Healthy Connections Checkup/ ACA Medicaid Changes Overview August 1, 2014 Overview Introducing Healthy Connections Checkup What is Checkup? Healthy Connections Checkup is a Medicaid limitedbenefit program. This program was previously called Family Planning. Who is Eligible for Checkup? Men and women of all ages with an income at or below 194% FPL who are ineligible for any other Medicaid program. Why the New Name? Checkup communicates the importance of preventive health care and a more holistic approach to family planning service provision. 1
Enhancement Enhanced Benefit for Healthy Connections Checkup New Covered Services (Effective August 1, 2014) 1.) Comprehensive Physical Examination (covered once every 2 years) 2.) Preventive Health Screenings (defined by the USPSTF) 3.) Referrals Goals 1.) Access 2.) Identification 3.) Connection 4.) Learning New Screenings Examples of Newly Covered Checkup Screenings Behavioral & Mental Health screenings Cholesterol abnormalities screening Diabetes screening Hepatitis C virus infection screening Obesity screening and counseling Breast cancer screening (mammography) Abdominal Aortic Aneurysm screening Colorectal cancer screening Lung cancer screening for smokers *Please refer to the U.S. Preventive Services Task Force guidelines (Grade A & B) for the most up-to-date preventive screening standards. Screenings vary by age, gender and risk factor. 2
Referrals Referral Process for Healthy Connections Checkup Importance of Referrals Checkup members have Medicaid coverage for certain preventive screenings Checkup members do NOT have coverage for follow-up care/treatment Where to Refer Checkup Patients Providers that offer care to the uninsured or underinsured Examples include free clinics, FQHCs, RHCs, hospital clinics that provide charity care, etc. Referral Procedures This process was established to compensate providers for administrative costs associated with referrals AND to collect important data on the health status of the Checkup population Cards Healthy Connections Checkup Cards 3
Affordable Care Act Medicaid Changes General Overview August 1, 2014 8 4
ACA Impacts on Medicaid Streamlined and simplified application process Automated data-matching and real-time eligibility determination Streamlined verification process Implementation of a Modified Adjusted Gross Income (MAGI) methodology for household and income determinations for somecategories Streamlined renewal process 9 Enrollment Single, Streamlined Application Medicaid Health Insurance Marketplace 10 5
Medicaid Application Process Applicants can apply online, telephone, mail or in person South Carolina Department of Health and Human Services (SCDHHS) will: Determine eligibility for Medicaid/CHIP If ineligible for Medicaid/CHIP, transfer their electronic account to the Health Insurance Marketplace to be assessed for the Advanced Premium Tax Credit (APTC) or Cost Sharing Reduction (CSR) 11 https://apply.scdhhs.gov 12 6
SCDHHS Paper Applications Based on the new streamlined application created by Center for Medicaid Services (CMS), the current Medicaid applications have been revised: DHHS Form 3400, Healthy Connections Application (replaces 2800) DHHS Form 3401, Healthy Connections Application for Institutional/Waiver Addendum and supplemental forms DHHS Form 3400-A, Healthy Connections Addendum for Specialty Programs DHHS Form 3400-B Addendum for Nursing Home and In-Home Care DHHS Form 3400-01, Healthy Connections Additional Person 13 What Is Not MAGI? The following Medicaid programs are not impacted by the MAGI methodology: Individual who are elderly, blind, have a disability SSI recipients Title IV-E Foster care children Long-term care services 14 7
What Did Not Change? MAGI is NOT a new Medicaid program, rather it is a new method of determining household composition and calculating income Continue to follow the existing Medicaid eligibility regulations for: Citizenship and Identity Immigration Residency Social Security Number Incarceration Current appeals rules remain in effect, but they may change in the future 15 MAGI Medicaid Categories Eligibility based on new MAGI rules: Pregnant women Children Parent/Caretaker Relatives Family Planning New Mandatory Coverage Group: Former Foster Care Children up to Age 26 16 8
MAGI New Mandatory Group Former Foster Care Children up to Age 26: Under age 26 Ineligible for other mandatory Medicaid coverage Were in foster care in South Carolina and enrolled in Medicaid on their 18th birthday (or at the time they aged out of foster care) 17 MAGI Key Components Income Household Composition Changes Mirrors federal tax filing rules Streamlined verification process through electronic data sources Elimination of income disregards (MAGI categories) Elimination of resources counting against eligibility. 18 9
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