HCEA External Partner Advisory Group August 20, 2013
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1 HCEA External Partner Advisory Group August 20, 2013
2 Agenda Anticipated System Functionality Application Process Electronic Verification Conversion Approach
3 Anticipated MNsure System Functionality on 10/1/2013 Online Application Eligibility Determination MA for Families with Children and MA Adults MinnesotaCare QHP with subsidy (e.g., APTC/CSR) QHP without subsidy Exemption from individual mandate Small Business Health Options Program (SHOP) Specific benefits for American Indians / Alaskan Natives Enrollment Enroll in QHP based on preferred plan benefits and cost levels
4 Anticipated MNsure System Functionality on 10/1/2013 (continued) Appeals Basic appeal submission Case Management Application routing Case transfer Worker tasks and notifications Non-MAGI referral Interfaces Federal Data Services Hub MMIS
5 Anticipated MA MNsure System Functionality on 1/1/2014 Expanded functionality to include: Retro MA EMA Presumptive eligibility for hospitals
6 Anticipated MA/MCRE MNsure System Functionality after 1/1/2014 Expanded functionality to include: Online health plan selection and enrollment for MA and MinnesotaCare Renewals MA cost-effective insurance determination TPL information Self-service change reporting
7 Application Processes HCAPPs, CAFs, and ApplyMN requests for health care submitted prior to January 1, 2014, will be processed on MAXIS using current policy and procedures. MNsure paper applications (subsidy and non-subsidy) will be available 10/1/2013 for people who choose not to apply online. Applicants will be instructed to send MNsure paper applications to a centralized post office box. A supplement to the MNsure paper application will be available 10/1/2013 to collect additional information for the non-magi referral. Additional procedures will be outlined based on the date the applicant requests coverage to begin. MA eligibility for months prior to January 2014 will be determined in MAXIS.
8 Verifications Reliance on electronic data sources to verify attestation ACA requires the use of electronic data sources as the primary source of verification for eligibility factors such as citizenship, immigration status, Social Security Number (SSN) and income Decreased reliance on paper documentation. Require paper documentation only when information cannot be obtained electronically or it is not reasonably compatible with attested information.
9 Verifications The new eligibility system will interface with the following electronic data sources: Federal Data Services Hub includes: Social Security Administration (SSA) Department of Homeland Security (DHS) Internal Revenue Service (IRS), and Equifax (The Work Number)
10 Verifications The new eligibility system will interface with the following electronic data sources: Other Electronic Data Sources, including: Department of Employment and Economic Development (DEED), which has quarterly wage and unemployment insurance data. PRISM (DHS child support system).
11 Verifications What is Reasonable Compatibility? A standard set by the State that defines the allowable amount/quantity of difference between an individual s attestation and information obtained from electronic data source(s). If the difference between the attestation and data source is within the reasonable compatibility standard, additional information is not required.
12 Verification Requirements: Medical Assistance (MA) ACA allows flexibility in defining verification requirements under MA Accept self-attestation of family size, residency, and pregnancy as long as reasonably compatible with electronic data Verification of income required before eligibility can be determined When paper verification is required eligibility pends until verified Continue to allow reasonable opportunity period to provide verification of citizenship, immigration status, and SSN
13 Verification Requirements: Advanced Premium Tax Credits (APTC) Verification requirements are defined by federal regulation Reasonable opportunity period for all required verifications when not reasonably compatible or no electronic data available Individual must attest that they intend to file taxes or expect to be claimed as a tax dependent for the coverage year to be eligible to receive APTC.
14 Verification Requirements: MinnesotaCare MinnesotaCare will follow APTC verification rules and processes Significant changes to verification process for MinnesotaCare Like APTC, allows for approval of eligibility based on attestation and 95 days to resolve inconsistency when not reasonably compatible
15 Resources/Communication DHS Health Care Reform: healthreform.mn.gov healthcare.gov
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