Slides - Washington State Hospital Association

Report
How the Affordable Care Act
Affects Eligibility for
Traditional Medicaid Programs
Webinar
January 9, 2014
Washington State Hospital
Association
Today’s Presenters
Mary Wood
Office of Medicaid and Medicare Eligibility Policy and
Outreach, Washington State Health Care Authority
Janet Walthew
Director, Patient Financial Services & Patient Access
Northwest Hospital & Medical Center
Barbara Gorham
Policy Director, Access
Washington State Hospital Association
Washington State Hospital
Association
Today’s Presentation
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Basic Health Plan
Washington State Health Insurance Pool
Managed Care Auto-Enrollment
Renewals
Retroactive Coverage
Alien Emergency Medical
Medicaid for Aged, Blind, and Disabled
Spend-down Coverage
Questions
Washington State Hospital
Association
Basic Health Program
Basic Health Program (BHP) – ended 12/31/13
– BHP recipients received 4 letters on the conversion process
– Recipients had 3 ways to apply
• Online at www.wahealthplanfinder.org
• Paper application
• Call HBE Customer Support Center at
1-855-923-4633
– It is not too late…families can still apply after 1/1/14 for
coverage
Washington State Hospital
Association
Washington State Health
Insurance Pool (WSHIP)
WSHIP recipients can keep WSHIP coverage or buy new
coverage through www.wahealthplanfinder.org
– If they wanted to keep WSHIP they were automatically renewed.
Recipients had the opportunity to switch to a different WSHIP plan
during fall open enrollment.
– Federal rules define state high risk pool coverage as “minimum
essential coverage” for 2014. That means recipients who decide to
keep WSHIP coverage in 2014, will not have to pay a penalty.
– Non-Medicare WSHIP coverage is scheduled to end 12/31/17.
Washington State Hospital
Association
Managed Care Auto-enrollment
• In 2014, Medicaid recipients will continue to be autoenrolled to a managed care plan.
• In 2015, HCA hopes to implement system changes
that would allow individuals to shop and select their
Medicaid managed care plan online through the
Healthplanfinder. (HPF)
Washington State Hospital
Association
Managed Care Auto-enrollment
Until online shopping is available, recipients can
make a change in their plan selection by:
• Go online at
http://www.hca.wa.gov/Documents/managed_care
/ChangePlanEnrollment.pdf
• Return a HCA 13-862 Enrollment form
• Call MACSC at 1-800-562-3022
Washington State Hospital
Association
Renewals
• HCA is concerned about the rate of successful
renewal completions for family, children and
pregnancy cases through the HPF.
• Several factors are believed to be involved in the
lower rate of completions:
– A new system
– System issues and availability (especially in the first two
months)
– System error which require a manual effort to fix
Washington State Hospital
Association
Renewals
As you work with individuals and families:
– Inform them that there is a new online system and provide
the address www.wahealthplanfinder.org
– Encourage them to try to complete their renewal online for a
real-time determination
– Individuals not comfortable with the online application can
complete an Application for Health Care Coverage (HCA 18001)
http://www.hca.wa.gov/medicaid/forms/Documents/18001P.pdf
Washington State Hospital
Association
Retroactive Coverage
All Medicaid coverage groups (including new adult) have
3 months retro coverage from the month of application.
– Answer yes to the question “Do you or anyone you are
applying for need help in paying for unpaid medical bills?”
– A report will be pulled and retro medical approved by HCA
enrollment staff
– No real-time determination available for retro coverage
Washington State Hospital
Association
Alien Emergency Medical Program
• If client is over 65 or on Medicare; apply through
www.washingtonconnection.org or send a HCA 18-001
directly to DSHS. There is no change in AEM
applications for this group.
• For client who fall under MAGI (family, children, and
new adult group); apply online or with paper
application through Healthplanfinder.
Washington State Hospital
Association
AEM, continued
Check one of the boxes in the non-citizen emergency
medical section of the application, if an individual:
– Has been treated for an emergency medical condition this
month or during the previous three months
– Needs dialysis or cancer treatment
– Needs anti-rejection medication as a result of an organ
transplant
– Needs nursing home, assisted living, or in-home care
Washington State Hospital
Association
AEM, continued
AEM remains a two-step process:
1. Individual must be determined financially eligible for and
related to a Medicaid program. This is decided through
HPF for MAGI cases and by DSHS eligibility staff for all
other cases.
2. Individuals must have an emergent medical condition.
This is decided by a HCA clinical staff review of medical
evidence. No change in medical evidence requirements.
Washington State Hospital
Association
AEM, continued
• With implementation of new adult group on 1/1/14,
many more adults who have emergent medical
treatment in a hospital will be eligible for AEM.
Washington State Hospital
Association
Non-MAGI Medicaid
• Sometimes referred to as Classic Medicaid
• Includes medical for:
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SSI cash recipients
Individuals over 65
Medicare recipients
Medicare Savings Programs
Long-Term Care and Waiver Services (COPES)
• These medical coverage groups will be processed by
DSHS - no change
Washington State Hospital
Association
Individuals with a Disability
• If receiving Medicare, they are considered Classic and
will have medical eligibility determined by DSHS – no
change
• If determined disabled by Social Security but not yet
on Medicare, they can be in new adult group.
Benefits to individual include:
– More comprehensive benefit package
– No spenddown
– No asset test
Washington State Hospital
Association
Spenddown for Pregnant
Women and Children
Why would someone choose the spenddown program
rather than purchase a Qualified Health Plan (QHP)?
– Applying for coverage outside the open enrollment period
and do not meet one of the exceptions.
– No retroactive coverage look-back period for QHP coverage.
Earliest begin date for QHP coverage is month after
application month.
Washington State Hospital
Association
Spenddown for Pregnant
Women and Children
• A report will be generated and worked by enrollment
staff at HCA when the following occurs:
– Woman marks she is pregnant and has income over 193%
FPL
– Application is for a child and family income over 312 % FPL
• Letter will be generated to household giving
spenddown option
Washington State Hospital
Association
QUESTIONS?
Washington State Hospital
Association
For More Information:
Mary Wood
Washington State Healthcare Authority
[email protected]
Janet Walthew
Northwest Hospital & Medical Center
[email protected]
Barbara Gorham
Washington State Hospital Association
[email protected]
Washington State Hospital
Association

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