cognosante magi eligibility rules
Post on 20-Aug-2015
1.795 Views
Preview:
TRANSCRIPT
Proprietary and Confidential
MAGI Eligibility Rules
MESC 2012
Boston, MA August 19-23, 2012
1
Proprietary and Confidential2
The Challenge:
For states, meeting the new eligibility rules of the ACA provides significant challenges:
• Conversion to MAGI • Conflicting Regulations• New State Options and Flexibility for Medicaid Expansion
Requires investment in updating systems, operations
• State Staff Time = $$$• DDI = $$$• Short Implementation Timeframe = $$$
Proprietary and Confidential3
Federal Mandate: “Seamless Eligibility Determination”
Proprietary and Confidential
State Flexibility: Medicaid Expansion Options
4
Proprietary and Confidential
– Business Logic Integration Platform – Business rules, workflow, and events
– Based on Open Source technology– Full set of Eligibility rules for determining QHP, APTC/CSR,
and Medicaid eligibility – Ability to determine MAGI Category within Medicaid
Eligibility – Capability to integrate rules with your state’s existing rules
engines– Use for HIX or IES
eSante-Rules Overview
5
Proprietary and Confidential
Cognosante eSante-Rules provides:– Single, stream-lined eligibility determination – Supports “No Wrong Door”– Flexible approach– Supports State Partnership Exchange (SPE) or State Based
Exchange (SBE) models
The result for States: “Speed to value”– Reduced implementation time– Reduced impact to state staff– Reduced implementation costs
6
How Cognosante can help: eSante-Rules Solution Benefits
Proprietary and Confidential7
Proprietary and Confidential8
eSante-Rules Demo: Eligibility Verification and Determination
Proprietary and Confidential9
Meet the Hood Family on January 7, 2014
Age: 39
Citizenship: LPR
Residency: TN
Income: $100
Income Type: UI
Income Frequency: Weekly
Age: 37
Citizenship: Yes
Residency: TN
Income: $2,000
Income Type: Wages
Income Frequency: Monthly
Age: 40
Citizenship: Yes
Residency: Yes
Income: $4,000
Income Type: Wages
Income Frequency: Monthly
Age: 11
Citizenship: Yes
Residency: TN
Income: $200
Income Type: Child Support
Income Frequency: Monthly
Age: 1
Citizenship: Yes
Residency: TN
Income: No
Age: 6
Citizenship: Yes
Residency: TN
Income: No
Age: 3
Citizenship: Yes
Residency: TN
Income: No
Proprietary and Confidential
https://app02.smartstream.cognosante.com/guvnor-5.4.0.Final-tomcat-6.0/org.drools.guvnor.Guvnor/Guvnor.jsp?
eSante-Rules
10
Proprietary and Confidential
Hood Family Results: 92% FPL (2012 rates)
11
Rule Mark Marilyn Alicia Alex Arthur Grant
Citizen LPR >5 Citizen Citizen Citizen Citizen Citizen
Residency √ √ √ √ √ √
Incarcerated No No No No No No
Tribal No No No No No No
Included in HH √ √ √ √ √ √
Monthly Counted Income $400 $2000 $0 $0 $0 $0
Household Size
Total Annual Income
6 $28,800
Parent Medicaid Child Medicaid
2 4
Proprietary and Confidential
• Subject matter expertise:– Understand:
• the federal regulations and requirements,• State specific Medicaid Eligibility policies• State Goals for Medicaid Expansion
– 25+ years experience with Medicaid eligibility – Experience performing requirements analysis, rules verification for numerous state
agencies – Healthcare Reform Subject Matter Expertise
• Right Technology tools and partners– Rules engine– Ability to integrate with YOUR Exchange solution– MAGI Rules pre-loaded– Configurable for state specific programs and policy decisions– Easy User Interface, Test Rule changes before implementation
Having a rules engine isn’t enough
12
Proprietary and Confidential
Expertise + Tools = The Right Implementation
It’s a snap!
Contact: Cathy.Graeff@Cognosante.com
HIX Practice Lead
Bruce.Dunham@Cognosante.com
Eligibility Practice Lead
top related