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What to Expect After Medicaid/CHP+ Approval

What to Expect After Medicaid/CHP+ Approval. 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. What a Member Receives in the Mail.

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What to Expect After Medicaid/CHP+ Approval

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  1. What to Expect After Medicaid/CHP+ Approval 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 a Member Receives in the Mail • Verification Checklist • Approval or Denial • Enrollment Materials • Connect for Health Colorado Information • Medicaid and/or CHP+ Card • Termination Notice (if applicable) • Redetermination Notice (annually) • Notices Regarding Changes (NOA or NOD) • Appeals Information • DentaQuest Information

  3. Verification Checklist

  4. Approval

  5. Denial Denial: Your application has been denied for the following individual(s).

  6. Key Info on All Notices • Eligibility determination for each household member • Eligibility determination for all programs (Medicaid, CHP+, APTC/CSR) • Who to contact with questions • Date eligibility decision was made • Case number • Medicaid or CHP+ ID number • Rule that governs eligibility determination • Appeals information

  7. Enrollment Materials • HealthColoradowelcome letter sent to most members • If no health plan choice made, member stays in Regular Medicaid

  8. Enrollment Materials

  9. Enrollment Materials • Some members auto-enrolled in ACC program • Can opt-out by calling HealthColorado

  10. Enrollment Materials

  11. Enrollment Materials • Some members auto-enrolled in Denver Health Medicaid Choice • Member Services: • 303-602-2116 • TTY/TDD: 303-602-2129 • Toll Free: 1-800-700-8140 • TTY/TDD Toll Free: 866-538-5288

  12. Letters sent after approval

  13. Letters sent after approval

  14. Letters sent after approval

  15. Letters sent after approval

  16. Letter sent during Open Enrollment • Members in ACC program receive • Can make a change or remain in same health plan

  17. Mail Center on PEAK

  18. Connect for Health Colorado Information • View FAQ’s on http://www.cohealthinfo.com/faqs/connect-for-health-colorado-marketplace/ • Contact Connect for Health Colorado: • 1-855-752-6749 / TDD 1-855-346-3432

  19. Medicaid Card • Member’s Medicaid card should arrive via mail7-10 days after a determination • Can print temporary card or request new card through PEAK

  20. Redetermination Notice - MAGI

  21. Redetermination Notice – non-MAGI

  22. Redetermination Process • Historically, had to renew every year • Now, system should recognize those who need to renew & those who can automatically continue coverage

  23. Notices Regarding Changes

  24. Appeals If an applicant does not agree with their determination (or cancelation) they may request a: • County Conference (or MA site Conference) • And/or a State Hearing

  25. When Do 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

  26. How do members know what type of providers they need? • Ask their PCP or PCMP • Call the Nurse Line for free medical advice • Contact their RCCO (if part of ACC program) • Contact their HMO (if applicable)

  27. How do Members Find Providers? For CHP+ Providers For Medicaid Providers • ContactRCCO- Info online @ Colorado.gov/HCPF/regional-care-collaborative-organizations • Provider search online @ Colorado.gov/hcpf/find-doctor • Contact Medicaid Customer Contact Center: • Toll Free: 1-800-221-3943 • TDD: 1-800-659-2656 • Contact Your HMO - Info online @ CHPplus.org • Click on “Providers” on left • Click on “Click here to go to HMO screen” link

  28. Dental Information • New benefit for Medicaid adults • Provides up to $1000 in dental services per state fiscal year • Separate packet gets sent by DentaQuest • DentaQuest Member Services: • 1-855-225-1729; TTY: 711

  29. Medical Assistance Providers Medical Assistance providers are regular: • Doctors • Dentists • Pharmacies • Specialists • Durable Medical Equipment Providers … who provide services at a special rate

  30. Reporting Income & Household Changes • Can report changes online @  Colorado.gov/PEAK • Can also call or visit local county Departments of Human/Social Services • Visit Colorado.gov/CDHS then click “Services by County” on right hand side • Or visit Colorado.gov/PEAK then click “Services by County” at the bottom of the screen

  31. Churning & Continuous Coverage • If income increases or family size decreases to a point where no longer eligible for Medical Assistance, member is removed • Children under 19 will remain eligible for Medical Assistance for 12 continuous months after being found eligible

  32. Kinds Of Help Available To Members • FAQ’s Online @ Colorado.gov/hcpf/member-faqs • Call or visit your county Department of Human / Social Services • Contact MedicaidCustomer Contact Center: • Toll Free: 1-800-221-3943 • TDD: 1-800-659-2656 • Contact CHP+ Customer Service: • 1-800-359-1991 • CHPPlus.org

  33. Who/ What is Health Colorado? • Colorado Medicaid’s enrollment broker • Helps Medicaid clients choose health plan • Clients who do not call to choose will stay in Regular Medicaid • Client can change health plan: • Within 90 days after selecting a plan, or • 2 months before client’s birth month

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

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

  36. 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

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

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

  39. 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

  40. BHOs • Behavioral Health Organizations • Provide behavioral health counseling & therapy for individuals • No co-payments • No limits • Prior Authorization may be required

  41. 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

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

  43. Role of Healthy Communities • Combines aspects of Early Periodic Screening Diagnostic and Treatment (EPSDT) with CHP+ outreach • Outreach & case management model helps both Colorado Medicaid & CHP+ families • Educate families on value of preventive health care services & how to access benefits • Provide members with information & referrals to other community programs & resources

  44. CHP+ Co-pays • No co-pays for preventive care • No co-pays for American Indians & Alaska Natives • Co-payment examples: • $2 to $5/visit for medical care & prescriptions • $3 to $15/visit for emergency services • $5/visit for most dental services • Find full list of co-pays on chpplus.org

  45. CHP+ Enrollment Fees • No enrollment fees for American Indians & Alaska Natives • Annual enrollment fees: • $0 for adult pregnant woman • $25 for one child • $35 for two or more children • New annual enrollment fees for families earning more than 205% & up to 260% of Federal Poverty Level (FPL): • $75 for one child • $105 for two or more children • Find full list of fees on chpplus.org

  46. How to find CHP+ Providers • Client must contact their CHP+ HMO for list of providers within their HMO network

  47. Where can CHP+ client call/go for more help? • Call CHP+: 800-359-1991 • Call their HMO: see CHP+ HMO Comparison chart or visit chpplus.org

  48. Thank You!

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