maximizing government program identification and eligibility … › docs ›...
TRANSCRIPT
Today’s Accomplishments…
Learn about the 20 different eligibility and enrollment process
Learn how to enhance your current identification process
Learn how to incorporate Covered California
Learn how to apply a proactive approach that helps to secure future benefits
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Change your approach ~ Think Proactively
Create your own “Community Enrollment Center”
Think of ways to get patients covered proactively
Covered California considerations
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Create an Enrollment Center
Enhance your current business model to include screening of all uninsured patients at registration or point of service
Understand how all Government Eligibility Programs work
Federal
State
County4
Understand Covered California and MAGI-Medi-Cal
Non-MAGI Medi-Cal
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Income
0-138% FPL
Income
138-200% FPL
Income
138-400% FPL
Income
400% FPL +
MAGI-Medi-Cal
*exempts assets
County Program Covered California
*exempts assets
Self Pay
(Under 21, Over 65 yrs, pregnant, children in the home with deprivation, disabled and/or requires skilled nursing care)
MAGI – Medi-Cal
Modified Adjusted Gross Income
Aid Codes:
AFDC 40, 45, 4H, 4L, 4K, 5K
Pregnancy 44, 48, 5F, 5W, 76, 86, 87
Pregnant Undocumented/Unverified D8, D9
Children 47, 69, 72, 74, 7A, 7C, 8N, 8P, 8R, 8T, 8U, 8V
Adoption 04, 30, 32, 33, 35, 3A, 3C, 3D, 3E
Calworks 3G, 3H, 3L, 3M, 3P, 3R, 3U, 3W, 4A, 4G, 4P, 4R
Families and Children 2A, 34, 37, 3N, 3V, 82, 83, C5, C6, C9, D1
Other Federal Programs 4M, 58, 6P, 71, 7H, F1-F4, G1-G4 6
Lets start with understanding the program hierarchy
Federal Programs
State Programs
County Programs
Charity Care7
Covered California
Federal Program Overview
Medicare
Medicaid (mandatory eligibility )
Social Security Retirement/Disability
Compassionate Allowance (CAL)
Low Income Health Program (LIHP) – terms 12/31/2013
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State Program Overview
Medi-Cal
250% Working Disabled Persons
Victims Compensation Program (VCP)
California Children Services (CCS)
IMPACT
BCCTP – Breast and Cervical Cancer Treatment Program
Genetically Handicapped Persons Program (GHPP)
Major Risk Medical Insurance Program (MRMIP)
Health Insurance Premium Program (HIPP)9
County Program Overview
Medically Indigent Adult (MIA)
County Medical Service Indigent Program (CMISP)
Medical Service Program (MSP)
Medical Service Initiative (MSI)
County Medical Services (CMS)
And many more…..
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Let’s Start with the Federal Programs
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Medicaid vs. Medi-Cal
Medi-Cal is California’s Medicaid Program.
Each state can have their own “optional state programs”
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Social Security Administration Programs
Social Security Disability Income (SSDI)
Supplemental State Income (SSI)
Medicare
Medicare Disability: Renal Dialysis & Lou Gehrig’s Disease (ALS)
Retirement13
Compassionate Allowance (CAL)
Compassionate Allowances (CAL) provides quick benefits to applicants whose medical conditions are so serious that their conditions obviously meet disability standards.
SSA has identified 200 medical conditions that range from Traumatic Brain Injuries, Dementia to rare diseases.
Benefits can occur within a month without having to wait for years! All you need is confirmed diagnosis!
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Low Income Health Program (LIHP)
Medical care for the uninsured adult population “childless adults”
19-64 years of age Must be a county resident
US Citizen or legal immigrant with 5 years residency
Medicaid Coverage Expansion (MCE)
Health Care Coverage Initiative (HCCI)
Income: 0-133% FPL Income: 134-200% FPL
Assets: Exempt Assets: Within Medi-Cal Limits
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Understanding the State Programs
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Medicare/Medi-Cal Integration– Dual Eligible
Cal MediConnect Counties:
Alameda
Los Angeles
Orange
San Diego
San Mateo
Riverside
San Bernardino
Santa Clara
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www.calduals.org
Program For All-Inclusive Care for the Elderly (PACE) Plans
55 or older and need a higher level of care to live at home and have chronic conditions . Alternative to LTC.
Alameda
Santa Clara
Los Angeles
San Diego
Maintain independence
Dignity and Quality of Life
Emergency Care
Day Center
Home care services
Transportation
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www.healthcareoptions.dhcs.ca.gov
Eligibility
Income eligible
Asset eligible
Benefits
Pays monthly Medicare
Part A or/and B premiums
Prescription Drug Assistance
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Low Income Medicare Beneficiary(QMB/SLMB)
Basic Medi-Cal Linkage
Under 21 years of age
Over 65 years of age
Pregnant
Parents with deprived children
Requires Long Term Care
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Medi-Cal Disability …
Never assume; always ask and confirm!
Understand the difference about the 3 different Disability (DDSD) Programs:
Medi-Cal Regular
Medi-Cal Presumptive Disability “PD”
Medi-Cal Urgent Presumptive Disability “Urgent”
Reminders Always assess the patient’s inability to perform the jobs that they’re accustomed to performing.
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250% Working Disabled Program
Disabled
Citizenship must be verified
Earned income: 1-250% of FPL
All disability-based income does not count (workmen’s compensations, SSA, state and private disability income)
$20 deduction for income (earned or unearned)
Property: 401k exempted
Premiums: All eligible persons must pay a monthly premium based upon countable income, ranging from $20 to $250 (for an individual). 22
Victims Compensation Program (CalVCP)
Enrollment: 3 years from incident date
Expenses that can be covered by the Program include:
Medical and Dental Care
Mental Health Treatment
Funeral Expenses
Income and Support Loss
Rehabilitation
Relocation 23
Cancer Programs
IMPACT – Prostate Cancer Program
BCCTP – Breast and Cervical Cancer Treatment Program
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Genetically Handicapped Persons Program (GHPP)
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•Must 21 years or older
•No income limit
•Enrollment fee based on income
•Can be applied for as a 2ndry program
MRMIP (Major Risk Medical Insurance Program )
PCIP (Pre-Existing Condition Insurance Plan)
STATE Program
You are a resident of California.
You have a pre-existing condition
You are not eligible for Medicare Part A and Part B(except for end-stage renal disease) or for COBRA orCal-COBRA benefits.
Still open for enrollment
FEDERAL Program
You are a resident of California.
You have a pre-existing condition
You are not enrolled in Medicare Part A and B, COBRA, or Cal-COBRA benefits.
You are a U.S. Citizen or Lawful Resident
No longer taking applications!26
Health Insurance Premium Program (HIPP)
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•Must have full scope or fee-for-service Medi-Cal
•Have a medical condition
•Have current health insurance coverage (or access to health coverage through an employer at the time of application) – policy must cover the health condition
•Health insurance coverage must not be court-ordered
Enrollment Methods
County Office, Service Center, Certified Entities
Online
Fax
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What to expect in January 2014!
Income determine the route for eligibility and enrollments
Income under 138% Medi-Cal linkage with asset waiver
Income over 138% Eligible for county program assistance or subsidized insurance enrollment through the “Marketplace”. Assets count!
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Reference Guides and Resources
Email: [email protected]
Contact: Ana Gonzalez
Direct: (415) 446-8116
Email: [email protected]
Technical Questions: [email protected]
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