He a lth Re form Imple me nta tion F orum: E ligibility, E nr - - PowerPoint PPT Presentation
He a lth Re form Imple me nta tion F orum: E ligibility, E nr ollme nt, and Re te ntion Ma rc h 28, 2013 OBJECTIVES FOR THE MEETING Health Care Reform is a great opportunity. Implementation = change, some that is challenging. Many
ake s A Village : Collaboration between HCSA and SSA, in
Key to enrolling & retaining current and newly eligible.
CHANGES TO ELIGIBILITY, ENROLLMENT, AND RETENTION
7
Medi-Cal
through “linkage” with CalWORKS, SSI, foster care, and adoption assistance
months or less: must pass asset test; income determines if there is a share of cost (SOC)
there is a share of cost
to 133% FPL)
133-200% FPL for pregnancy services)
HealthPAC - Low Income Health Program, Medi-Cal Expansion (LIHP-MCE)
HealthPAC – LIHP Health Care Coverage Initiative (LIHP-HCCI)
HealthPAC County
Private Health Insurance
is provided through their employer, with some exceptions for certain children and women’s programs (AIM, WIC, Share of Cost Medi-Cal)
Child Health Plan, which offer insurance for certain populations (low-income children, individuals with certain disabilities, etc.) who do not otherwise qualify for a public or private health plan.
Non-MAGI* Medi-Cal
CalWORKS, SSI, foster care, and adoption assistance
months or less: must pass asset test; income determines if there is a share of cost
*MAGI – Modified Adjusted Gross Income - the new methodology for calculating income thresholds using IRS rules that excludes an asset test. Non-MAGI applicants will still use an asset test.
Exchange-Based Programs (Private Health Insurance Through Covered California)
(QHP), which is a plan that provides a comprehensive package of services, broken down into 10 essential health benefits.
premiums
HealthPAC County
January 2013 January 2014
MAGI Medi-Cal
138-200% FPL for pregnancy services)
citizen or LPR for 5+ years This former LIHP MCE population will transition to Medi-Cal in 2014 and will be referred to as the “newly eligibles”
Private Health Insurance
the Exchange, on the Exchange, or through their employer
exemption, you are at risk to pay a penalty
compare plan. Those between 138-400% FPL will be eligible for a subsidy to help pay for insurance premiums for Exchange-based programs. This chart provides a general overview of all programs. Eligibility requirements, especially FPL, vary by specific program and require a case-by-case analysis for an accurate determination of program eligibility.
The “MAGI Population” or “Newly Eligibles”
e move d for Medi-Cal eligibility
Cove r e d Ca lifor nia Assistor a nd Na vig a tor Pr
a m
s are entities/people that the Exchange will
To Be Determined - Compensation will also be available through The California Endowment for Medi-Cal applications and renewals.
s are entities/people that will help the Exchange
Make final determination for Non-MAGI applications started in CalHEERs. Resolve inconsistencies for MAGI and Non-MAGI Medi-Cal applications. Responsible for case management of MAGI and Non-MAGI beneficiaries.
Hours of operation 30 second “warm hand off”
155,000
Medi-Cal Expansion for Newly Eligible Population (HealthPAC MCE enrollees transition to Medi-Cal). California Health Benefit Exchange “Covered California” Goes Live (HealthPAC HCCI transition to the Exchange). Projected start CalHEERs starting to accept Medi-Cal applications.
Meeting materials and presentations Fact sheets FAQ
www.achealthcare.org www.alamedasocialservices.org www.acgov.org/health
www.healthexchange.ca.gov (policy site) www.coveredca.com (resident site)
Looking to Enroll in a Health Coverage Program Today?
Current Programs and Ways to Enroll in Coverage through December 2013 Check www.achealthcare.org for updates on how enrollment and eligibility will change in January 2014
Medi-Cal is a health insurance program for children, parents, seniors, and persons with disabilities. Income, citizenship, and family size will affect eligibility for Medi-Cal. Ways to Apply:
phone.
Unit at 1-800-422-9495 to find a location, or visit www.achealthcare.org HealthPAC is a county-based coverage program that covers the cost of medical services for low-income Alameda County residents who do not qualify for full-scope Medi-Cal, or who qualify with a high share of cost. Some of the individuals who enroll in HealthPAC today will be eligible for Medi-Cal or the Exchange on Jan 1, 2014. Ways to Apply:
The Kaiser Child Health Plan is a low-cost private health insurance option for children who do not qualify for Medi-Cal. Ways to Apply:
enrollment appointment at a health clinic or community-based location where you can be screened for both Medi-Cal and
current locations). North County Multi-Service Center 2000 San Pablo Ave. Oakland CA 94612 (510) 891-0700 Alameda County Social Services- Eden Multi-Service Ctr 24100 Amador St., Hayward, CA 94544 (510) 670-6000 Alameda County Social Services- Enterprise Office 8477 Enterprise Way, Oakland, CA 94621 (510) 777-2300 Alameda County Social Services – Eastmont Center 6955 Foothill Blvd Suite 100 Oakland CA 94605 510-383-5300 Alameda County Social Services- Fremont Family Resource Center 39155 Liberty St Ste C330, Fremont, CA 94536 (510) 670-6000 Alameda County Social Services- Livermore Outstation 3311 Pacific Ave, Livermore, CA 94550 (925) 455-0747
Medi-Cal HealthPAC Kaiser Child Health Plan Unsure what health coverage program you and your family members may qualify for?
Health Reform 101 – California’s Health Exchange aka “Covered California”
constitutional by the U.S. Supreme Court in June 2012, calls for states and federal agencies to set up “Exchanges,” or web-based health insurance supermarkets, by October 1, 2013.
individuals, families and small businesses to compare, and purchase, different health insurance
“Covered California.”
for federal financial assistance (Medi-Cal or a federal sliding scale subsidy) that can lower the cost of health insurance plans available on the Exchange.
enrollment for Exchange health plans, federal subsidies, and for MAGI* Medi-Cal.
an electronic verification (income, social security identification, etc). Barring problems, the applicant will be enrolled without any additional follow-up.
Social Services Agency staff will complete follow-up and verification as necessary.
California staff will complete follow-up and verification as necessary.
*MAGI – Modified Adjusted Gross Income: The new methodology for calculating income thresholds using streamlined IRS rules.
family characteristics and income. If applicants are potentially MAGI or non-MAGI Medi-Cal eligible, the agent will transfer the call to the individual’s home county as quickly and seamlessly as possible. They are expected to stay on the line until the county agent answers. This has been labeled a “warm handoff.”
enrollment in Medi-Cal programs.
“bouncing” of a customer back and forth.
What is the Exchange? What is CalHEERS and How Does it Relate to the Exchange? What are the Call Centers?
Health Reform 101 – California’s Health Exchange aka “Covered California”
different portals, including the Covered California Website, the State Call Center, and County SSA offices.
to complete Covered California applications in CalWIN and screen for eligibility in Exchange subsidy programs, MAGI and Non-MAGI Medi-Cal.
applicants that begin their application through Covered California (MAGI applications are determined in CalHEERS and SSA follows- up if there is an inconsistency).
MAGI beneficiaries. The Exchange will be responsible for case management of Exchange and federal subsidy beneficiaries.
and renewing individuals in Exchange health plans during the initial enrollment period from October 2013 through March 2014 ($58/successful application and $25/successful renewal).
Endowment for Medi-Cal applications and renewals. Details To Be Determined.
uninsured after the initial enrollment period. These entities will be sustained through the Exchange’s operating costs and will be paid through a block grant, rather than a fee-for-enrollment program.
through Covered California for the application assistance
enrolled and certified individuals will generate compensation for their certified entities.
applicants during pre-enrollment from October 2013 to January 2014 and on- going after pre-enrollment.
(projected start data of January 1, 2014).
beneficiaries with Plan selection.
What is the Assister and Navigator Program? How Does the County Social Services Agency (SSA) Work with the Exchange to Promote “No Wrong Door”? For more information on California’s Exchange, go to their website at: www.CoveredCA.com. Updates, Assister Entity Interest forms and Applications will be found on the Exchange Board’s website at: www.hbex.ca.gov.
Health Reform 101 – Health Coverage Options Today and in 2014
Medi-Cal
through “linkage” with CalWORKS, SSI, foster care, and adoption assistance
months or less: must pass asset test; income determines if there is a share of cost (SOC)
there is a share of cost
to 133% FPL)
133-200% FPL for pregnancy services)
HealthPAC - Low Income Health Program, Medi-Cal Expansion (LIHP-MCE)
HealthPAC – LIHP Health Care Coverage Initiative (LIHP-HCCI)
HealthPAC County
Private Health Insurance
is provided through their employer, with some exceptions for certain children and women’s programs (AIM, WIC, Share of Cost Medi-Cal)
Child Health Plan, which offer insurance for certain populations (low-income children, individuals with certain disabilities, etc.) who do not otherwise qualify for a public or private health plan.
Non-MAGI* Medi-Cal
CalWORKS, SSI, foster care, and adoption assistance
months or less: must pass asset test; income determines if there is a share of cost
*MAGI – Modified Adjusted Gross Income - the new methodology for calculating income thresholds using IRS rules that excludes an asset test. Non-MAGI applicants will still use an asset test.
Exchange-Based Programs (Private Health Insurance Through Covered California)
(QHP), which is a plan that provides a comprehensive package of services, broken down into 10 essential health benefits.
premiums
HealthPAC County
January 2013 January 2014
MAGI Medi-Cal
138-200% FPL for pregnancy services)
citizen or LPR for 5+ years This former LIHP MCE population will transition to Medi-Cal in 2014 and will be referred to as the “newly eligibles”
Private Health Insurance
the Exchange, on the Exchange, or through their employer
exemption, you are at risk to pay a penalty
compare plan. Those between 138-400% FPL will be eligible for a subsidy to help pay for insurance premiums for Exchange-based programs. This chart provides a general overview of all programs. Eligibility requirements, especially FPL, vary by specific program and require a case-by-case analysis for an accurate determination of program eligibility.