San Mateo County Health Coverage Unit/Children*s Health Initiative

Report
San Mateo County
Health Coverage Unit/Children’s
Health Initiative Overview
Claudia Lopez
April 4, 2014
What is the Health Coverage
Unit/Children Health Initiative?
• The San Mateo County Health Cover
Unit (HCU) or also known as the
Children’s Health Initiative (CHI) was
established to address communitywide concern for the 17,000 county
children who lacked access to
comprehensive health insurance
coverage.
• We now serve both children and
indigent adults who do not qualify for
Medi-Cal we have change our unit
name to Health Coverage Unit.
How is CHI/HCU helping?
• We provide application
assistance for both the adult
indigents and families.
–
–
–
–
ACE
Healthy Kids
Medi-Cal
Cover California
• We conduct outreach,
enrollment and education on
the process or eligibility and
enrollment.
Who is eligible?
•
HCU/CHI is available to assist all San Mateo County residence regardless of
immigration status.
•
For children: Potentially eligible for Medical/ Healthy Families/Healthy Kid, who
are:
•
•
•
•
•
Under Age 19, except for Medi-cal (21);
Residents of San Mateo County;
Not Insured through employer sponsored
insurance coverage;
Incomes below 400% of the FPL.
For Adults: Potentially Medi-Cal, ACE,
DHC, and Self pay Medically Indigent
Adult who are:
•
•
•
•
Age 19-64;
Residents of San Mateo County;
Not Insured through employer sponsored
insurance coverage;
Income below 400% of FPL
Eligibility Criteria
Medi-Cal for Children
and Families
MAGI Medi-Cal
Healthy Kids
Resident of San Mateo
County
No-It is a state program
No-It is a state Program
Yes
Legal Immigrant/
US Citizenship
Legal Permanent
Resident
or US Citizen
Legal Permanent
Resident
or US Citizen
No
Legal Permanent
Resident,
or US Citizen, lawful immigrants
Age
Up to 19th birthday
0-64
Up to their 19th birthday
0 – 64
Income Limit – Federal
Poverty Limit (FPL)
Up to 250%
0 – 138% FPL
139% – 200% FPL
139%-200% FPL
Monthly Premium
Retroactive coverage?
0-150% None
150% - 250% will be
subject to monthly
premium of $13
None
under 133% None
133-150% $12
151%-200% $39
201%-300% $63
301%-400% $150
Covered California
No- it’s a state program
Depending on income and
family size
Coverage begins the following month
Yes
Yes
if application is completed by 15. If
Once application is
Once application is
after the 15 coverage begins two
No retroactive coverage
approved, coverage
approved, coverage
month later.
available. Coverage
begins first day of month begins first day of month
Example
begins 10 days from
application was
application was
Application completed December 12thdate application is
created. Retro coverage created. Retro coverage
Coverage begins January 1
approved.
available up to three
available up to three
Application completed December 20thmonth back
month back
Coverage begins February 1.
Family Size
Children
Birth thru Age 1
Children
Ages1-18
Min
Max
Min
Max
$0
$2,433
$0
$1,460
Medi-Cal
$1,461
$2,433
Medi-Cal (TLICP)
$0
$1,967
Healthy Kids
Medi-Cal
$1,968
$3,278
Medi-Cal (TLICP)
1
$3,892
$3,278
$0
2
$5,244
$0
$4,123
Healthy Kids
$2,585 - $3,879 AIM (Pregnant Women Program)
$0
$2,474
Medi-Cal
$2,475
3
$6,596
$0
$4,908
$7,952
$0
$5,745
$9,304
$0
$6,583
$10,656
$839
Medi-Cal (TLICP)
$5,815
Medi-Cal (TLICP)
$6,660
Medi-Cal (TLICP)
Healthy Kids
$5,265- $7,899 AIM (Pregnant Womem Program)
$507
Medi-Cal
$508
$1,352
$4,970
Healthy Kids
$4,595 - $6,894 AIM (Pregnant Women Program)
$0
$3,949
Medi-Cal
$3,950
6
Medi-Cal (TLICP)
Healthy Kids
$3,925- $5,889 AIM (Pregnant Women Program)
$0
$3,489
Medi-Cal
$3,490
5
$4,123
Healthy Kids
$3,255 - $4,884 AIM (Pregnant Women Program)
$0
$2,944
Medi-Cal
$2,945
4
Add for each
additional family
member:
Program
$845
Medi-Cal (TLICP)
Healthy Kids
$670- $1,006 AIM (Pregnant Women Program)
Monthly
Premium
No Premium
$13 per child up to
$39 max for family of three or more
Please see chart
No premuim
$13 per child up to
$39 max for family of three or more
Please see chart
No premium
$13 per child up to
$39 max for family of three or more
Please see chart
No premium
$13 per child up to
$39 max for family of three or more
Please see chart
No premium
$13 per child up to
$39 max for family of three or more
Please see chart
No premium
$13 per child up to
$39 max for family of three or more
Please see chart
No premium
$13 per child up to
$39 max for family of three or more
Please see chart
Eligibility Criteria
ACE-County FW
MAGI Medi-Cal
ACE-County
Temporary ACE
ACE County Excess
Income with Chronic
Disease
DHC
Self-Pay
Charity Care
Resident of San
Mateo County
Yes
Yes
Yes
Yes
Yes
No
No
No
Legal Immigrant/
US Citizenship
No
Legal Permanent
Resident
or US Citizen
No
Legal Permanent
Resident,
or US Citizen
No
No
No
No
19 and above
19 – 64
19 and above
19 – 64
19 and above
No limit
No limit
No limit
0 - 138% FPL
0 – 138% FPL
139% – 200% FPL
139%-200% FPL
201% – 225% FPL
0 – 400% FPL
No limit
0 - 100% FPL
No Asset Limit
None
No Asset Limit
None
No Asset Limit
$360
No Asset Limit
$360
No Asset Limit
$360
No Asset Limit
None
No Asset Limit
None
$10,500
None
65% discount Varies
Varies2 patients have
30 days from the bill
date to receive a 50%
discount
Not Covered3
None3
Age
Income Limit –
Federal Poverty Limit
(FPL)
Asset Limit
Annual Fee
Payment for
Outpatient Visits
Payment for
Inpatient Stays and
Same Day Surgeries
Prescriptions
Repayment Plan4
Available?
None
None
None
$10
$10
$10
None
$300 co-pay +
35% of charges
$300 co-pay +
35% of charges
$300 co-pay +
35% of charges
65% discount Varies1
Varies2 patients have
30 days from the bill
date to receive a 50%
discount
None
None
$7
$7
$7
65% discount
50% discount
None
Not applicable
Not applicable
Yes
Yes
Yes
Yes
Yes
Not applicable
Retroactive
coverage?
Yes
Once application is
approved, coverage
begins first day of
month application
was created. SMMC
may waive bills in the
three months prior to
coverage effective
date
Yes
Once application is
approved, coverage
begins first day of
month application
was created. Retro
coverage available
up to three month
back
Yes
Once application is
approved, coverage
begins first day of
month application
was created. SMMC
may waive bills in the
three months prior to
coverage effective
date
*Only available after
4/1/2014 and
through 12/31/2014
for those that did not
apply for coverage
with Covered
California.
Yes
Once application is
approved, coverage
begins first day of
month application
was created. SMMC
may waive bills in the
three months prior to
coverage effective
date
Yes
(No time limit if after
January 1, 2007)
Not applicable
Yes
(Limited to 150 days
from 1st bill date)
Other requirements
None
None
None
Must not be eligible
for Medi-Cal with or
without a share of
cost.
Must be experiencing
a hardship and have
a chronic condition
None
None
None
Forms Required
None
SSApp or CalHEERS
MC 13 (LPR or
Prucol)
None
DRA
Excess
Income/Chronic
Disease Application
None
None
Charity Care
Application
[1]
DHC charges will not exceed the highest amount that SMMC receives for medical services from Medicare, Medi-Cal, Healthy Families or other government-sponsored
programs
2 Deposit required before receiving non-emergency services. 50% discount if bill is paid within 30 days; must pay 100% after 30 days.
3 The County Charity Care program is available only for emergency room visits, and inpatient and surgery visits transferred from SMMC’s emergency room.
4 Repayment plan interest-free based on ability to pay
Family Size
MAGI MC/ACE
Fee Waiver
Excess Income Chronic
Disease w/a Financial
Hardship
ACE
DHC
0%
138%
139%
200%
201%
225%
400%
1
$0
$1,343
$1,344
$1,946
$1,947
$2,189
$3,892
2
$0
$1,809
$1,810
$2,622
$2,623
$2,950
$5,244
3
$0
$2,276
$2,277
$3,298
$3,299
$3,710
$6,596
4
$0
$2,743
$2,744
$3,976
$3,977
$4,473
$7,952
5
$0
$3,210
$3,211
$4,652
$4,653
$5,234
$9,304
6
$0
$3,676
$3,677
$5,328
$5,329
$5,994
$10,656
7
$0
$4,144
$4,145
$6,006
$6,007
$6,757
$12,012
8
$0
$4,611
$4,612
$6,682
$6,683
$7,517
$13,364
9
$0
$5,077
$5,078
$7,358
$7,359
$8,278
$14,716
10
$0
$5,545
$5,546
$8,036
$8,037
$9,041
$16,072
Additional Family Member
$0
$466
$467
$676
$677
$761
$1,352
One-e-App
• For our local program we use the One-e-App web
base application system.
• All Healthy and ACE application are processed
through One-e-App
How does One-e-App Work?
• Information is collected
and entered in One-e-App
by the Application
Assistor.
• A preliminary eligibility is
established based on the
information provided by
client.
• Depending on the
program that client is
found eligible for, the
information is routed to
that entity.
Question
Claudia Lopez
Trainer/Supervisor
San Mateo County Health Coverage Unit
650 616-2045
[email protected]
www.smchcu.org
650 616-2002

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