!!!DRAFT Slidedeck for Oversight Committee and General Audience!!!

Montana Medicaid & Expansion 101

1What is Medicaid ?Federal and State program that pays medical costsfor people with limited income and assets.

22Coverage Groups3Some of the groups that do not fall under ACA that you may see at some point.However if you were to have someone : you can help direct them to the door that meets their needs. Online application or manual.

Example: Medicare recipient, or HIFA HIFA, online.. Medically needed : spend down

3 Presumptive eligibility4Few things to remember with presumptive. Only can have 1 time per year except pregnancy.. Which is once per pregnancyA presumptive application is not a Medicaid application.

Presumptive Eligibility: providing Medicaid services for a presumptive period (usually no more than two months) following a determination by a qualified entity. Determination is based on preliminary information that the individual is within income standards, is a Montana resident, is a US citizen, or qualified non-citizen.

4Retroactive Medicaid Coverage55Affordable Care Act

6Documentation7Self Attestation vsRequired

Transition in to what is required.. What is required when determine.True for all Medicaid programs. 7Modified Adjusted Gross Income (MAGI)88Is there a resource test for ACAprograms?9No!Visit about other programs and that they do have. 9Expansion 101

10Medicaid Eligibility

Parents and adults without kids living at home between the ages of 19-64 with an income at or below 138% of the Federal Poverty Level (FPL)

$16,424 for an individual and $27,724 for a family of three in 201511Everything I just talked to you about is in the red.. And now expansion is in the blue.

Reminder: There are pieces in SB405 that are not connected Medicaid eligibility

The new law extends health coverage to parents and childless adults between the ages of 19-64, with an income at or below 138% of the Federal Poverty Level (FPL);

138% FPL = $16,424 for an individual and $27,724 for a family of three in 2015.

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Eligible and Services Delivered by Medicaid State Plan(Subject to Copayment)ACA Adult MedicaidEligible and Services Delivered by TPA (Subject to Premiums and Copayment)ACA AdultAmerican Indians/Alaska Natives;Individuals with exceptional medical needs;Individuals who live in a geographical area with insufficient health care providers; Individuals in need of continuity of care that would not be available or cost-effective; andAny other individuals exempt by federal law who are aged 19-64 and with incomes up to 138% FPL.

All are eligible to participate in employment services assistance including those not subject to disenrollment.Other newly eligible adults and parents under 138% FPL, aged 19-64.

Participation in job assessment and planning and wellness can earn exemption from disenrollment for those who earn 100-138% FPL.Workforce Assessment, Employment, and TrainingOver 100% FPL Under 100% FPLCovered by the Help Act12Native Americans:Any individuals that self-attest to being Native American that are eligible for coverage through the Montana Health and Economic Livelihood Partnership (HELP) Act will not have to pay a premium.

Medically Frail: Individuals attesting to having special medical needs, including but not limited to, disabling mental disorders, chronic substance use disorders, and serious and complex conditions

NOTE: The Department of Labor Workforce Assessment, Employment, and Training programs are optional for those eligible for Medicaid expansion. DOL Programs include workforce assessment, employment assistance, and training. Employment assistance is available to everyone other assessment and training subject to DOL eligibility criteria 12Where can you help someone apply?13David

We will send the link to the online application trainingOther reasons why you would use the online application:more documentation is needed for someone who applied. Self Service Portal has the option to upload documentation.

13What does this mean for OPA and Medicaid Eligibility?Just another ACA category!

Eligibility is determined by Offices of Public Assistance and is very similar to the other ACA categories that we have been doing for the last 2 years.

Retro Medicaid and Presumptive Eligibility are still available

Clients can apply through the Federally Facilitated Marketplace or through the state.

We already serve many of these individuals and families in our other public assistance programs.

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14What does this mean for CAC and navigators ?

1515Health Coverage Options: Pre-enrollment

David16What is Pre-enrollment?Pre-enrollment is dependent on approval of the waiver by CMS. Pre-enrollment will allow individuals to opt-in for coverage in 2016 Pre-enrollment is allowed and supported by the federal Centers for Medicare and Medicaid (CMS)A Pre-enrollment Health Coverage Option Notice is scheduled to be sent early October to eligible individuals on giving them the option to opt-in for benefits

Individuals can Pre-enroll by calling 1-844-792-2460 or through apply.mt.gov

After the individual opts-in, the system will automatically set up benefits and notify the individual via the About Your Case/Approval notice

17Why Pre-enrollment?It is allowed under federal law

Streamlined enrollment for eligible individuals, and already verified as eligible based on case and program data

Good news for the client and for staffReduces work burden for staff related to new application processing for adding a programEase of use for client

18Pre-enrollment ProcessThe Pre-enrollment process will contain three parts:

Identify individuals and send general notice for enrollment:Individuals registered in CHIMES who are eligible for Medicaid Expansion benefits will be automatically identified by the system. The system will calculate a premium amount for each of these individuals, and a notice will be automatically sent with the premium amount details and an option to opt-in to receive coverage.1Collect Individual responses:Individuals can opt-in through apply.mt.gov or by calling # 1-844-792-2460. The responses will be available monthly starting at the end of November. 23Set up benefits for individuals: Benefits will be automatically processed for individuals who chose to opt-in.

19Pre-enrollment Process - Filter CriteriaIndividuals will be identified as eligible from existing and verified open SNAP/TANF cases or cases with open Medicaid/HMK that have at least one adult between ages 19-64 who is not receiving benefits.

Additional Filter Criteria for Individuals: Has verified citizenship or alien statusHas verified incomeHas a verified social security numberHas an income under 138% FPL (133% plus 5% disregard) determined using the filing unitIs a Montana residentMust live in the householdLives in the householdHas no ongoing span for noncompliance if the individuals has Medicaid programHas no IPV record with penalty imposed20Pre-enrollment Process Video

21Pre-enrollment Process Setting Up Benefits.

If an individual that contacts the Office of Public Assistance (OPA) and requests to opt-in for benefits, it is recommended the CSC work with the client to call the opt-in line or complete the apply.mt.gov opt in process together. This will ensure the client completes the process accurately to reduce any potential complications.

22Pre-enrollment Health Coverage Option Notice

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Pre-enrollment Health Coverage Option NoticeThe Pre- enrollment Health Coverage Option Notice will be sent automatically one time per household to the Primary Individual through Correspondence including the following: JOE SILVERSMITHP.O. Box 123Helena, MT 59601JOE SILVERSMITH,JOE SILVERSMITH1234567JANE SILVERSMITH7654321Premium amountRequest for eligible individuals to opt-in for benefitsList of individuals eligible for Pre-enrollmentEligible start date24Timeline

25TimelineThe deadline to opt-in will be January 31, 2016Important next steps: The About Your Case Notice will be automatically sent out after benefits are set up in CHIMES EABenefits will be automatically set up in CHIMES EA as individuals opt-inThe Pre-enrollment Health Coverage Option Notice is scheduled to be mailed out early October26Commonly asked questions?What can someone expect if they request a Full determination on the FFM?

Who can you call to trouble shoot on a FFM to State application?

Is Medicaid available for a Seasonal Farmworker?

27Full: possible notice from the OPA asking other questions or needing other verifications

New position : Health care coordinators

If there is not an intent to stay in Montana then no. There is a possibility of emergency Alien Medical coverageExamples: 1. placing the individuals health in serious jeopardy (this includes child birth)2. Serious impairment to bodily functions3. Serious dysfunction of any bodily organ or part

27Questions?

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