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Medicaid 201 - PowerPoint PPT Presentation

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Medicaid 201
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  1. Medicaid 201 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 • You will learn about the services covered by Medicaid to help you answer customer questions • You will learn about the individual programs within Medicaid to better understand them

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

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

  5. Colorado Medicaid 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

  6. Colorado Department of Health Care Policy & Financing

  7. County Departments of Human/Social Services

  8. Medical Assistance Sites (MA)

  9. Certified Application Assistance Sites (CAAS)

  10. 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)

  11. Presumptive Eligibility Sites (PE)

  12. Who Does Medicaid Serve? • Unqualified non-citizens facing emergency medical situations Qualified non-citizens • Citizens People with limited income& resources

  13. 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 woman & American Indian/Alaska Natives are some examples of populations who do not pay co-pays

  14. Medicaid Benefits What’s Covered?

  15. Pediatric services • Personal hygiene items • Physical therapy • Prescriptions • Medical equipment • Preventative Care • Rehabilitative care • Some vision services • Speech therapy • Sports equipment • Substance abuse services • Vaccines for travel • Wellness care • Acupuncture • Chiropractic services • Cosmetic procedures • Dental services • Emergency services • Family planning • Primary Health care visits • Infertility treatments • Laboratory and X-ray • Maternity and newborn care • Medical marijuana • Mental health care • Most over-the-counter drugs

  16. Pediatric services • Personal hygiene items • Physical therapy • Prescriptions • Medical equipment • Preventative Care • Rehabilitative care • Some vision services • Speech therapy • Sports equipment • Substance abuse services • Vaccines for travel • Wellness care • Acupuncture • Chiropractic services • Cosmetic procedures • Dental services • Emergency services • Family planning • Primary Health care visits • Infertility treatments • Laboratory and X-ray • Maternity and newborn care • Medical marijuana • Mental health care • Most over-the-counter drugs

  17. 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​

  18. 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

  19. MAGI Medicaid Programs • MAGI Children • MAGI Parent/Caretaker • MAGI Adult • MAGI Pregnant • Needy Newborn • Legal Immigrant Prenatal • Transitional Medicaid • 4 Month Extended • Presumptive Eligibility

  20. Who Qualifies for MAGI Medicaid? It Depends

  21. How is MAGI Income Calculated? Start no no yes no Does the individual expect to be claimed as a tax dependent? Does the individual expect to be claimed as a tax dependent? Does the individual expect to file taxes? yes yes • Does the individual meet any of the following exceptions: • The individual expects to be claimed as a tax dependent of someone other than a spouse, biological, adopted or step parent • The individual is under 19 living with both parents, but parents do not expect to file a joint tax return • The individual under 19 & expects to be claimed by non-custodial parent no yes Use Tax Filer Rules Use Tax Dependent Rules Use Non-Filer Rules

  22. The Income Rules

  23. Countable Income Countable Income forNon-MAGI Programs Countable Income forMAGI Programs • Varies by program • Taxable income: • • Salaries, Wages, Tips • • Capital Gains • • Unemployment Benefits minus • 5% Income Disregard equals

  24. Federal Poverty Level Measure of income level issued annually by the Department of Health and Human Services Find this @ aspe.HHS.gov/ poverty/14poverty.cfm

  25. Program Specific Income Guidelines

  26. Income Disregard (current rule) Countable Income forNon-MAGI Programs Income Disregard forMAGI Programs • Varies by program • 5% across the board equals

  27. Program Specific Income Guidelines $2270 -$82.45 =$2188

  28. Income Disregard (starting Jan 1, 2015) Countable Income forNon-MAGI Programs Income Disregard forMAGI Programs • Varies by program • (still) • 5% across the board • (only if the disregard drops the applicants to a lower FPL category) equals

  29. MAGIChildren Income Limit Benefits • Basic Medicaid Package • Early Periodic Screening Diagnosis & Treatment (EPSDT) • 12 months Continuous Coverage Age • 18 and younger Other Requirements • None

  30. Continuous Coverage • For kids under the age of 19 • Continuous enrollment regardless of changes in household income or size

  31. MAGI Parent/Caretaker Benefits Income Limit • Basic Medicaid Package Age • No Requirements Other Requirements • Must be parent or caretaker to a Medicaid eligible child under age of 19 • Any relation by blood, marriage or adoption who is within the fifth degree of kinship to the dependent child

  32. MAGIAdult Income Limit Benefits • Basic Medicaid Package • EPSDT if under 21 Age • Age 19 through month that the individual turns 65 Other Requirements • Cannot be eligible for Medicare

  33. MAGIPregnant Income Limit Benefits • Basic Medicaid Package • EPSDT if under 21 Age • Age 19 & over • Under age 19 will be covered in the MAGI Children category Other Requirements • Pregnant through 60 days postpartum

  34. Needy Newborn Benefits • Basic Medicaid Package • + Early Periodic Screening Diagnosis & Treatment (EPSDT) Age • Babies 0-12 months Other Requirements • Born to a mother on Medicaid

  35. LegalImmigrantPrenatal Income Limit Benefits • Only related to pregnancy: • prenatal • Labor • Delivery • post-partum care Age • Age 19 & over Other Requirements • Pregnant through 60 days postpartum

  36. TransitionalMedicaid • Available to Members in either the MAGI Parent/Caretaker Relative or MAGI Children category who would lose coverage due to earned income • Must have been receiving Medicaid for 3 of the 6 months preceding the month in which the family became ineligible • Granted for 12 months • Beginning the first month of ineligibility • Transitional Medical Assistance is a guaranteed program

  37. 4 Month Extended • Offered to families who become ineligible for Medicaid due solely or partially to the receipt of maintenance or alimony • Must have been receiving MAGI Parent/Caretaker Relative or MAGI Children Medicaid in 3 of the 6 months preceding the month in which the family became ineligible • Granted for 4months • Beginning the first month of ineligibility

  38. Presumptive Eligibility Income Limit Benefits • Immediate & temporary coverage for 45 days Age • Under 19 • Over 19 (and Pregnant) Other Requirements • Pregnant through 60 days postpartum

  39. The Need to Know: PE Benefits • Inpatient (hospital) care, labor and delivery are NOT covered for pregnant women under PE. It is a covered benefit under MAGI Adult.

  40. Early Periodic Screening & Diagnostic Treatment (EPSDT) Services • Screenings • Case Management • Behavioral Health Organization • Laboratory Tests • Vision • Oral Health • Assistive Technology • Physical & Behavioral Health Services • Immunizations • Outreach Services(aka Healthy Communities) Age • Children 20 and younger • Pregnant woman of any age Other Requirements • Cannot be on CHP+ • Cannot receive benefits under the Colorado Indigent Care Program (CICP)

  41. Healthy Communities Family Health Coordinators (case managers) help with: • Informing families where to submit applications • Educating families on the value of preventive health care services • Linking members to providers • Providing clients with information and referrals to other community programs and resources • Explaining the re-enrollment process to families who continue to be eligible for Colorado Medicaid and CHP+ to eliminate gaps in coverage

  42. Methods to Apply Find all of this online @ Colorado.gov/HCPF/how-to-apply Colorado Department of Health Care Policy and Financing

  43. When Do MAGI Services Start? • Benefits start as soon as a member is determined eligible for Medicaid • May take a few days after enrollment for a health care provider to confirm in their system • It is important to call a provider before you go to the office to make sure they are able to see you

  44. Non-MAGI Programs

  45. Non-MAGI Rules • The Social Security Administration (SSA) is the guiding law for most Non-MAGI categories • Income and asset (resources) methodologies • Disability determinations • Some Non-MAGI categories are state only, not federal; these categories fall under state law

  46. Supplemental Security Income (SSI) • Social Security Administration (SSA)(Independent federal agency) • Supplemental Security Income (SSI) • Social Security (Retirement) • Social Security Disability (SSDI) Find eligibilityrequirements & more @ SocialSecurity.gov

  47. Federal Benefit Rate (FBR) Boththe SSI income limit and the maximum federal monthly SSI payment Find this @ SSA.gov/oact/ cola/SSI.html

  48. Countable Income for Non-MAGI Countable Income forNon-MAGI Programs • Varies by program

  49. Countable Resources Countable Resources forNon-MAGI Programs Countable Resources forMAGI Programs • Varies by program • MAGI categories do not consider resources • May include, but not limited to: • Life Insurance Cash Surrender Value • Life Insurance Face Value • Residences (not primary) • Vehicles (if he/she owns more than one) minus