New Health Coverage for Virginia Adults...New Health Coverage for Virginia Adults 1 Visit | Call 1 -855-242-8282 | TDD: 1-888-221-1590 Thank you for inviting me to speak to you today.\爀吀栀椀猀
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New Health Coverage for Virginia Adults Visit www.coverva.org | Call 1-855-242-8282 | TDD: 1-888-221-1590 1
Thank you for inviting me to speak to you today. This is an exciting time in Virginia. Thousands of Virginians will soon be able to sign up for quality, low-cost health care coverage.
Agenda
Overview
Who is Eligible?
What Services will be Covered?
New Adult Coverage Uses Current Programs
"Medically Complex” Enrollees
New Adult Coverage Initiatives
How to Apply for Medicaid
Visit www.coverva.org & Partner With Us
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We are already getting many questions about the new coverage options. We want to make sure that everyone has accurate information, and all of you can help us spread the word. You have been an important part of the work that got us to this point, and we hope that you will continue to support the Cover Virginia outreach campaign. You can do that by sharing what you learn today with people in your communities. Here are the topics that we are going to cover over the next few minutes.
• The rules have changed. Virginians who may have applied for Medicaid in the past and been denied may be eligible beginning January 1, 2019.
• Up to 400,000 more Virginia adults will enroll in quality, low-cost health coverage.
• People working in retail, construction, childcare, landscaping, food service or other jobs that do not offer health insurance may be eligible for this low-cost health insurance in Virginia.
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Until now, few adults in Virginia could qualify for coverage because of the strict rules in place. You probably have met people who have applied in the past and been rejected. Our greatest challenge is persuading these people to come back and try again, and we need your help to reach out and let them know that the rules will change starting January 1, 2019. This is a major change in our program that will open the door to up to 400,000 Virginia adults. Many of the new people who will join our program work in jobs that do not offer health insurance. That includes jobs in retail, construction, childcare, landscaping and food service. We believe these individuals should have coverage so that they don’t have to worry about getting sick or having an accident.
Who is Eligible?
Adults ages 19 – 64, not Medicare eligible Income from 0% to 138% Federal Poverty Level
New eligibility rules will provide quality, low-cost health care coverage to up to 400,000 men and women
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The Number 1 question we get is “Who is eligible?” There will be an application process to go through all of the requirements, but I can give you the highlights today. First, individuals must be between the ages of 19 and 64 to qualify. This coverage is not for people who are in Medicare now or eligible for Medicare.
Income Eligibility GuidelinesAdults may be eligible if they make less than:
Who is Eligible?
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Second, individuals must meet income requirements, which vary by the number of people in their household. For example, a single adult living alone may be eligible if her or his annual income is at or below $16,754 dollars. A parent living with a spouse and a child may be eligible if the total annual income for everyone in the household is at or below $28,677 dollars.
What Services are Covered?
• Doctor, hospital and emergency services, including primary and specialty care• Prescription drugs• Laboratory and X-ray services• Maternity and newborn care• Home health services• Behavioral health services, including addiction & recovery treatment services• Rehabilitative services, including physical, occupational and speech therapies• Family planning services• Medical equipment and supplies• Preventive and wellness services, including annual wellness exams, immunizations,
smoking cessation and nutritional counseling• And more
New enrollees will receive all services available to current members including evidence-based, preventive services
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The second most common question we hear is “What services are covered?” As you can see from the list on the slide, this coverage includes a wide variety of services. They include doctor visits, hospital stays, prescription drugs and behavioral health care. There are many more services available than we could include on this list, so people should not be discouraged if they don’t see a specific type of medical care that is important to them.
New Adult Coverage Uses Current Health Plans
Coverage will be provided for most individuals through the Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) managed care programs
Medicaid’s six current health plans will serve the new adult members
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The new people signing up for coverage will be part of the same programs that our existing members are already using. The vast majority of our members today are enrolled in managed care programs, and that will also be true for new members. Most people will be covered through our Medallion 4.0 program. People who have a complex behavioral or medical condition that limits their daily activities will be enrolled in Commonwealth Coordinated Care Plus (also known as CCC Plus), which is our managed long-term services and supports program. The CCC Plus program offers extra support so that these individuals get help with coordinating all of their health care needs. Whether individuals are enrolled in Medallion or CCC Plus, they will be able to choose from the six health plans. The same six plans are available for both programs.
“Medically Complex” Enrollees
“Medically Complex” members will be enrolled in the CCC Plus managed care program, which will provide enhanced care coordination services
Application QuestionApplicant responds to a “Yes/No” question at time of the initialMedicaid application.
If Applicant marks “Yes,” then the member will receive a screening to validate.
“Medically Complex” includes individuals with a complex behavioral or medical condition and functional impairment, which may be established by:
Question on the Medicaid Application:
10. Do you need help with everyday things like bathing, dressing, walking or using the bathroom to live safely in your home? Or Has a doctor or nurse told you that you have a physical disability or long term disease, mental or emotional illness, or addiction problem? Yes No
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Those of you who work with people who have significant health needs are probably already familiar with CCC Plus, which is our managed long-term services and supports program. If you are helping with outreach to individuals with complex health needs, you will need to have a basic understanding of the term “medically complex,” because that is the category of new adults who will be enrolled in this program. The important thing to remember is that an individual is considered to be “medically complex” if he or she has a complex behavioral or medical condition AND functional impairment, meaning the complex condition makes it difficult to handle daily activities on their own Individuals applying for coverage will be asked about the level of their health needs when they enroll. If they mark “yes” on the application question, then they will receive a screening to validate their status as medically complex. If you want to ensure that a Medicaid applicant with a chronic condition is initially enrolled in CCC Plus, then please make sure the applicant spends time to answer this question correctly. If an individual does not mark “Yes,” on the Medicaid application, they can still be determined medically complex by their health plan.
Eligibility & EnrollmentEnrollment Pathways
GAP (Governor’s Access Plan) Adults 21 to 64 years of age with Severe Mental Illness (SMI)Plan First Family planning services ≤ 138% FPL
SNAP beneficiaries Supplemental Nutrition Assistance Program formerly know as Food StampsParents of Child(ren) enrolled in Medicaid
Individuals currently enrolled in a qualified health plan (QHP) from the Federally-facilitated Exchange (FFE), also known as the Marketplace or Healthcare.gov
Newly eligible adults not captured in Streamlined Enrollment groups
PriorityPopulations
Transition to Full Benefit Medicaid
Limited Benefit Programs
ExpressApplication
Transition to Virginia Medicaid
GeneralPublic
Uninsured individuals served through other systems of care
The new adult population will enroll in coverage through a variety of enrollment pathways, including streamlined enrollment processes
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October November December January
Plan First Heads Up Letter
10/25/2018
SNAP & Parents -Short Application -Mailing
10/29/2018 VaCMS batch process to enroll
11/19/2018
Second GAP Heads Up letter
VaCMS to send Notice of Action for approvals/denials
11/15/2018
GAP transitioned-Notice of Action letter sent
12/15/2018
Federal Marketplace – Open Enrollment 11/1 – 12/ 15
Expanded Coverage Begins
01/01/2019
Medicaid ID card mailed; enrollment file (834) generated to the MCOs
9/10/2018 & 9/12/2018 Healthcare.gov sends a notice to current QHP members
Early October
DMAS sends an outreach letter to current QHP members that will be eligible for Medicaid
Mid- October
Medicaid Expansion Streamlined Enrollment
GAP – First GAP Heads Up notice to inform members that GAP will be closing. (Two letters; one to expansion eligible GAP and one to GAP not eligible for expansion due to citizenship status)
Key of AcronymsGAP – Governor’s Access Plan; provides limited medical and behavioral health care coverage for low income individuals with Serious Mental Illness (SMI) - http://dmas.virginia.gov/#/gapQHP – Qualified Health Plan through the Federal Marketplace https://www.healthcare.gov/glossary/qualified-health-plan/SNAP – Supplemental Nutrition Assistance Program; provides financial assistance to households with low income to buy foodVaCMS – Virginia Case Management System; Virginia Department of Social Service’s automated eligibility systemMCO – Managed Care Organization, contracted with DMAS to provide Medicaid coverage to eligible members
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*QHP MCOs may also send an outreach letter to their enrolled members
If individuals want to apply for Medicaid, they can apply: By phone by calling the Cover Virginia Call Center or VDSS Enterprise Call Center; In person by visiting their local Department Of Social Services; and Online by visiting healthcare.gov or commonhelp.Virginia.gov More information about when to apply for the new adult coverage will be available soon on the Cover VA Website, so check there frequently for updates on when to apply
How Can I Help People Apply?
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Participate in SignUpNow SignUpNow is a 4+ hour training for people
interested in helping individuals and families apply for Medicaid and FAMIS, including new coverage for adults.
Trainings will be offered throughout the state, starting in November 2018
To receive workshop dates and locations, please sign up at http://tinyurl.com/sunworkshops
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If you’re interested in learning how to help people apply for Medicaid and FAMIS, then you can participate in Sign Up Now, which is an in depth training provided by the Virginia Health Care Foundation. Trainings will be offered throughout the state, starting in November 2018, so please visit “tiny U-R-L dot com slash sun workshops” to learn about workshop dates and locations
Beginning January 1, 2019: Implement New Adult Coverage And Other Policy Initiatives
Beginning January 1, 2019 – New coverage for adults with incomes
up to 138% FPL
Key initiatives include: Health and Wellness Incentives Referrals to Workforce Resources Appropriate Utilization of ER Services
Future initiatives in development for certain individuals: Health and Wellness Accounts Cost-sharing including copayments Training, Enrollment, Education,
Employment and Opportunity Program (TEEOP)
Supportive Employment and Housing Benefit
Future Initiatives in Development:(These initiatives require federal approval of a § 1115 Demonstration Waiver)
New Adult Coverage: Early and Future Initiatives
The 2018 Appropriations Act directs Virginia Medicaid to implement new coverage for adults and transform coverage
New adult coverage begins January 1, 2019, while future initiatives are still in development13
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The state budget creates a framework for expanding adult coverage as well as making additional changes to our Medicaid program. It’s important to understand the timing of these changes. New coverage will be available to adults with incomes up to 138 percent of the federal poverty level beginning January 1, 2019 Several new initiatives will also begin January 1, 2019, such as: Health and Wellness Incentives that will be offered as a benefit through the health plans; Referrals by health plans to the Career Works Centers (One Stops) to help with job training, education, and job placement assistance; and Outreach and care coordination to frequent emergency room visitors. In the future, there will be other initiatives for certain individuals, but the details for those changes are still in development and will require federal approval through a Section 1115 Demonstration Waiver, which gives a state flexibility to test innovations within the Medicaid program. I want you to know that you will have an opportunity to submit public comments on these future initiatives before they are final. Virginia Medicaid encourages you to monitor the Cover Virginia website for updates and participate in this process when the public comment period begins. As an advocate, you may work with an individual who is interested in applying for the new adult coverage when enrollment begins, but that person may have some questions about the future initiatives. Please encourage people to go ahead and apply when enrollment begins so they can have coverage beginning on January 1, 2019. You can let them know that any additional benefits or requirements will happen later, and they will get information in plenty of time to ask questions and understand how they might be affected.
Health & Wellness Program
• Requirement for premiums and co-payments, health & wellness accounts and healthy behavior incentives.
• Applies to Medicaid enrollees with incomes between 100-138 percent of the federal poverty level, who do not meet an exemption. Exemptions are the same as in the TEEOP program.
1115 Waiver: Summary Overview
The 2018 Appropriations Act requires DMAS to submit an 1115 Demonstration Waiver within 150 days of passage with the following key components:
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Work/Community Engagement (TEEOP)
• Requirement to participate in training, education, employment and other community engagement opportunities for 80 hours per month in order to maintain Medicaid coverage.
• Applies to all “able-bodied adults” in the Medicaid program who do not meet an exemption (e.g., parents of dependent children, medically-frail, disabled).
Housing & Employment Supports for High-Risk Enrollees
• A supportive housing and employment benefit for high-risk Medicaid enrollees, including those with severe mental illness, substance use disorder, or other complex, chronic conditions.
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Future Medicaid Initiatives - Virginia COMPASS Program The 2018 Appropriations Act allows us to expand adult coverage and requires that we add additional requirements to our Medicaid program. It is important to understand the timing of these changes. New adult coverage through Medicaid expansion will be available beginning January 1, 2019. The Appropriations Act, also requires DMAS to add new cost sharing requirements as well as Training, Education, Employment, and Opportunity Program (TEEOP), Health and Wellness Program, and Housing and Employment Supports Benefit for High Needs Enrollees. These new changes will not begin to be implemented until later in 2019. To accomplish these changes, we will amend our current 1115 waiver, that includes ARTS program. The Waiver will be branded as C.O.M.P.A.S.S., which stands for Creating Opportunities for Medicaid Participants to Achieve Self Sufficiency, It is important that we provide clear and consistent information about these changes.
Comments and questions should be directed to the DMAS website (link below) where the COMPASS Waiver’s full Public Notice and draft Waiver application are posted. The Virginia COMPASS waiver application is currently out for public comment and is available on the DMAS website at http://www.dmas.virginia.gov/#/1115waiver. The 30-day public comment period for the Virginia COMPASS application is from September 20, 2018 until October 20, 2018. in Addition, four public hearings are scheduled around the state and begin next week. All comments must be received by midnight (Eastern Time) on Saturday, October 20, 2018. Public comments may be submitted by email to [email protected]
Please visit www.coverva.org regularly for updates or call Cover Virginia at 1-855-242-8282.
More information will be coming soon on the timing and process for enrollment. Outreach
materials will be posted on the website so that our partners can share them in their communities.
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I am sure that you have additional questions, and you will think of even more questions after you get home. The most important source of information about this new coverage is our Cover Virginia website. That’s Cover V-A dot org.
Cover Virginia Website
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When you get to the home page, click on the big green button to get to the page with information on new adult coverage.
Cover Virginia Website: New Adult Coverage Webpage
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You’ll find a list of Frequently Asked Questions, and we will be adding new information regularly. Be sure to check out the eligibility screening tool and the resources for advocates
Cover Virginia Website: New Eligibility Screening Tool
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When you click on the screening tool, you will get a series of questions will help you figure out if a person meets the income rules.
Cover Virginia Website: Resources for Advocates
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When you click on the “Resources for Advocates” link, you’ll have access to the Advocates Toolkit, this presentation and script, and other useful materials including posters and flyers.
Partner With Us
• Talk to your family, friends and neighbors about new adult coverage• Visit the Cover VA website for information and updates• Access the eligibility tool on www.coverva.org to see if you or
Please take a brochure with you, visit the Cover Virginia website, and please share this information with people in your community. Thanks again for your time.
