits (APTC) • Must have Medical Assistance denial in order to be eligible for marketplace tax credit or cost sharing reductions

  11. What is Medical Assistance? \ Public health care programs administered by state or federal government

  12. Federal Medical Assistance Structure • Agriculture • Independent Establishment & Government Corporations • Commerce • Veterans Affairs • Defense • Treasury • Education • United States Department of • Transportation • Energy • Health& Human Services • State • Labor • Housing & Urban Develop-ment • Center for Medicare & Medicaid Services(CMS) • Justice • The Interior

  13. Colorado Medical Assistance Structure • Center for Medicare & Medicaid Services(CMS) County Departments of Human/Social Services Certified Application Assistance Sites Colorado Department of Health Care Policy & Financing (HCPF) Medical Assistance Sites Healthy Communities Sites Presumptive Eligibility Sites

  14. Colorado Department of Health Care Policy & Financing

  15. County Departments of Human/Social Services

  16. Medical Assistance Sites (MA)

  17. Certified Application Assistance Sites (CAAS)

  18. Healthy Communities Sites • Receive state funding • 64 counties served by 25 community organizations • Family Health Coordinators: • promote preventive & wellness services for children & pregnant women • Each Healthy Communities site has its own business process: • In person assistance • Phone assistance • Drop off applications • PEAK kiosks/computers • Utilizes CBMS & assists applicants in applying for: • Medical Assistance • Other programs (at certain sites)

  19. Presumptive Eligibility Sites (PE)

  20. Who Does Medical Assistance Serve? • Unqualified non-citizens facing emergency medical situations Qualified Non-Citizens • Citizens People with limited income& resources

  21. What Kinds of Colorado Medical Assistance Programs are There? \ Medicaid Child Health Plan Plus (CHP+) MAGI Non- MAGI

  22. What is Colorado Medicaid? • Public Health Insurance • No monthly or annual enrollment fee • Members pay no or very low co-pay amounts depending on the population • For example, children, pregnant women, & American Indian/Alaska Natives are some examples of populations who do not pay co-pays

  23. Let’s Talk About MAGI & Non-MAGI What is MAGI? Methodology for: • how income is counted • how household composition & family size are determined What is Non-MAGI? • Medicaid categories exempt from applying the MAGI methodology​

  24. MAGI & Non-MAGI at a Glance MAGI Populations • Age 64 & younger • Not eligible for Medicare • Low income: • Children • Adults • Pregnant Women • Parents orCaretakers of a Medicaid eligible child that is under the age of 19 Non-MAGI Populations • Low-income individuals who meet any of the following: • Age 65+ • Blind • Disabled by Social Security Administration (SSA) standards

  25. MAGI Programs

  26. Non-MAGI Programs

  27. Medicaid Benefits

  28. Accountable Care Collaborative (ACC) Medicaid Health Plans Managed Care Organization (MCO) RegularColorado Medicaid

  29. Accountable Care Collaborative (ACC) • Most medical services • Preventive services • Help finding a specialist • Education about health conditions • Information about improving health Medical Home RCCO

  30. Accountable Care Collaborative (ACC) • Connect members to providers & specialists • Coordinate care • Help members get the right care • Help with life changes • Help members find community & social services Medical Home RCCO

  31. Regional Care Collaborative (RCCO) Map Find this map & more @ Colorado.gov/HCPF/ACC

  32. Managed Care Organizations (MCO) Find a comparison chart & more @ Healthcolorado.net/list-pdfs/ComparisonChart.pdf

  33. Regular Colorado Medicaid • If a member wants to opt out of the other two Health Plan options they can do so as soon as they get a letter saying they are eligible for Medicaid services • Must call or visit HealthColorado.org to change plans or opt out

  34. What Kinds of Colorado Medical Assistance Programs are There? \ Medicaid Child Health Plan Plus (CHP+) MAGI Non- MAGI

  35. What is CHP+? • Public Health Insurance for children & pregnant women only • Annual enrollment fees range from $25 - $105 depending on income, population, & number of children enrolled • Max out of pocket expenses/co-pays is 5% of gross annual income

  36. CHP+ Benefits

  37. CHP+ Health Maintenance Organizations (HMOs) Find this map, a comparison chart,& more @ CHPplus.org

  38. How are Medicaid& CHP+ Different? • No enrollment fee • Members can be covered under another insurance policy at same time • Income limits lower than those for CHP+ • All populations potentially eligible • Annual enrollment fee • Members cannot be covered under another insurance policy at same time • Income limits higher than those for Medicaid • Only covers children & pregnant women

  39. So who Qualifies for Medical Assistance? It Depends

  40. Colorado Benefits Management System (CBMS) • Every assistance application (including medical) is entered into CBMS • Complex rules engine used to determine if someone is eligible • When an applicant applies through Colorado.gov/PEAK or ConnectforHealthCO.com, their information feeds into CBMS

  41. New HCPF Website Colorado.gov/HCPF Applicant & Member Focused

  42. Every Person in a Household Might Qualify for a Different Program • Eligibility is determined on an individual level • Income is determined by “household” using tax-filer & non-filer rules • Applying is the only way to know for sure who might qualify for what program

  43. How & When to Apply for Medical Assistance No Open Enrollment Period:Applicants can apply for Medical Assistance atany time

  44. About Applying • Individuals who are eligible for Medical Assistance are automatically enrolled in the appropriate program • If denied Medical Assistance, Applicant’s information is automatically used to calculate the amount of financial assistance (if any) available for use on the Connect for Health CO Marketplace • Applicant can choose to simultaneously apply for Medical, Food, & Cash assistance on one application

  45. What is Needed to Apply • Name, address, & contact information • Social Security numbers (or document numbers) for each member of your household to be covered by your plan • Birth dates • If someone in your home is pregnant, the due date & number of babies for that pregnancy • Information & policy numbers for health insurance plans currently covering members of your household • Asset & expense information for the household if anyone in the home is disabled