PCASG Technical Assistance Series Medicaid and LaCHIP Screening Tool

Transcription

1 PCASG Technical Assistance Series Medicaid and LaCHIP Screening Tool PROTOCOL 1. Ask patient if she/he has health insurance. 2. Ask patient if she/he has Medicaid or LaCHIP 3. If not, ask patient the questions on the screening tool to assess whether she/he should be referred to a Medicaid Application Center. If the answer to any of the screening questions is yes, read the information below the question and, if the information applies to the patient s situation, refer the patient to a Medicaid Application Center. 4. Review with (and give to) the patient a list of the documentation that the patient must bring with her/him to the Medicaid Application Center (see Appendix 1). 5. Give the patient a copy of Appendix 2, which lists the various locations of the Medicaid Application Centers in the four-parish region. 6. Notify the patient that once the application has been completed at the Medicaid Application Center, it will be submitted to the local Medicaid Office for review. A decision regarding eligibility will be made within 45 days from the time of submission. In the event that the patient does not receive any feedback at the end of 45 days, the patient should contact the Medicaid Application Center to follow-up on their application. 7. Notify the patient that, if determined eligible, she/he can receive retroactive coverage for medical expenses incurred from the first day of the third month prior to filing the Medicaid application. SCREENING QUESTIONS Eligibility Questions for Pregnant Women and Children 1. Is the patient pregnant? a. In Louisiana, pregnant women may be considered presumptively eligible for Medicaid for a period of up to 45 days while her application is being processed. During this time, the patient s provider will be reimbursed for all pregnancy-related outpatient services rendered to the patient (labor and delivery is not included in this eligibility category) until the patient s eligibility for Medicaid can be fully established. b. For reference though, the income eligibility level for pregnant women in Louisiana is an annual income of less than 200% FPL ($34,340) for a family of three POYDRAS STREET, SUITE

2 2. Is the patient between the ages of 0-19 years and living in a family of three with an income level below 200% or 250% FPL ($34,340 or $42,925)? a. In Louisiana, infants and children up to 19 years of age who live in a family of three are eligible for regular Medicaid up to 200% FPL and are eligible for LaCHIP up to 250% FPL. 3. Is the patient a child in foster care or an adopted child? a. There is no income or asset limits for children in foster care as these children are, by definition, under state care. b. Income eligibility levels for adopted children, however, may apply and such levels are usually determined by the Office of Children s Services. 4. Is the patient a child with a disability? a. In Louisiana, children who receive SSI due to disability are automatically eligible for Medicaid. 5. Is the patient a child with a disability so severe that he or she could be admitted to a medical institution? a. When a child resides in an institution for more than 30 days, the income and resources of the parents are no longer counted in determining Medicaid eligibility of the child. Therefore, children who are institutionalized for more than a month will generally qualify for Medicaid. Eligibility Questions for Adults 6. Is the patient a parent of a dependent child or a child not eligible under any of the previous questions? a. If yes, does the parent work? a. If yes, and the parent earns less than 20% FPL ($3,360) per year for a family of three, the patient can qualify for Medicaid. b. If no, but the parents earns less than 13% FPL ($2,280) per year for a family of three, the patient can still qualify for Medicaid. 7. Is the patient a relative caring for a dependent child? a. When relatives assume responsibility for a dependent child, they can elect to apply for Medicaid as part of the child s family. Their eligibility standards for Medicaid are the same as the ones that apply to the parent of the dependent child (see above question). 8. Has the patient s family income recently increased? a. Families with dependent children may be eligible for Transitional Medical Assistance (TMA) when their earnings increase. If they received Medicaid 1515 POYDRAS STREET, SUITE

3 for 3-6 months prior to their increased earnings, they are entitled to an additional six months of Medicaid. 9. Does the patient have significant medical expenses? a. Aged, blind, and individuals whose monthly income exceeds eligible income levels, but is insufficient to pay for medical care can apply their medical expenses to spend down their income levels to the appropriate income eligibility levels. Eligibility Questions for Adults with Specific Diseases 10. Does the patient need breast or cervical cancer treatment? a. Women under the age of 65 and otherwise unable to meet Medicaid eligibility requirements may receive treatment for breast or cervical cancer (or a pre-cancerous condition) under Medicaid. 11. Does the patient have Tuberculosis? a. Patients with tuberculosis who are not otherwise eligible for Medicaid may receive TB related outpatient services (physician fees, pharmacy, lab x-ray, and clinic services). Inpatient hospital or nursing services are not included. Eligibility Questions for Adults with Medicare 12. Does the patient have Medicare? a. Provided the federal resource requirements of less than $4,000 for an individual or $6,000 for a couple or the state s more liberal resource requirements are met. a. Medicare beneficiaries with incomes at or below the federal poverty level, known as Qualified Medicare Beneficiaries (QMBs), are entitled to have Medicaid pay their Medicare premiums, deductibles, and copayments b. Medicare beneficiaries with incomes between 100 and 120 percent of the poverty level, known as Specified Low-Income Medicare Beneficiaries (SLMBs), are entitled to have Medicaid pay their Medicare Part B premiums only. c. Medicare beneficiaries with incomes between 120 percent and 135 percent of the federal poverty level, known as Qualified Individuals (QIs), are eligible through a federal block grant program to apply for payment of their Medicare Part B premiums. d. Working people with disabilities who receive Medicare and whose incomes after disregards are less than 200 percent of poverty level, known as Qualified Disabled Working Individuals (QDWIs), are entitled to full or partial payment of their Medicare Part A premiums POYDRAS STREET, SUITE

4 States can opt either to cover premiums in full or to charge QDWIs on a sliding-fee scale. Eligibility Questions for Disabled and Adults and Other Special Populations 13. Is the patient an immigrant? a. Undocumented immigrants are only eligible for emergency services, including labor and delivery. b. Documented immigrants can only qualify for Medicaid if they meet the requirements of any eligibility category. In some cases, a five-year waiting period is first warranted. 14. Is the patient homeless or has the person recently moved into the state? a. States cannot exclude individuals from Medicaid based on whether they have a fixed address or the length of time they have lived in the state. Thus, as long as the individual meets the requirements of any of the Medicaid eligibility categories, the patient should qualify for Medicaid. 15. Is the patient disabled or blind? a. People who meet the blindness and disability definitions used in the SSI program are eligible for Medicaid if they meet the state s income and resource tests. 16. Did the person at one time receive SSI benefits? a. States must provide Medicaid coverage to the following groups of people who once had and then lost SSI benefits: a. Adults over 18 who began receiving SSI due to disability or blindness before they reached age 22 but lost SSI when they received other Social Security benefits; b. Widows and widowers who lost SSI or state supplements due to Social Security benefit increases in 1984 and who applied for continued Medicaid coverage before 1988; c. Widows and widowers age 50 and over who lost SSI or state supplements because they received early Social Security retirement or disability benefits; d. People who lost SSI; state supplements; or assistance from the predecessor cash assistance programs for the aged, blind, and disabled due to a Social Security increase in 1972; and e. People who once received both SSI and Old-Age, Survivors, and Disability Insurance (OASDI) Social Security benefits but lost SSI due to Social Security cost-of-living increases POYDRAS STREET, SUITE

5 REFERENCES 1. Department of Health and Hospitals: Office of Management and Finance, Medicaid (Health Services Financing). Available at: Accessed of June 27, FamiliesUSA: Screening for Medicaid and State Children s Health Insurance Program Eligibility. Available at: Accessed on June 25, Health Services Resource Administration: Louisiana Medicaid and SCHIP Eligibility. Available at: Accessed on June 25, Kaiser Family Foundation: State Health Facts. Available at: Accessed on June 25, POYDRAS STREET, SUITE

6 APPENDIX 1 DOCUMENTS TO BRING TO THEMEDICAID APPLICATION CENTER 1. Copies of all health insurance cards (front and back) 2. If you are NOT a U.S. citizen, send copies of Permanent Resident Cards (green cards) or other forms from U.S. Citizenship and Immigration Services. 3. If you were NOT born in Louisiana AND you have never received benefits from Social Security Disability, Supplemental Security Income (SSI), or Medicare, send proof of U.S. Citizenship such as birth certificate, souvenir birth certificate from hospital, U.S. Passport, or adoption papers. If you don t have any of these, call to ask about other documents you can use. 4. Pay stubs from last month showing gross pay (before taxes) or a letter from the employer. If self-employed, send copies of last year s tax return and all schedule attachments for you, your spouse, and (if you are under age 19) your parents in the home with you. 5. Proof of gross income (before taxes) from Veteran s Benefits, worker s comp, alimony, and any other income that is not from working. Proof could be award letters and 1099 tax statements from last year s tax return for you, your spouse, and (if you are under age 19) your parents in the home with you. 6. Statement from friends or relatives who give money to you, your spouse or children. 7. Proof and the value of things owned like bank accounts, retirement accounts, life/burial insurance, pre-arranged burial contracts, or anything else. Examples: bank statements, insurance policies, burial contract, savings bonds, stock certificates, trust document, succession documents. 8. Proof of child care payments from the day care center. Proof of payments fr adult care from the caregiver. 9. Court order and proof of alimony or child support payments made to persons outside the home. If it is paid through Louisiana Support Enforcement Services (SES), you do not have to send proof. 10. If Medicaid coverage is needed for the three months before you apply, send proof of income for those months. 11. If you have been screened by the Early Detection Program & diagnosed with breast or cervical cancer, send proof of the results POYDRAS STREET, SUITE

7 APPENDIX 2 MEDICAID APPLICATION CENTERS IN FOUR-PARISH AREA Parish Name Mail Address Contact Person Phone E JEFF COMMUNITY HEALTH CENTER, INC EAST JEFFERSON GENERAL HOSPITAL JEFF CAP DOROTHY B WATSON COMM CNTR JEFF CAP HAZEL HURST COMMUNITY CNTR KENNER REGIONAL MEDICAL CENTER LAKESIDE HOSPITAL MENDOZA MEDICAL CENTER SAMUEL YOUNG BROWN, M D ABLE LIFE CARE SERVICES, INC ACCESS PREG & REFERRAL CTR KENNER ACCESS PREGNANCY & REFERRAL CENTER- GRETNA ADVANCED COMPREHENSIVE TESTING - GRETNA BETHESDA COMMUNITY PROGRAMS, INC JEFF CAP AVONDALE COMMUNITY CENTER JEFF CAP HARVEY COMMUNITY CENTER JEFF PARISH HSA/DCS WESTBANK JEFFERSON HWY DONNIE LEWIS RIVER RIDGE, LA HOUMA BLVD PATTIE DUPRE METAIRIE, LA MYRTLE STREET Luisa Cazabon METAIRIE, LA SOUTH CAUSEWAY BLVD. JEFFERSON, LA WEST EXPLANADE MARRIANN HOLLINSWORTH KENNER, LA I-10 SERVICE RD, SOC SERV DEPT METAIRIE, LA Kathy Morris WILLIAMS BLVD MINNY LAVELLE KENNER, LA WILLIAMS BLVD. Lisa Rodriquez KENNER, LA WESTBANK EXPRESSWAY, STE 6 GRETNA, LA W ESPLANADE AVE SUITE 130 KENNER, LA ALAN TUCKER STUMPF BLVD GRETNA, LA MEADOWCREST ST - SUITE 320 GRETNA, LA STUMPF BLVD, BLDG 8 GRETNA, LA MERCEDES SMITH Ester Brumfield US HWY 90 Chrystie Robinson AVONDALE, LA ESTALOTE STREET HARVEY, LA WESTBANK EXPRESSWAY Sheryl Celestin POYDRAS STREET, SUITE

8 LDJ CHILDREN'S RESIDENTIAL PALACE MEADOWCREST HOSPITAL TCP THEOPHILUS COMMUNITY PROGRAMS WEST JEFFERSON MEDICAL CENTER ACCESS PREGNANCY & REFERRAL CENTER- METAIRIE BERRY'S RELIABLE RESOURCES MARRERO, LA MISSION CT AVONDALE, LA BELLE CHASSE HWY. GRETNA, LA BEHRMAN HWY SUITE 107 GRETNA, LA MEDICAL CENTER BLVD. MARRERO, LA POYDRAS STREET, SUITE Gevondelear Morris Melissa Hentze VETERNS METAIRIE, LA FAZZIO RD. SUITE B CHALMETTE, LA CATHOLIC CHARITIES OF NEW ORLEANS 1000 HOWARD AVE, STE CHILDREN'S HOSPITAL 200 HENRY CLAY AVENUE COLUMBIA LAKELAND MEDICAL CENTER RHONDA WILLIAMS NICOLE WINCHESTER BULLARD AVE. SUSAN NUNEZ DENTAL EYE UNIT 2121 MAGAZINE STREET Rose Henry GREAT EXPECTATIONS - DESIRE/FLORIDA GREAT EXPECTATIONS - LOWER NINE GREAT EXPECTATIONS FOUNDATION, INC HOPE & FAITH FAMILY CARE SERV INC IN THIS TOGETHER 1661 CANAL STREET, SUITE KINGSLEY HOUSE 1600 CONSTANCE STREET OCHSNER FOUNDATION HOSPITAL LOUISA STREET CAFFINE AVE JACKSON AVE., MATILDA TENNESSEE SUITE THAYER STREET BH JEFFERSON HWY Pamela Dixon

9 ODYSSEY HEALTHCARE OF NEW ORLEANS VETERANS BLVD METAIRIE, LA TOURO INFIRMARY 1401 FOUCHER STREET Terry Smith Plaquemines WE CARE NURSING AND FAMILY SERVICE CATHOLIC CHARITIES- PADUA COMM SERVICES P /2 TECHE ST Janice Westerfield BETA STREET DEBORAH SERPAS St. Bernard Moore's Respite Care & PCA Serv Inc BELLE CHASSE, LA E St Bernard Hwy Yolanda Allen Violet, LA POYDRAS STREET, SUITE

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