Washington Apple Health. Washington Coalition of Medicaid Outreach Amy Johnson, Eligibility Policy and Service Delivery December 18, 2015

Transcription

1 Washington Apple Health Washington Coalition of Medicaid Outreach Amy Johnson, Eligibility Policy and Service Delivery December 18, 2015

2 Washington Apple Health Agenda Enrollment and Renewals Update 1095-B Apple Health Updates Apple Health Reminders Share Your Apple Health Story Resource and Contact Info

3 Enrollment and Renewals Update 3

4 4

5 Apple Health MAGI Renewals Auto-Renewal: Automatic renewal after federal hub data-match Data-match finds household under the Medicaid standard No data-match found and household income on file under the Medicaid standard No additional information needed by recipient Recertified for twelve months Manual: Data-match finds household above Medicaid standard Individual must manually complete their renewal 5

6 Apple Health MAGI Renewal Rates Auto-Renewal Averaging 67% monthly (Jan 2015 Dec 2015) Total Renewed Timely Averaging 84% monthly (Dec 2014 Oct 2015) Total Renewed After 90 Day Period Averaging 91% monthly (Dec 2014 July 2015) 6

7 Estimated MAGI Renewals Month December ,646 January ,609 February ,181 March ,249 Total Individuals Renewals are ramping up again, with our largest workload beginning in December and lasting through March 7

8 1095-B 8

9 IRS Form 1095-B Health Care Authority is required to mail the IRS form 1095-B to all Apple Health recipients who received minimum essential coverage (MEC) in 2015 Most Apple Health (Medicaid) coverage is considered minimum essential coverage (MEC) The 1095-B is proof of MEC This form should be retained for their records 9

10 IRS Form 1095-B This form, including IRS instructions and an insert, will be mailed to roughly 1.2 million households beginning in mid-january 2016 Expected to significantly impact call volumes for state agencies and community organizations beginning in January 10

11 IRS Form 1095-B 11

12 1095-B Instructions 12

13 1095-B HCA Insert The mailing includes IRS instructions for the 1095-B, as well as an insert sharing contact information for Health Care Authority and resources for tax questions. 13

14 14

15 15

16 Other 1095 forms Individuals may also receive other 1095 forms: 1095-A: Sent from the Health Benefit Exchange regarding Health Insurance Premium Tax Credits (HIPTC) or Qualified Health Plan (QHP) coverage 1095-B and 1095-C: Sent from employers or insurance carriers for employer sponsored health coverage Questions: Individuals should contact the agency or health insurer that sent these other 1095 forms 16

17 Apple Health Updates 17

18 Post-Eligibility Review Update Continue focusing on families active on N01(Family coverage) and N05 (Adult coverage) Next area to review is self-employment cases that are federally non-compatible New audit system coming in 2016! 18

19 Health Care Integration Update Changes are coming in April 2016 to Apple Health Managed Care, including: Regional service designations Earlier enrollment Fully integrated health care services (Clark and Skamania counties only) A single managed care plan for Foster Care An overview of Behavioral Health Organizations 19

20 Health Care Integration Update Three webinars offered: 11/20, 12/4 & 12/18 Recorded webinars and presentation slides posted to HCA Training & Education web page, as available: Postcards being mailed to clients beginning in January 20

21 Open Enrollment Happening Now! HBE Open Enrollment November 1, 2015 to January 31, 2016 For those applying for or renewing QHP coverage for

22 Apple Health Year-round Enrollment Washington Apple Health year-round enrollment! Apply for, renew or report changes for Apple Health coverage 22

23 Apple Health Reminders 23

24 Reporting Income in Healthplanfinder Ensure that you are assisting the client in reporting their correct gross monthly income on their Healthplanfinder application. Gross monthly income is the income earned before any taxes and deductions are taken out. 24

25 Reporting Income in Healthplanfinder Clients who are less than forthcoming in reporting their income will be audited through a post eligibility review and will be required to provide verification of their actual income. Reporting income that is not true or inaccurate is insurance fraud. 25

26 Designating an AREP for Apple Health Authorized Representative (AREP) A person or organization that is authorized by an applicant or recipient to act on behalf of him or her for Apple Health eligibility purposes. An AREP may: Obtain information needed to determine the applicant s or recipient s eligibility for Apple Health programs; and Obtain other information related to Apple Health coverage such as certification periods, renewals, changes, etc. 26

27 Responsibilities of an AREP Have a good-faith belief that the information he or she provides to the agency is correct. Act responsibly in assisting with an application and renewal of eligibility and other ongoing communications with the agency, while acting on behalf of the client. Report changes in circumstances as required under WAC

28 How to Designate an AREP Online application in Healthplanfinder Paper application HCA P MAGI HCA Classic AREP form DSHS (shared DSHS/HCA form) 28

29 Organizations as an AREP If a department within an organization is designated as an AREP for a client, other individuals within that department may also act as an AREP for that client. Individuals from other departments within that organization may not act as an AREP. Example: King County Public Health is a large organization with many departments. While any employee from the Access and Outreach department may be authorized to act as an AREP for a client, individuals from other departments within their organization (such as the West Nile Virus program) would not be authorized to act as an AREP for that client. 29

30 Share Your Apple Health Story 30

31 Share Your Apple Health Story Can you help? We re looking for individuals in Washington whose lives have changed for the better because they have Washington Apple Health coverage under the new MAGI eligibility families, children, pregnant women, and adults (especially younger adults). The Health Care Authority and the Health Benefit Exchange (which operates are working together to build a collection of these stories. 31

32 Share Your Apple Health Story With individuals permission, their testimonials could be featured on the Healthplanfinder or Health Care Authority website or in HCA s printed materials, or their stories and photos could appear on the Health Benefit Exchange corporate site under Share Your Story. 32

33 Share Your Apple Health Story The first step for anyone who is willing to publicly share their experience is to fill out the Share Your Story form at get-involved/share-yourstory/. 33

34 Resource & Contact Info 34

35 35

36 Resource Information HCA Medical Assistance Customer Service Center HCA Medical Eligibility Determination Services us/contactus.aspx Cross-Agency Customer Support Center Desk Aid: 36

37 Additional Medicaid Resources HCA Training & Education Resources Cross-agency Desk Aid r_referrals.pdf HCA Community-Based Specialists _Contact.pdf Questions? Contact Us 37

38 Questions? 38