Pr e par ing for 2014 ACA imple me ntation E ligibility, E nr - - PowerPoint PPT Presentation

SLIDE 1

Pr e par ing for 2014 ACA imple me ntation E ligibility, E nr

• llme nt & Re te ntion

Public He alth Cove r age Public Be ne fits

SLIDE 2

PRESENTATION OVERVIEW

1. Pre pa ring fo r He a lth Ca re Re fo rm: E lig ib ility, E nro llme nt, a nd Re te ntio n 2. Curre nt Sta tus o f E lig ib ility, E nro llme nt & Re te ntio n : Ma pping 3. Ne xt ste ps in 2013: pre pa ring fo r ACA imple me nta tio n

SLIDE 3

PREPARING FOR 2014

• He a lth c o ve ra g e e lig ib ility, e nro llme nt a nd re te ntio n

syste ms will c ha ng e in Ja nua ry 2014

• Ne w rule s g o ve rning e lig ib ility
• Ne wly e lig ib le MC po pula tio n
• E

xc ha ng e

• Simplifie d a pplic a tio ns a nd re ne wa ls
• I

ntro duc tio n o f ma jo r ne w e lig ib ility syste m

• Ca lHE

E Rs (CA he a lthc a re e lig ib ility, e nro llme nt a nd re te ntio n syste m)

SLIDE 4

What happens in 2014?

• Medi-Cal (poor and: “linkage” = pregnant,

parenting, disabled, or over 65) + asset test

• HealthPAC Medi-Cal Coverage

Expansion (MCE) “no linkage”

• HealthPAC Health Care

Coverage Initiative (HCCI) “no linkage”

• HealthPAC County (not eligible

for MCE or HCCI and are between 0 and 200% of FPL) MAGI* Medi-Cal 0-138%FPL, citizen/LPR

Exchange 138-200% FPL, citizen/LPR County Program Eligibility TBD

4

Non-MAGI* Medi-Cal, 0- 138% FPL with linkage + asset test After January 1, 2014 Existing Programs

*MAGI = Modified Adjusted Gross Income

SLIDE 5

PREPARING FOR 2014 CONT

• Ma ximize e nro llme nt in Ala me d a Co unty: 3 Ste ps
• Ste p One :

Ma pping o f c urre nt syste m

• Ste p T

wo : Ana lysis o f a lte rna tive s mo ving fo rwa rd

• Ste p T

hre e : I mple me nta tio n

• Ove rvie w o f Ste p One : Ma pping

SLIDE 6

CURRENT STATUS: MAPPING EXERCISE

• Co lla b o ra tio n b e twe e n SSA a nd HCSA
• Ma p c urre nt syste m (One -e -App, He a lth-e -App,

Ca lWiN, Be ne fits Ca lWIN, a nd Pa pe r Applic a tio ns)

• Und e rsta nd who c a n use e a c h syste m, wha t pro g ra ms

c a n b e a pplie d fo r, a nd e a se a nd use .

• While it o nly d e sc rib e s a po int in time , it se rve s a s a

fo und a tio n fo r e va lua ting wha t is a nd is no t wo rking .

SLIDE 7

MAPPING EXERCISE (CONT)

• Ove rvie w o f c urre nt syste m
• Sc e na rio s
• F

inding s

SLIDE 8

ENROLLMENT PORTALS

• HealthPAC County
• HealthPAC LIHP MCE
• HealthPAC LIHP HCCI

Benefits Continuum Administered by SSA Health Care Coverage Continuum Administered by HCSA, SSA and the Exchange

• Healthy Families (HF) Transition to the

Targeted Low-Income Children’s Program (TLICP) under Medi-Cal

• Access for Infants and Mothers (AIM)
• Other Medi-Cal Programs
• Foster care, Adoption, Pregnancy,

Disability

• Small Employer Health Option Program (SHOP)
• Individuals

HCSA Indigent Programs General Assistance (GA) CalWORKS CalFresh

0% FPL 400% FPL

SLIDE 9

Applic a tio n

e le c tr

• nic a lly

tr a nsfe r r e d v ia BCW to

SSA E nte rprise

BENEF IT S CAL WIN:

Applic a nt c o mple te s a Me di-Ca l a nd/ o r Ca lfre sh a pplic a tio n

• n Be ne fits Ca lwin.

Applic a tio ns ma ile d fro m Sa c ra me nto to E nte rprise

SPE MAIL

• INS:

Apps sub mite d v ia He a lth-e -App de e me d Me di-Ca l e lig ib le a t the SPE in Sa c ra me nto

O NE- E- APP PR EL

• IM. MEDI-

CAL EL IG IBIL IT Y SUBMISSIO NS:

(S e e Chart 2 fo r O ne - e -App F lo w) Applic a tio ns

e le c tr

• nic a lly

tr a nsfe r r e d v ia O ne -e -

App to SSA E nte rprise

Pape r Me di- Cal Applic ation Comple tion with a BHCS PST

(S e e Chart 3, BHCS flo w- PS T is an autho rize d re pre se ntative ) BHCS PST s do in-pe rso n

dr

• p- offs a t SSA

E nte rprise 2-3x a mo nth

INT AKE AT SSA Ente rprise O ffic e (O akland, CA):

BCW APPL ICAT IONS: Assig ne d to a Re g io na l Ce nte r fo r pro c e ssing b y zip c o de BHCS Me di- Ca l Apps: Assig ne d to in-ho use Hospita l Inta ke Unit SPE Ma il- Ins: Re c e iv e a c c e le ra te d e nro llme nt in Me di-Ca l during pro c e ssing One - e - Apps: Printe d o ut fo r file c le a ra nc e a nd da ta e ntry into Ca lwin (no e le c tro nic inte rfa c e ) SSA CL E RICAL ST AF F RE VIE W & F IL E CL E ARANCE : All pa pe r a pplic a tions a nd One - e - App submissions: c le ric a l wo rke r pe rfo rms file c le a ra nc e in ME

DS & Ca lwin to e nsure the a pplic a tio n is unkno wn; the n ma nua l e ntry o f a pplic a tio n info rma tio n into Ca lwin.

BCW a pplic a tions: Info rma tio n is a lre a dy in Ca lwin UNKNOWN T O ME DS/ CAL WIN or CL OSE D ME DS/ CAL WIN CASE : Cle r ic a l sta ff c o mple te s a n a pplic a tio n re g istra tio n a nd a ssig ns the c a se to a n Inta ke E lig ibility Wor ke r (usua lly a n E T 2). KNOWN T O CAL WIN/ ME DS: Applic a tio n is se nt to the E lig ibility T e c hnic ia n of r e c or d (usua lly a n E T 3) Assig ne d E lig ibility Wor ke r (E T 2 or E T 3):

T he a ssig ne d e lig ib ility wo rke r pro c e sse s a pplic a tio n; re q ue sts the missing info rma tio n if ne c e ssa ry thro ug h a wr

itte n , ma ile d notic e.

All BHCS Me di-Ca l Applic a tio ns & O ne -e -Apps Applic a tio ns sub mitte d v ia ACMC site s: E T c o mmunic a te s with the PST a ssisto r b e c a use the y a re a n Autho rize d Re pre se nta tiv e . Applic a nts Jo intly Applying fo r Ca lF re sh v ia BCW o r Pa pe r Applic a tio n: E T c a n pro c e ss e nro llme nt in a dditio n to Me di

• Ca l

DE NIAL F OR NON- COMPL IANCE

(Missing info no t re c e iv e d within the 45 da y windo w)

APPL ICAT ION DE E ME D E L IGIBL E for F UL L SCOPE , RE ST RICT E D, SOC/ NSOC ME DI- CAL :

. Notic e of Ac tion se nt to c lie nt; e lig ib ility wo rke r e nsure s c a se is a c tiv e in ME DS; Ca se

tr a nsfe r r e d to a ne w distr ic t E T who will pe rfo rm c a se ma inte na nc e & pro c e ss re ne wa l(s) (se e

c ha rt 2).

PAPER MEDI- CAL APPL ICAT ION CO MPL ET ION

Applic a nt c o mple te s a pa pe r Me di-Ca l a pplic a tio n pic ke d up a t a n SSA O ffic e , re q ue ste d b y ma il fro m c a lling the 1- 800-698-1118 SSA Ho tline , o r pic ke d up a t a c o mmunity-b a se d lo c a tio n*. An a pplic a nt ma y o r ma y no t re c e iv e a ssista nc e with this a pplic a tio n.

Pape r Me di- Cal Applic ation Comple tion a t a loc a tion with a n

• ut- sta tione d SSA E

lig ibility T e c hnic ia n (E T ):

Applic a nt c o mple te s a pa pe r Me di-Ca l a pplic a tio n a t a c linic , CBO , o r o the r lo c a tio n* tha t re c e iv e s re g ula r v isits fro m a n o ut-sta tio ne d E T . Applic a nt no rma lly c a n re c e iv e so me a ssista nc e fro m a c linic lia iso n o r CBO sta ff to c o mple te a pplic a tio n.

E T pe rfo rms c le ric a l re v ie w; de te rmine s if

the a pplic a tio n is kno wn in Ca lwin/ e ithe r syste m (O ptio na l) SAWS 1 Comple tion by Phone : An a pplic a nt ma y c o mple te a SAWS 1 b y pho ne with SSA; re c e iv e s a ppo intme nt to c o me in a nd c o mple te the re st o f the a pplic a tio n. T he Me di-Cal applic atio n date is re tro ac tive to S AWS 1 c o mple tio n.

DHCS issue s BIC Me di- Ca l Ca r d He a lth Pla n/ Pr

• vide r

Se le c tion: He a lth Ca re O ptio ns

c a lls/ ma ils a pplic a nt info rma tio n to se le c t pla n/ pro v ide r. If the y do no t re spo nd the y will de fa ult to a pla n/ pro v ide r (b a se d o n a n a lg o rithm).

Disa bility De te r mina tion

Se nt to O a kla nd fo r DDSD re v ie w; pro c e ss c a n ta ke a n a dditio na l 90 da ys

PAPE R ME DI- CAL APP DROPPE D OF F , MAIL E D, F AXE D , OR COMPL E T E D IN- HOUSE AT AN SSA OF F ICE . T

he applic atio n date will b e the date re c e ive d b y S S A intake if dro ppe d o ff o r the date po stmarke d, if maile d, U NL E S S the applic ant c o mple te d the S AWS 1 b y pho ne (in whic h c ase it is the S AWS 1 c o mple tio n date ). Applic a tio n ke pt a t o ff-site lo c a tio n a nd de liv e re d to the o ut-sta tio ne d SSA E T fo r pro c e ssing upo n the ir ne xt v isit. E T s so me time s me e t with a pplic a nts to re v ie w a pplic a tio n.

E ND for a ll a pplic a tions re g a rdle ss of orig in/ NO COVE R AGE

(Apps o rig ina ting fro m One -e -a pp a re no t e lig ib le fo r the se c o nda ry He a lthPAC c o ve ra g e if de nie d fo r no n-c o mplia nc e re a so ns fro m Me di-Ca l)

INT AKE AT SSA R EG IO NAL DR O P- IN L O CAT IO NS

No rth Co unty Multi-Se rv ic e Ctr (O a k), E a stmo nt Se lf-Suffic ie nc y (O a k), E de n Are a Multi-Se rv ic e , F re mo nt O utsta tio n, L iv e rmo re O utsta tio n, E nte rprise O ffic e (O a k)

DE NIAL F OR ME DI- CAL BASE D ON INE L IGIBIL IT Y

Clie nt no t e lig ib le fo r Me di-Ca l pro g ra ms.

END for Pape r Applic ations, BCW Applic ations, and O ne - e - App applic ations with no

• the r c ove rage e ligibility;

F UL L

• SCOPE

OR R E ST R ICT E D ME DI- CAL COVE R AGE ACT IVAT E D IN ME DS (RET

ROACT IVE T O APPL ICAT ION DAT E F OR 3 MONT HS PRIOR, IF APPL IED F OR) APPL ICAT IONS ORIGINAT ING F ROM ONE

• E
• APP WHO WE

RE ASSE SSE D F OR SE CONDARY HE AL T HPAC COVE RAGE PE NDING ME DI- CAL APPROVAL :

Applic a nts de nie d fro m Me di-Ca l fo r e lig ib ility re a so ns, o r who a re fo und e lig ib le fo r Re stric te d Me di-Ca l o r F ull-Sc o pe with a hig h sha re o f c o st ma y no w b e e nro lle d in He a lthPAC if o ne -e -a pp de te rmine d se c o nda ry e lig ib ility fo r He a lthPAC pe nding Me di-Ca l e lig ib ility a t the time o f O ne -e - a pp sc re e ning . O rig ina l He a lthPAC a pplic a tio n is a udite d a t HIT fo r He a lthPAC a ppro v a l.

APPROVAL for He a lthPAC a s pr ima r y or se c onda r y c ove r a g e ; One - e - App is the syste m of r e c or d Out- sta tione d E T pr

• c e sse s the se

a pplic a tion on site & re q ue sts missing info if

ne c e ssa ry, wo rking with c linic / CBO lia ison to c o nta c t c lie nt

APPL ICAT ION MISSING INF O R MAT ION

Clie nts ha ve up to approximate ly 45 days to re spo nd to a writte n re q ue st fo r a dditio na l do c ume nta tio n ne c e ssa ry to pro c e ss the a pplic a tio n.

APPL ICAT ION CO MPL ET E

*See Appendix for list of Alameda County locations with out-stationed SSA ETs

Medi-Cal Eligibility & Enrollment: Application Portals & Eligibility Determination

Completion & Submission Eligibility Determination Recording

Ala me da Allia nc e issue s c a r d; he a lth pro v ide r pre v io usly

se le c te d in O ne -e -App pro c e ss HEALTH PLAN/PROVIDER SELECTION: Applicants dropping off applications have the

• ption of visiting the Health Care Options window to elect a health plan/provider when

they submit their application (not all do).

CHART 1

SLIDE 10

So me c linic s sta ff c all c e nte rs whic h pre sc re e n a pplic a nts using a b a sic pa pe r sc re e ning to o l, sc he dule a n a ppo intme nt fo r c lie nt, & no tifie s the m o f re q uire d do c ume nta tio n to b ring b a se d o n wha t pro g ra ms it lo o ks like the y a re e lig ib le fo r.

O NE- E- APP:

Applic a nt me e ts with a patie nt advoc ate to c o mple te One -e -a pp a t the c linic lo c a tio n.

Patie nt Advoc ate c he c ks Ca lWI

N (vie w-o nly) b e fo re b e g inning o ne -e -a pp to se e if the a pplic a nt ha s a pa st c a se o r file . Clinic s do no t ha ve ME DS a c c e ss to c he c k pa st Me di-Ca l sta tus in o the r c o untie s o r se e ME DS c a se de ta ils.

Community- Base d O rganizations with O ne - e - App Use rs:

1) Asia n He a lth Se rvic e s (Oa kla nd), 2) Axis Co mmunity He a lth (L ive rmo re ), 3) L a Clinic a de la Ra za (Oa kla nd), 4) L ife lo ng Me dic a l (Be rke le y & Oa kla nd), 5) Na tive Ame ric a n He a lth Ce nte r (Oa kla nd), 6) We st Oa kla nd He a lth Co unc il (Oa kla nd), 7) T ib urc io Va sq ue z He a lth Ce nte r (Ha ywa rd), 8) T ri-Citie s He a lth Ce nte r (Fre mo nt), 9) He a lthy Co mmunitie s, I nc . (Oa kla nd)

Alame da County Me dic al Ce nte r Site s:

1) Hig hla nd Ho spita l, 2) Fa irmo nt Ho spita l, 3) Jo hn Ge o rg e Psyc hia tric , 4) E a stmo nt We llne ss, 5) Ne wa rk He a lth Ce nte r, 6) Winto n We llne ss

He alth Insuranc e T e c hnic ian (HIT ) Unit (HCSA, San L e andro)

1-800 Numb e r, Flye rs, SSA Co ve r L e tte r se rve a s o utre a c h I nitia l pho ne sc re e ning , re q uire d do c list ma ile d, a ppo intme nt sc he dule d with HI T

Pre limina ry E lig ib ility

Ka ise r Child He a lth Pla n (HIT

ONL Y)

HIT assist applic ant to c o mple te a pape r applic atio n whic h the y mail to Kaise r.

CO UNT Y AUDIT

Syste m of Re c or d: One - e - App E L E CT RONIC SUBMISSION T O SINGL E POINT OF E NT RY (SPE ) AT SACRAME NT O (Se e Cha r t 4, He a lth- E

• App)

Pre limina ry E lig ibility for ME DI-CAL

MEDI- CAL Supple me ntal F

• rms in O ne - e - App:

SAWS1 50-85 L

a ng ua g e Pre fe re nc e Surve y

MC007 Me di-Ca l Ge ne ra l Pro pe rty L

imit

MC219 Me di-Ca l Rig hts a nd Re po rting Re spo nsib ilitie s MC210A Re tro a c tive Me di-Ca l Applic a tio n (o ptio na l) MC13 Sta te me nt o f Citize nship, Alie na g e , &

I mmig ra tio n Sta tus

CW2.1Q No n-c usto dia l Pa re nt CW2.1A Ag re e me nt to Atta c h Ab se nt Pa re nt

I nfo rma tio n

MC220: Autho riza tio n fo r Re le a se o f I

nfo rma tio n*

MC223: Sta te me nt o f Fa c ts Re g a rding Disa b ility*

*All Use rs have the se fo rms turne d o n in One -e -App, b ut no t all c linic s c o mple te fo rms with c lie nts- so me de fe r to SSA E T to assist

O NE- E- APP:

Applic a nt me e ts with a PST

to c o mple te

• ne -e -a pp a t the lo c a tio n. PST

has both Calwin and MEDS ac c e ss (re ad- only) and c he c ks b e fo re b e g inning o ne -e -a pp to

se e if the a pplic a nt ha s a pa st Me di-Ca l c a se o r e xisting re ne wa l file .

O NE- E- APP:

Applic a nt me e ts with a HIT

to c o mple te o ne -

e -a pp a t HCSA. HIT

has both Calwin and MEDS ac c e ss (re ad- only) a nd c he c ks b e fo re

b e g inning o ne -e -a pp to se e if the a pplic a nt ha s a pa st c a se o r file . I nitia l pho ne sc re e ning with fina nc ia l se rvic e s o r re fe rra l fro m a ho spita l de pa rtme nt; a ppo intme nt sc he dule d with a n e lig ib ility spe c ia list (PST

)

E L E CT RONIC SUBMISSION T O SSA E NT E RPRISE

S e e Chart # 1 fo r Me di-Cal Applic atio n F lo w

Child found Me di- Ca l e lig ible upon r e vie w a t SPE Syste m of Re c or d E ntr y: ME DS He a lthy F a milie s F ina l Appr

• va l

Child r e c e ive s ACCL E RAT E D E NROL L ME NT & a pplic a tion ma ile d to SSA for fina l e lig ibility de te r mina tion (se e c ha r t 1)

F inal Approval De nial De nial

One-E-App Portals & Eligibility Determination: Medi-Cal, Healthy Families*, HealthPAC, and Kaiser CHP

Pre limina ry E lig ibility for He a lthy F a milie s*

HEAL T H- E- APP INT ER F ACE WIT IHIN O NE- E- APP

1.U se r Sub mits One -e -App info rma tio n to He a lth-E

• App;

e le c tro nic 5 ste p tra nsfe r 2.He a lth-E

• App will sc a n o the r ho use ho ld me mb e rs fo r

Me di-Ca l– AL

L assistors re que st “No” as all adults are proc e sse d through AC SSA offic e through a dire c t O ne - e - App transfe r

3.Clie nt se le c ts a He a lth Pla n a nd a He a lth Ho me 4.Sig na ture , Rig hts a nd De c la ra tio ns fo r b o th He a lthy Fa milie s & Me di-Ca l 5.All ve rific a tio n do c ume nts fo r a ll fa mily me mb e rs must b e fa xe d within 24 hours o r the a pplic a tio n will b e te rmina te d

F inal Approval

(ta ke s a ppro xima te l y 45 da ys to pro c e ss)

De nial

Pre limina ry E lig ibility for He a lthPAC

(a s e ithe r prima ry c o ve ra g e o r se c o nda ry c o ve ra g e to Re stric te d Me di-Ca l o r FS Me di-Ca l with a hig h sha re o f c o st)

Completion & Submission Final Eligibility Determination Recording

*Transitioning to the Targeted Low Income Health Program within Medi-Cal as of 1/1/13

One-e-App “Users”

Ala me da Allia nc e issue s be ne fits c a r d; he a lth home pr e - se le c te d in One - e - App a pplic a tion pr

• c e ss

Ap p lic a tio n Sub missio n

CHART 2

SLIDE 11

Ve rifying Cove rage : CBO wo rke r will c he c k I

NSYST to se e if the c lie nt ha s a c urre nt re c o rd o f c o ve ra g e .

If the c lie nt ha s no c urre nt c ove ra g e :

Wo rke r sc re e ns the c lie nt fo r a n U MDAP to de te rmine the ir a b ility to pa y fo r me nta l he a lth c o sts b a se d o n a sliding sc a le , a nd: Po ssib le He althPAC e ligib ility Clie nt c o mple te s the

1) R e side nc y and Inc ome De c laration F

• rm

2) L e gal Status De c laration F

• rm

3) He althPAC Applic ation of R ights and De c larations

CBO sta ff c o lle c t 1) original doc ume ntation of

re side nc y, 2) doc of inc ome 3)original le gal status doc ume ntation

PST

• r CBO sta ff fa x a ll do c ume nts to

Provide r R e lations/ BHCS He althPAC Coordinator (510) 777- 2225 or mail it BHCS HIT at Provide r R e lations uplo a ds

a He a lthPAC po lic y into I NSYST

A BHCS c lie nt may be sc re e ne d on an appointme nt basis for c ove rage at

• ne of the following loc ations with out- statione d BHCS HIT

s:

1) T ri-City Clinic , 2) No rth Co unty Crisis, 2) So uth Co unty Crisis, 4) Va lle y Clinic , 5) Autho riza tio n Se rvic e s, 6) ACCE SS, 7) Oa kla nd Clinic , 8) Sc huma nn-L ile s Clinic , 9) E de n Clinic , 10) Ala me da Clinic , 11) the Co ve , 12) Villa a t Fa irmo nt

BHCS c lie nt sc re e ne d at a BHCS c ontrac te d CBO lic e nse d to do He althPAC e nrollme nt:

Do c ume nts sto re d a t T

he Cove (1900 Embarc ade ro), Ele c tronic Doc Storage Ve rifying Cove rage : BHCS HI

T will c he c k I NSYST , ME DS, Ca lWI N, a nd/ o r One -e -App to ve rify c urre nt o r pa st Me di-Ca l o r He a lthPAC c o ve ra g e .

If the c lie nt ha s no c urre nt c ove ra g e :

BHCS HI T sc re e ns the c lie nt fo r a n U MDAP to de te rmine the ir a b ility to pa y fo r me nta l he a lth c o sts b a se d o n a sliding sc a le , a nd: BHCS a uto ma tic a lly se c ure s filing da te fo r a He a lthPAC po lic y a nd use s a da ta ma tc hing pro c e ss with Ca lWI N fo r ne c e ssa ry c itize nship/ inc o me da ta BHCS HI T a ssists c lie nt to c o mple te the He althPAC De c larations 1) Re side nc y & I nc o me De c la ra tio n Fo rm 2) L e g a l Sta tus De c la ra tio n Fo rm 3) Applic a tio n o f Rig hts a nd De c la ra tio ns

Pape r Me di- Cal Applic ation

BHCS HI T wo rke r will a ssist c lie nt to c o mple te a pa pe r Me di-Ca l a pplic a tio n. BHCS HI T is the a utho rize d re pre se nta tive .

BHCS c lie nts with c urre nt G e ne ral Assistanc e or CalF re sh be ne fits, and all c ounty G e ne ral Assistanc e re c ipie nts

Clie nts who are : No t e ligib le fo r Full Sc o pe Me di-Cal Sub mitting a Me di-Cal applic atio n pe nding a disab ility de te rminatio n

Automate d polic y transfe r proc e ss from INSYST to O ne - e - App via a flat file BHCS HIT uploads a He althPAC polic y into INSYST , the prac tic e manage me nt/ billing syste m.

De c la ra tio n fo rms sto re d o n site .

Automate d polic y transfe r proc e ss from INSYST to O ne - e - App via a flat file Pape r Me di- Cal Applic ation c o mple tio n

with the c lie nt

Process 1: Screening with a BHCS HIT (go to Chart 1 – Medi-Cal Enrollment)

Alameda County Behavioral Health Care Services: Eligibility Determination & Enrollment Processes for Medi-Cal & HealthPAC

Process #2: Automated Enrollment Process Process #3: Screening/Enrollment at a BHCS Contracted CBO

CHART 3

Ala me da Allia nc e issue s be ne fits c a r d Ala me da Allia nc e issue s be ne fits c a r d Ala me da Allia nc e issue s be ne fits c a r d

BHCS HI T s a lso ha ve O ne - e - App

ac c e ss a nd c a n

use One -e -App to dire c tly e nro ll the c lie nt in He a lthPAC a s a se c o nd o ptio n Clie nts who are :

No t e ligib le fo r Full Sc o pe Me di-Cal Sub mitting a Me di-Cal applic atio n pe nding a disab ility de te rminatio n

Automate d polic y transfe r proc e ss from INSYST to O ne - e - App via a flat file

Po ssib le He althPAC e ligib ility

(go to Chart 1 – Medi-Cal Enrollment)

SLIDE 12

Annual Me di-Cal Re ne wals thr

• ugh Calwin

De sig na te d c le rk pulls RRR list fro m SSI RS 60 da ys prio r to the due da te a nd se nds to e a c h o ffic e De sig na te d c le rk a t e a c h o ffic e prints the MC210 R

e ne wal Notic e (a ppro xima te ly 10,000 pe r

mo nth) fro m Ca lWin a nd ma nua lly e nte rs the due da te . No tic e s a re usua lly re c e ive d a ro und the 12th o r 15th o f the mo nth

Nor th County Multi- Se r vic e Ctr

2000 Sa n Pa b lo Av e O a kla nd CA 94612 510.891.0700

E a stmont Se lf- Suffic ie nc y Ctr

6955 F

• o thill Blv d Suite

100 O a kla nd CA 94605 510.383.5300

E nte r pr ise Offic e

8477 E nte rprise Wa y O a kla nd CA 94621 510.777.2300

E de n Ar e a Multi- Se r vic e Ctr

24100 Ama do r St Ha ywa rd CA 94544 510.670.6000

F r e mont Outsta tion

39155 L ib e rty St Ste C330 F re mo nt CA 94536 510.670.6000

L ive r mor e Outsta tion

3311 Pa c ific Av e L iv e rmo re CA 94550 925.455.0747

Co mple te d MC210 R

V ma ile d o r

de live re d in pe rso n to a n SSA o ffic e

Clie nt re c e ive s pape r MC210R V in mail: He alth Home / Clinic re minds c lie nt the y ne e d to re ne w through maile d le tte rs and/ or automate d phone c alls Clie nt doe s not re c e ive the ir MC210R V in the mail and/ or fails to c omple te form Be ne fic iary R e c ipie nt Comple te s MC210R V

• Ma y se e k a ssista nc e fro m CBO

c linic s, c o mmunity-lo c a tio ns, HI T unit

• All re ne wa l fo rms must b e ma ile d;

no e le c tro nic o ptio n a va ila b le c urre ntly thro ug h BCW

T e rmination of Be ne fits Notic e from SSA re quiring ac tion within 30 days Missing information-

le tte r ma ile d to c lie nt

Comple te

E T 3 pro c e sse s, autho rzie s applic atio n in CalWIN and re ne ws

Information Submitte d If the be ne fit re c ipie nt ac c e sse s c are within 30 days of the e xpiration date :

He a lth pro vide rs ma y b e a b le to he lp c lie nt ide ntify the re a so ns the ir a pplic a tio n is pe nding re ne wa l & a ssist to c o lle c t do c ume nta tio n. (i.e ., ACMC q uic k c o de s do c ume nts to E T 3).

De nial/ c ase c losure if nothing re c e ive d within 30 days from e xpiration date Comple te

E T 3 pro c e sse s, autho rzie s applic atio n in CalWIN and re ne ws

Notification Completion/Submission & Processing

CHART 4

SLIDE 13

Pre sump tive Elig ib ility:

He a lthy F a milie s Ma ximus/ MR MIB Sa c ra me nto, CA Sing le Point of E ntry De te rmine d Me diCa l E lig ible Syste m of R e c ord ME DS He a lthy F a milie s/ AI M F ina l Approva l He a lthy F a milie s: DE NIAL He a lth- e - App e le c tronic inte rfa c e with One - e - App, e le c tronic submission to SPE ONE

• E
• APP

(se e c ha rt 3)

HE AL T H- E

• APP.ne t

Se lf-use

HE AL T H- E

• APP.ne t

Use with a Ce rtifie d Ap p lic a tio n Assisto r Pre sump tive Elig ib ility:

He a lthy F a milie s, Me di- Ca l for F a milie s, or AIM Childre n with F S Pre limina ry e lig ibility re c e ive ACCE L E R AT E D E NR OL L ME NT in Me di- Ca l Syste m of R e c ord E ntry: ME DS BIC Ca rd Ge ne ra te d

(c a nc e lle d in ra re c a se tha t c hild is d e e me d ine lig ib le fo r Me d i-Ca l a t c o unty fina l e lig ib iilty a sse ssme nt)

BIC Ca rd Ge ne ra te d; provide r pre - se le c te d in He a lth- e - App

See Chart 1 – Mailed in Applications from SPE

Health-e-App*: Application Submission for Healthy Families, Medi-Cal for Children and Pregnant Women, and AIM

*Note: Health-e-App is not used extensively in Alameda County as a self-use enrollment platform, nor is it used extensively by certified application assistors in the community (One-e-App is used more). Additionally, Healthy families is transitioning to the Targeted Low Income Health Program within Medi-Cal as of 1/1/13. The role of the SPE long-term is unknown at this time.

CHART 5

SLIDE 14

SCENARIO 1

Clie nt Applie s to Me di- Ca l thr

• ug h Be ne fits Ca lWIN (BCW)
• Clie nt c a n a pply fro m the c o nve nie nc e o f the ir ho me / c o mmunity.
• BCW syste m is no t de sig ne d fo r a n a pplic a tio n a ssisto r to he lp.
• BCW will po pula te a Me di-Ca l a pplic a tio n b a se d o n pro mpte d q ue stio ns.
• If the c lie nt c ho o se s to a pply fo r Ca lF

re sh in a dditio n to Me di-Ca l, BCW will a lso po pula te a Ca lF re sh a pplic a tio n fo r the c lie nt. Ho we ve r, BCW will no t a uto ma tic a lly a sse ss e lig ibility a nd/ o r po pula te a pplic a tio ns fo r o the r b e ne fits pro g ra ms suc h a s Ca lF re sh unle ss the c lie nt se le c ts the y wo uld like to a pply.

• If the a pplic a nt is de nie d fo r Me di-Ca l, the y a re se nt a le tte r tha t the y ma y b e

e lig ib le fo r He a lthPAC, b ut the c lie nt wo uld ne e d to g o to a lo c a tio n to sta rt a He a lthPAC a pplic a tio n. No a pplic a tio n info rma tio n tra nsfe rs to One -e -Ap p .

SLIDE 15

SCENARIO 2

Clie nt shows up a t a he a lth c linic s a nd ha s not ye t e nr

• lle d in a ny pr
• g r

a m.

• An a pplic a tio n a ssisto r will he lp the c lie nt a pply fo r a lo w-inc o me he a lth c o ve ra g e

pro g ra m thro ug h One -e -App. If a n a pplic a nt a ppe a rs e lig ib le fo r He a lthPAC, the a ssisto r will wo rk with the c lie nt to c o mple te a n a pplic a tio n o n One -e -App. If the a pplic a nt a ppe a rs e lig ib le fo r Me di-Ca l with a hig h sha re o f c o st o r re stric te d Me di- Ca l, b o th a He a lthPAC a nd Me di-Ca l a pplic a tio n a re g e ne ra te d a nd the a pplic a tio n da te is se c ure d fo r b o th pro g ra ms.

• T

he Me di-Ca l a pplic a tio n sho ws up a s a pa pe r a pplic a tio n a t SSA whic h g e ne ra te s mo re wo rk fo r SSA (the a pplic a tio n ne e ds to b e re -e nte re d into Ca lWIN).

• T

he c lie nt will no t b e a sse sse d fo r e lig ib ility in o the r b e ne fits pro g ra ms suc h a s Ca lF re sh o r Ge ne ra l Assista nc e .

• So me c linic s he lp c lie nts fill o ut Ca lF

re sh pa pe r a pplic a tio ns, b ut it isn’t inte g ra te d into One -e -App o r sta nda rdize d a c ro ss the pro g ra m.

SLIDE 16

SCENARIO 3

Clie nt shows up at a Be havior al He alth Car e Se r vic e s spe c ialty me ntal he alth site with no c ove r age .

• Pro g ra m suppo rt re pre se nta tive s wo rk with the c lie nt to sc he dule a n a ppo intme nt with

a BHCS HIT .

• BHCS HIT

wo rks to a sse ss the c lie nt’s po ssib le e lig ib ility fo r lo w inc o me he a lth pro g ra ms. Ma ny BHCS c lie nts a re e lig ib le fo r Me di-Ca l thro ug h disa b ility. BHCS HIT will a ssist the se c lie nts to c o mple te a pa pe r a pplic a tio n fo r Me d i-Ca l in the se c a se s whic h is dro ppe d

• ff a t SSA fo r pro c e ssing a t the ir Ho spita l Inta ke Unit.
• BHCS HIT

s a re a utho rize d re pre se nta tive s o f the c lie nts a nd re c e ive a ll no tic e s fro m SSA a b o ut the sta tus o f the a pplic a tio n a nd c a n c o mmunic a te dire c tly with the a ssig ne d E T .

• F
• r c lie nts no t e lig ib le fo r Me di-Ca l, o r e lig ib le fo r Me di-Ca l pe nding disa b ility, BHCS will

uplo a d a He a lthPAC po lic y in INSYST , the ir c lie nt da ta b a se , a nd a He a lthPAC po lic y is a uto ma tic a lly g e ne ra te d in One -e -App.

SLIDE 17

SCENARIO 4

Clie nt with Me di- Ca l re c e ive s a re ne wa l notic e a nd RRR form in the ma il.

• Clie nt ma y se lf-c o mple te a nd ma il, fa x, o r dro p -o ff a t a n SSA
• ffic e .
• Clie nt ma y a tte mpt to se e k a ssista nc e fro m a c o mmunity-b a se d

lo c a tio n o r c linic to c o mple te a pplic a tio n.

• No o nline po rta l fo r sub mitting Me di-Ca l re ne wa ls c urre ntly e xists

(pe nding thro ug h BCW).

• No wa y fo r a n a pplic a tio n a ssisto r to sub mit a re ne wa l o nline o n

a n a pplic a nt’s b e ha lf.

SLIDE 18

SCENARIO 5

Clie nt with He althPAC r e c e ive s a r e ne wal notic e in the mail.

• Clie nt ma y re ne w a t the ir he a lth ho me , a t the HIT

unit,

• r a n ACMC site .
• Clie nt must pre se nt inc o me d o c ume nta tio n to the

a ssisto r.

• No wa y fo r c lie nt to re ne w o n the ir o wn witho ut

pre se nting a t a c linic , HIT unit, o r ACMC site with a One - e -App a ssisto r.

SLIDE 19

KEY FINDINGS

• E

nro llme nt po rta ls ve ry c o mple x

• Syste ms d o no t ta lk to e a c h o the r- re sulting in c lie nts

ha ving to pro vid e d o c ume nta tio n multiple time s

• Clie nts a re no t a lwa ys e nro lle d in a ll pro g ra ms, d e spite

b e ing e lig ib le

• Applic a tio ns c a n b e ha rd to tra c k
• Re ne wa ls a re no t stre a mline d

SLIDE 20

NEXT STEPS 2013

• Cre a te No Wro ng Do o r fo r c lie nts
• Me di-Ca l, E

xc ha ng e , He a lthPAC

• Pe r ACA re q uire me nt, e nro ll in SSA b e ne fits a s we ll
• E

xc ha ng e De c isio ns:

• Ca lHe e rs
• Sta te Ca ll Ce nte r
• Co mmunity E

ng a g e me nt a nd Co mmunic a tio n