Today s Accomplishments
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2 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 2
3 Change your approach ~ Think Proactively Create your own Community Enrollment Center Think of ways to get patients covered proactively Covered California considerations 3
4 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 County 4
5 Understand Covered California and MAGI-Medi-Cal Income Income Income Income 0-138% FPL % FPL % FPL 400% FPL + MAGI-Medi-Cal County Program Covered California Self Pay *exempts assets *exempts assets Non-MAGI Medi-Cal (Under 21, Over 65 yrs, pregnant, children in the home with deprivation, disabled and/or requires skilled nursing care) 5
6 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
7 Lets start with understanding the program hierarchy Federal Programs State Programs County Programs Covered California Charity Care 7
8 Federal Program Overview Medicare Medicaid (mandatory eligibility ) Social Security Retirement/Disability Compassionate Allowance (CAL) Low Income Health Program (LIHP) terms 12/31/2013 8
9 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
10 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.. 10
11 Let s Start with the Federal Programs 11
12 Medicaid vs. Medi-Cal Medi-Cal is California s Medicaid Program. Each state can have their own optional state programs 12
13 Social Security Administration Programs Social Security Disability Income (SSDI) Supplemental State Income (SSI) Medicare Medicare Disability: Renal Dialysis & Lou Gehrig s Disease (ALS) Retirement 13
14 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! 14
15 Low Income Health Program (LIHP) Medical care for the uninsured adult population childless adults years of age Must be a county resident US Citizen or legal immigrant with 5 years residency Medicaid Coverage Expansion (MCE) Income: 0-133% FPL Assets: Exempt Health Care Coverage Initiative (HCCI) Income: % FPL Assets: Within Medi-Cal Limits 15
16 Understanding the State Programs 16
17 Medicare/Medi-Cal Integration Dual Eligible Cal MediConnect Counties: Alameda Los Angeles Orange San Diego San Mateo Riverside San Bernardino Santa Clara 17
18 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 Maintain independence Dignity and Quality of Life Emergency Care Los Angeles San Diego Day Center Home care services Transportation 18
19 Low Income Medicare Beneficiary (QMB/SLMB) Eligibility Income eligible Asset eligible Benefits Pays monthly Medicare Part A or/and B premiums Prescription Drug Assistance 19
20 Basic Medi-Cal Linkage Under 21 years of age Over 65 years of age Pregnant Parents with deprived children Requires Long Term Care 20
21 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. 21
22 250% 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
23 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
24 Cancer Programs IMPACT Prostate Cancer Program BCCTP Breast and Cervical Cancer Treatment Program 24
25 Genetically Handicapped Persons Program (GHPP) Must 21 years or older No income limit Enrollment fee based on income Can be applied for as a 2ndry program 25
26 MRMIP (Major Risk Medical Insurance Program ) 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 or Cal-COBRA benefits. Still open for enrollment PCIP (Pre-Existing Condition Insurance Plan) 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 26 applications!
27 Health Insurance Premium Program (HIPP) Must have full scope or fee-forservice 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 27
28 Enrollment Methods County Office, Service Center, Certified Entities Online Mail Fax 28
29 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! 29
30 To subscribe to our yearly distribution of Reference Guides and Resources Contact: Ana Gonzalez Direct: (415) Technical Questions: 30
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