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MoKP Webinar July 2012

MoKP Webinar July 2012. MO Spend Down Status, MoKP programs, Medigap policies. Leanne Peace, Director . MHN Spend Down Change. July 1, 2012 for ALL Spend Down patients state-wide! Letters have been sent to “pause” patients. (Oct-Jan incurred billed patients)

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MoKP Webinar July 2012

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  1. MoKP WebinarJuly 2012 MO Spend Down Status, MoKP programs, Medigap policies Leanne Peace, Director

  2. MHN Spend Down Change • July 1, 2012 for ALL Spend Down patients state-wide! • Letters have been sent to “pause” patients. (Oct-Jan incurred billed patients) • Can only use “true patient responsibility” for Spend Down. • Under certain circumstance, 3 months prior and post documentation will be accepted. Details pending. • DSS form expected to be developed for documentation of on-going charges. Details pending. • Nothing hand written will be accepted. • Needs DATES of SERVICE not # of treatments! • Questions go to Anna Beckett, 573-751-3221 or anna.beckett@dss.mo.gov

  3. MHN News: • New policies to be released later today! • New form to be released later today! • Will send out asap to listserv. • Uncertain when training of caseworkers will occur.

  4. New Terminology • Active Medicaid – Patient is approved for assistance through MO HealthNet (Medicaid) for the aged, blind and disabled.  • Active Coverage – Patient has Active Medicaid and has either met their spend down liability with bills or have paid in their spend down.

  5. Why should I keep my Medicaid Active even though I can’t meet spend down by bills or payment? • If a patient meets their spend down by either bills or pay-in their spend down (meaning they have Active Coverage) at least once between July and December they will remain dual eligible for: •  $0.00 premiums for Dual Eligible Part D plans •  Have low co-pays •  Retain MO Rx which pays half of your co-pays  • MoKP usually pays in patients spend down at least once per year to keep them dual eligible.

  6. Why go thru the reinvestigation process for Mo HealthNet every year to keep Active Medicaid? • If a patient chooses to terminate their Active Medicaid. They will have to fill out yearly applications for:  • Low Income Subsidy (LIS) to receive reduced premiums based on sliding scale for Part D plans and lower co-pays. • Missouri Rx – to retain help with 50% of those co-pays • Missouri Kidney Program – You will no longer proxy into our program and income and asset information will have to be obtained once per year. • So instead of 1 application per year they will have 3 applications to fill out.

  7. Other MHN programs to consider • Ticket to Work Health Assurance • Qualified Medicare Beneficiary • Specified Low Income Medicare Beneficiary • Program for All Inclusive Care for the Elderly

  8. TWHA • Client has to be disabled • Age 16—64 • Has a W2 paystub to show employment • Income is below 300% FPL • Referral to local FSD office http://www.moga.mo.gov/statutes/C200-299/2080000146.HTM

  9. QMB • Must have Medicare Part A • Pays for Part B premiums, co-insurance, and deductibles. • Participants can have higher assets, and incomes up to FPL 100%. • Referral to FSD • Does NOT help with transportation needs! • http://www.dss.mo.gov/fsd/qmb.htm

  10. SLMB • Must have Medicare Part A • Provides Part B premiums only • Income and assets can be higher (135% FPL) • Does Not help with Transportation or 20% after Medicare • http://dss.mo.gov/fsd/slmb.htm

  11. PACE • Program of All-Inclusive Care for the Elderly • Supported by the Alexian Brothers Charity • Located only in STL area. • Provide all the medical, health, and social services necessary for Seniors (age 55+) to remain independent at home so that they do not have to move into a NH. (Includes dialysis and transportation). • 314-771-5800 or www.AlexianBrothers.net

  12. Legal Service Lawsuit • 5 dialysis patients and Paraquad filed a lawsuit with DSS on the grounds that the new Spend Down change will force them into institutional settings, impacting their rights under ADA. • A Temporary Restraining Order was denied on 6/29 asking to halt the July 1 implementation. • Lawsuit continues, date of hearing unknown.

  13. MoKP • New Fiscal Year with stable funding • Programs: • Medication assistance w/ CDP (Kilgore’s) • Spend Down pay in for some patients • Private Premiums for a select few patients • Transplant Grant • Staff changes: Will be hiring for a coordinator position, will also have part-time clerical help.

  14. New MoKP Program under consideration: • Transportation— • Small amount set aside to cover extreme transportation hardships. • Will send out a state-wide survey in mid-July to determine true need.

  15. MoKP Database • Patient on MoKP listings, reports of MHN Spend Down lists, (purple sheet) • Password protected, contact your coordinator to get started. • https://mokp.missouri.edu/mokp_web

  16. Medigap or Medicare Supplement Policies • Disabled beneficiaries (Under 65) have 2 six month open enrollment periods: • When they first enroll in Part B, • Beginning the month they turn 65, and have Part B. • Loss of EGHP has a special enrollment period. • Starting in Aug. MoKP will be emailing a list to social workers of MoKP patients as they turn 64 ¾.

  17. Medigap Policies That are Guarantee Issue • BC/BS of KC • TransAmerica--offers only through membership organizations: VFW, NRA, AMA, ABA, • MoKP has researched state-wide insurance plans and have found no policies for our patients, • however some clinics and patients have had success w/ Anthem BC/BS. • Medicaid is Creditable coverage, but losing it does not mean Guarantee Issue, per MO Dept. of Ins. Guarantee Issue = company can not deny you a policy because of health status.

  18. MoKP Website • http://som.missouri.edu/mokp/ • Link to MO Dept. of Insurance’s Medigap Rate Guide

  19. Advocacy Efforts • Office of Governor Jay Nixon • http://governor.mo.gov/contact/ fax # 573-526-3291 • Local legislators http://www.house.mo.gov/ • www.senate.mo.gov/ • Jeff Harris jeff.harris@mo.gov fax# 573-526-0750 • Brian Kinkade Brian.D.Kinkade@dss.mo.gov • fax # 573-751-3203 • Alyson Campbell Alyson.F.Campbell@dss.mo.gov • fax # 573-751-0507 • Ian McCaslin Ian.McCaslin@dss.mo.gov fax # 573-522-8514

  20. Thank You! • Questions and Answers to follow Tracey’s talk • Leanne Peace, Directorpeacelj@health.missouri.edu

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