The 2014/2015 Renewal Process. Kristen Dowty, Medical Administration Manager, DSS Josephine Sempere, Training and Education Manager, AHCT

Size: px

Start display at page:

Download "The 2014/2015 Renewal Process. Kristen Dowty, Medical Administration Manager, DSS Josephine Sempere, Training and Education Manager, AHCT"

Kristin Allison
6 years ago
Views:

1 1 The 2014/2015 Renewal Process Kristen Dowty, Medical Administration Manager, DSS Josephine Sempere, Training and Education Manager, AHCT

2 Renewals Renewal an opportunity for a member who is already enrolled in a CT marketplace health plan to enroll in the same or another health plan (based on an applicant s eligibility) Why do we need a renewal process? In compliance with the ACA, Access Health CT has implemented a streamlined renewal process to promote retention of active members. We want to keep our current members for multiple years.

2014/2015 Renewals Process 11/15 2/15 10/27 10/30 12/5

Period) 10/17 10/23 12/1 Bulk Services October November

Notice M/CH 30 Day 12/15*** Medicaid/CHIP (Recurring

prior to coverage end date **30 days prior to coverage

3 2014/2015 Renewals Process 11/15 2/15 10/27 10/30 12/5 Auto Renew Effective Date 1/1 QHP/APTC (Annual OE Period) 10/17 10/23 12/1 Bulk Services October November December January February March 11/1* 12/1** 1334 Notice M/CH 30 Day 12/15*** Medicaid/CHIP (Recurring monthly cycle) *Actual Date to be Reconfirmed *60 days prior to coverage end date **30 days prior to coverage end date ***15 days prior to coverage end date Reconsideration Period

4 Access Health CT Enrollments Total enrollment as of 10/1/14: Qualified Health Plan: 74,221 Medicaid: 205,905 TOTAL 281,026 Renewals For 1/1/2015 Qualified Health Plan: 74,221 MAGI Medicaid: 27,000 QHP Medicaid

12 Meet Tina The Access Health CT Virtual Assistant Tina will be appearing on the Access Health Consumer Portal before 2015 Open Enrollment. She will provide shopping, eligibility and enrollment guidance to our website visitors. Her role is to provide information and to answer questions about the ACA (Affordable Care Act) and the application process.

13 2014 Qualified Health Plan (QHP) Offerings QHP Issuers Individual Standard Plans Individual Non-Standard Plans SHOP Standard Plans SHOP Non-Standard Plans Anthem 1 Gold 1 Silver* 1 Bronze 1 Gold 1 Silver* 2 Bronze 1 Catastrophic 1 Gold 1 Silver 1 Bronze 1 Gold 1 Bronze ConnectiCare Benefits, Inc. 1 Platinum 1 Gold 1 Silver* 1 Bronze 2 Bronze 1 Catastrophic 0 0 HealthyCT Co-op 1 Gold 1 Silver* 1 Bronze 1 Bronze 1 Catastrophic 1 Gold 1 Silver 1 Bronze 1 Bronze UnitedHealthcare 1 Gold 1 Silver* 1 Bronze 0 1 Gold 1 Silver 1 Bronze 0 *All Individual Silver Plans include three cost sharing reduction plans All Standard Individual Plans include AI/AN zero cost sharing plans and AI/AN limited cost sharing plans 14

Standard Plan Designs 2015 Bronze Bronze H.S.A Silver Gold Platinum Deductible Prescription Deductible Out of Pocket Max In-Network Out of Network In-Network Out of Network In-Network Out of Network

14 Standard Plan Designs 2015 Bronze Bronze H.S.A Silver Gold Platinum Deductible Prescription Deductible Out of Pocket Max In-Network Out of Network In-Network Out of Network In-Network Out of Network Individual $5,000 $4,600 $2,600 $1,000 $0 Family $10,000 $9,200 $5,200 $2,000 $0 Individual $10,000 $9,200 $6,000 $3,000 $2,000 Family $20,000 $18,400 $12,000 $6,000 $4,000 Individual n/a n/a $25 $0 n/a Family n/a n/a $50 $0 n/a Individual n/a n/a $350 $350 n/a Family n/a n/a $700 $700 n/a Individual $6,600 $6,450 $6,600 $3,000 $2,000 Family $13,200 $12,900 $13,200 $6,000 $4,000 Individual $13,200 $12,900 $12,500 $6,000 $4,000 Family $26,400 $25,800 $25,000 $12,000 $8,000 15

15 QHP/APTC Renewal Process: The Active Role Individuals are given the following 3 options to renew coverage during the Open Enrollment Period: 1.Renewing online on the Access Health CT Consumer Portal 2. Returning the signed Signature Form included in the Open Enrollment Renewal notice 3. Contacting the Access Health CT Call Center by phone or inperson at one of our two Enrollment Centers

16 Renewals- Medicaid Medicaid and CHIP Renewal - Year One (Pre-MAGI to MAGI) There are no changes required to the AHCT system to accommodate Pre- MAGI to MAGI Medicaid and CHIP renewals. Individuals currently enrolled in pre-magi Medicaid or CHIP are instructed to complete their Medicaid or CHIP renewal through the AHCT system. Pre-MAGI Medicaid or CHIP enrollees who enter AHCT for renewals will complete the full AHCT application and undergo full eligibility determination using MAGI-based rules. The system will verify if the individual is currently receiving Medicaid or CHIP and is within the renewal period of 60 days. If so, an eligibility determination will be made and notices sent to the individuals. Individuals cannot renew coverage outside of this 60 day window.

Renewals- Medicaid Year Two Medicaid/CHIP Renewal Timeline Key Points Medicaid renewals will occur throughout the year on a monthly basis Medicaid enrollees will be able to renew online as soon as

17 Renewals- Medicaid Year Two Medicaid/CHIP Renewal Timeline Key Points Medicaid renewals will occur throughout the year on a monthly basis Medicaid enrollees will be able to renew online as soon as the first renewal notice is received and the coverage start date will be coordinated appropriately The batch process is run 15 days prior to the coverage end date for Medicaid/CHIP enrollees who have not manually renewed coverage. The system will auto-renew eligible enrollees OR terminate the coverage, effective the end of the month, if it cannot be renewed There will be no gap in coverage for auto-renewals Medicaid enrollees should receive a full 12 months of coverage (except for those aging out such as HUSKY A and B children or Former Foster Care Children turning 26 during that coverage year)

18 Renewals- Medicaid Medicaid and CHIP Renewal Year Two (2015) and Beyond (MAGI to MAGI) 60 days Prior to the Medicaid and/or CHIP coverage end date, a renewal notice will be sent to all active enrollees, informing them about their projected eligibility determination results and instructions on how to renew Medicaid/CHIP coverage. Individuals who are eligible for auto-renewal will be informed in the notice as well. No action required unless otherwise noted. Individuals are given the following options to renew coverage during the renewal period if their circumstances have changed: Renewing online on the Access Health CT Consumer Portal Returning the signed AH3-R form (pre-populated renewal form) to AHCT* Contacting the AHCT call center by phone or in person

19 Renewals- Medicaid Medicaid and CHIP Renewal 30 days Prior to the coverage end date, the Medicaid and CHIP Renewal Reminder Notice will be sent again to all eligible active enrollees 15 days Prior to the coverage end date, for all individuals who are currently enrolled in Medicaid/CHIP and who have not reported a change in circumstances, the system will auto-renew coverage beginning the 1 st of the following month. If coverage cannot be auto-renewed, the system will terminate the coverage, at the end of the month.

20 Renewals- Medicaid Medicaid and CHIP Renewal The AHCT system will send a notice to notify the enrollee of the final eligibility determination For individuals who can be auto renewed, the system will send an additional verification notice if self-attested income and lawful presence cannot be verified with the external data sources. In addition, an enrollment PDF will be sent to EMS/ConneXion to renew the coverage. If coverage cannot be auto renewed or the client reported a change that resulted in eligibility, the system will send a change PDF to close the programs.

21 Renewals- Medicaid Households are able to auto-renew if: The system can retrieve sufficient information from application and data sources AND All necessary application information is verified by electronic data sources AND The household s program eligibility has not changed (e.g. HUSKY A to HUSKY )OR Individuals in the household have switched between Medicaid/CHIP coverage groups except for CHIP Bands 2 & 3. (e.g. HUSKY A to HUSKY D or HUSKY A to HUSKY B band 1)

22 Renewals- Medicaid Households are unable to auto-renew if: Information is inaccurate or insufficient to determine eligibility and renew coverage. The individual must contact Access Health CT and report changes (Online, Paper or Phone) OR Any necessary application information is not verified by electronic data sources OR Changes reported during the Renewal period result in a loss of Medicaid/CHIP eligibility for at least one household member OR Changes reported during the Renewal period result in a gain of CHIP Band 2 or 3 eligibility from Medicaid or CHIP Band 1 Individual is in the Medicaid Pregnant Women or MAGI for the post-partum period For the above scenarios, a notice with a pre-populated renewal form will be sent out to the individual. The pre-populated form will not contain PII and sensitive information, such as tax return information retrieved from IRS. The notice also includes detailed instructions on how to renew Medicaid and CHIP coverage. The individual is instructed that he/she must take an action within 45 days of the notice to complete the renewal process.

23 Renewals- Medicaid The system will not try to renew individuals in the following scenarios: Individuals are not within the 60 day renewal window when this process is running. Individuals who have had their eligibility overridden on an application are excluded from the renewal process. A pre-populated form is not provided, but the individual will receive a notice to call the AHCT Contact Center.

24 Renewals- Medicaid Current Coverage Projected Determination Auto Renew Medicaid QHP No MA ineligible Medicaid QHP w/ APTC No MA ineligible Comments Medicaid P/C Medicaid P/C Yes Same sub-program Medicaid LIA Medicaid P/C Yes Different MA sub-program Medicaid CHIP Band 1 Yes Medicaid CHIP Band 2, Band 3 No CHIP band 2 and Band 3 have a premium CHIP QHP No CHIP ineligible CHIP QHP w/ APTC No CHIP ineligible CHIP Medicaid Yes CHIP Band 1, Band 2, Band 3 CHIP Band 1 Yes CHIP Band 1 CHIP Band 2 No CHIP band 2 has a premium CHIP Band 3 CHIP Band 2 Yes Reduction in premium CHIP Band 1, Band 2, CHIP Band 3 No CHIP band 3 has a premium CHIP Band 3 CHIP Band 3 Yes CHIP Band 2 CHIP Band 2 Yes This table demonstrates when auto-renewal will occur for current Medicaid enrollees

25 Auto Renewals- Medicaid/CHIP Medicaid/CHIP enrollees eligible for auto-renewal will be able to view their renewed coverage on the Account Home page

26 Renewals- Medicaid Reconsideration Period Individuals who lost coverage due to inaction during the renewal period will have the opportunity to regain the Medicaid/CHIP coverage within three months from the loss of coverage (i.e., Reconsideration period) Individuals who regain coverage during the Reconsideration period will receive Medicaid/CHIP coverage retroactive to the day coverage was lost. There will be no gap in coverage. The system will determine the correct effective coverage date automatically (day after coverage was lost if applicant is within redetermination period) using their previous eligibility period in the system Individuals who wait until after the reconsideration period to enroll in Medicaid/CHIP will receive coverage starting on the 1st of the month a new application is submitted. There can be a gap in coverage

27 Renewals- Coverage End Dates If an individual s coverage is renewed, the individual will receive a full 12 months of coverage from his/her coverage start date and the coverage end date will be set appropriately. If an individual s renewed coverage begins on 7/1/15, his/her coverage end date will be set to 6/30/16 Individuals receiving Former Foster Care Medicaid will have an end date set to the month they turn 26 if his/her birthday is within 12 months. If an individual s renewed coverage begins on 7/1/15 and his/her 26th birthday is 11/15/2015, the coverage end date will be set to 11/30/15 Individuals renewing for Medicaid Children or CHIP, and who are turning 19, are notified directly by the HUSKY Program when they are aging out. Individuals within the same household who have different coverage start dates will have their coverage end dates aligned. This will result in the whole household being up for renewal at the same time the next year. E.g. two individuals in the household, one with a start date of 7/1/14 and the other with a start date of 9/1/14, the coverage end date for both individuals will be set to 6/30/15

Income or Household will display on the Home Screen Step 2: The applicant is given the opportunity to

28 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 1: When a Medicaid consumer logs into his or her account within 60 days of their coverage end date the option to Renew/Report a Change in Income or Household will display on the Home Screen Step 2: The applicant is given the opportunity to review their existing coverage before renewing the application. The applicant clicks Next to continue

Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 3: The applicant is given the opportunity to review their existing coverage section by section before renewing the application.

29 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 3: The applicant is given the opportunity to review their existing coverage section by section before renewing the application. The applicant clicks Next to continue Step 4: After reviewing previous application data the user is presented with the option to report a change. If the consumer does not have any changes the individual clicks Proceed to Renew. If the consumer would like to report a change before renewing the individual should click Report a Change and Renew

Application signature section where the individual should e-sign and click Next

30 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 5: If the consumer has no changes to the application the individual will be directed to the Application signature section where the individual should e-sign and click Next Step 6: The consumer receive information on their current enrollment and should click Next

Qualification Information Screen and should click Next Step 8: The consumer will be

31 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 7: If a consumer s renewal period is outside of open enrollment, the consumer will receive the Enrollment Qualification Information Screen and should click Next Step 8: The consumer will be able to view their eligibility determination screen and can click Next to complete the renewal

Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 9: The consumer will be asked to confirm that they would like to proceed with their

32 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 9: The consumer will be asked to confirm that they would like to proceed with their enrollment. Consumer should click Continue Step 10: The consumer will be asked to confirm their additional Medicaid Questions. If there are no changes click Next

conditions and should click Next Step 12: The consumer

33 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 11: The consumer will review the terms and conditions and should click Next Step 12: The consumer is able to upload any documents. The consumer can the click Next

click Next Step 14: The consumer confirms their renewal and

34 Medicaid Consumer Renews Coverage on Consumer Portal Steps Step 13: The consumer can continue to confirm their plan and should click Next Step 14: The consumer confirms their renewal and clicks Confirm Effective Date: June 1, 2015 Effective Date: May 31, 2016

35 Questions?

OVERVIEW OF THE AFFORDABLE CARE ACT. September 23, 2013

OVERVIEW OF THE AFFORDABLE CARE ACT September 23, 2013 Outline The New Continuum of Coverage Medicaid and CHIP Are Changing The New Marketplaces Insurance Affordability Programs Shared Responsibility Requirement