Medical Assistance 101
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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. What You Will Learn Today.
Medical Assistance 101
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Presentation Transcript
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
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
Affordable Care Act (ACA) or FACT FICTION
Statement # 1 ObamaCare & the Affordable Care Act are different laws
Statement # 2 The ACA prevents health insurance companies from denying people because of pre-existing conditions
Statement # 3 Connect for Health Colorado is the same as the Federal marketplace or Healthcare.gov?
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
The Affordable Care Act (ACA) Image from: www.hhs.gov/healthcare
Public & Private Health Insurance Private Health Insurance • CSR & APTC to buy Private Health Insurance Public Health Insurance And more!!!
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
What is Medical Assistance? \ Public health care programs administered by state or federal government
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
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
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)
Who Does Medical Assistance Serve? • Unqualified non-citizens facing emergency medical situations Qualified Non-Citizens • Citizens People with limited income& resources
What Kinds of Colorado Medical Assistance Programs are There? \ Medicaid Child Health Plan Plus (CHP+) MAGI Non- MAGI
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
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
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
Accountable Care Collaborative (ACC) Medicaid Health Plans Managed Care Organization (MCO) RegularColorado Medicaid
Accountable Care Collaborative (ACC) • Most medical services • Preventive services • Help finding a specialist • Education about health conditions • Information about improving health Medical Home RCCO
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
Regional Care Collaborative (RCCO) Map Find this map & more @ Colorado.gov/HCPF/ACC
Managed Care Organizations (MCO) Find a comparison chart & more @ Healthcolorado.net/list-pdfs/ComparisonChart.pdf
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
What Kinds of Colorado Medical Assistance Programs are There? \ Medicaid Child Health Plan Plus (CHP+) MAGI Non- MAGI
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
CHP+ Health Maintenance Organizations (HMOs) Find this map, a comparison chart,& more @ CHPplus.org
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
So who Qualifies for Medical Assistance? It Depends
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
New HCPF Website Colorado.gov/HCPF Applicant & Member Focused
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
How & When to Apply for Medical Assistance No Open Enrollment Period:Applicants can apply for Medical Assistance atany time
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
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
