Outreach and Enrollment Regional Training & Networking Meetings

Transcription

1 Outreach and Enrollment Regional Training & Networking Meetings May and June, 2014 Julie Tatko, MSW Lydia Ormsby, MSW Michigan Primary Care Association

2 Coverage Progress Report

3 Marketplace Progress Enrollment Data Through April 19, ,539 Michigan residents have selected a plan in the Marketplace Michigan s enrollment total exceeded HHS projections (enrolling 161,000) for the state by nearly 112,000 55,399 residents have also selected a stand-alone dental plan 37.6% of the eligible population in Michigan has enrolled Michigan currently has the 6 th highest percentage of eligible residents enrolled and the 8 th highest number of enrollees The percentage of young adults (age 18-34) enrolling through the Marketplace in Michigan reached 29% Michigan s young adult enrollment was slightly higher than the average for all states (28%) 88% of Michigan s enrollees selected a Silver medal level plan or higher This is higher than the average for all states (81%) 87% of Michigan s enrollees received financial assistance through the Marketplace 81% of those who received financial assistance selected a silver plan

4 Healthy Michigan Plan Enrollment Goal 320,000 Enrollees In the first year

5 Healthy Michigan Plan Progress 276,662 enrolled in HMP so far! 226,714 enrolled since April 1 st 49,948 enrolled before April 1 st through the ABW transition process New enrollment numbers released every Monday Localized enrollment data posted at

6 Healthy Michigan Plan Enrollment Data Report by County

7 Healthy Michigan Plan Enrollment Data Report by County

8 Enrollment Medicaid Health Plans The total number of HMP eligible beneficiaries enrolled in a health plan as of May 1 is: 57,915 The number of enrollees statewide who chose a health plan is: 36,558 (63.1 %) The number of enrollees statewide auto assigned to a plan is: 21,357 (36.9%)

9 Healthy Michigan Plan Overview

10 Healthy Michigan Plan Benefits A comprehensive range of benefits including: All 10 Essential Health Benefits Dental Vision Hearing Home Health Non-Emergency Medical Transportation

11 HMP Service Delivery System The vast majority of Healthy Michigan Plan beneficiaries will enroll into the one of the current Medicaid Health Plans Beneficiaries enrolled in a plan will also receive their dental services through that plan Beneficiaries not enrolled in a health plan will utilize the FFS Medicaid dental network HMP utilizes the Michigan s current carve out system for severe mental health conditions and substance abuse

12 HMP Copayments & Contributions In addition, % FPL will pay a monthly contribution based on 2-5% of annual income.

13 HMP Cost Sharing Example 4 Physician Office Visits $2 $8 6 Generic Prescriptions $1 $6 2 Dental Visits $3 $6 2 Non-Emergent Uses of the ER $3 $6 1 Vision Visit $2 $2 $28.00 / 6 Months = $4.67 $12,000 Annual Income x 2% = $ $ / 12 Months = $ = $24.67 Monthly Payment to MI Health Account (After The First Six Months Enrolled)

14 HMP Proposed Protocols MI Health Account October 1, 2014 Quarterly statements: include deposits and expenditures, future amounts due, explanation of services received. Required contributions: For % FPL Starts in month 7 2% of the amount that represents the beneficiary s percentage of FPL A beneficiary with 3 dependents has an annual income of $28,000. A beneficiary with no children has an annual income of $14,000. Both are eligible for HMP at 120% of the FPL. Both are assessed the same contribution.

15 HMP Proposed Protocols Cost-sharing Reductions Both co-pays and contributions may be reduced if doing so promotes greater access to services related to managing chronic disease. Health plans have a list of services, including both diagnosis codes and drug classes, for which copays must be waived: Account_Protocol_for_Comment_455149_7.pdf

16 HMP Proposed Protocols Health Behavior Incentives Health Risk Assessment assesses a broad range of health issues and behaviors including physical activity, nutrition, alcohol, tobacco and substance use, mental health, flu vaccination Members who acknowledge the need for behavior change and agree to address those behaviors will earn a reduction in cost-sharing Most HRAs completed at first visit, and there is no time frame required to complete it 50% reduction in required contributions or a comparably valued gift card for those who complete the HRA and agree to address or maintain healthy behaviors

17 Healthy Michigan Plan Proposed Protocols Member agrees to maintain healthy behaviors (if already healthy) OR Member agrees to address at least one healthy behavior

18 Healthy Michigan Plan Eligibility & Enrollment

19 Understanding MAGI Eligibility Our Role as Assisters Navigators and CACs do not hold responsibility for determining eligibility Our actions should never discourage a client from applying or seeking an eligibility determination Information presented about eligibility processes is intended to help assisters better communicate with clients regarding the eligibility determination they receive and better recognize and advocate for clients in situations where an error may have been made

20 How is MAGI Different? Some income that is currently counted is not counted Elimination of asset/resource limits Elimination of income disregards New disregard equal to 5 percentage points of the poverty line (only applied if necessary) New household rules result in changes in whose income is counted

21 Who does MAGI apply to? MAGI rules apply to: Children (Healthy Kids and MIChild) Pregnant Women (Healthy Kids and MOMS) Parents and Caretaker Relatives Former Foster Children Plan First! Recipients (ending June 30, 2014) New Adult Group (Healthy Michigan Plan) Previous income counting rules apply to seniors (people 65 and over) and most people with disabilities

22 MAGI Policy in Michigan MDCH s Modified Adjusted Gross Income Eligibility Policy is available online at: GI_Manual_457706_7.pdf Healthy Michigan Plan specific policy is available at: k_page_448984_7.pdf

23 Residency This got a lot simpler An individual is considered to be a Michigan resident if the individual attests to living in Michigan Homeless and transient individuals can use a mailing address and attest to resident, a fixed address is not required

24 Citizenship/Alien Status To be eligible for full coverage, an individual must be a U.S. citizen or have a qualified alien status Citizenship is not a factor for emergency services only (ESO) Medicaid but the individual must meet all other eligibility criteria Pages 8-11 of MDCH s Modified Adjusted Gross Income Eligibility Policy list the myriad of acceptable statuses

25 Household Composition Household size and makeup will be determined by the principles of tax dependency in the majority of cases Members of a family can have different household sizes Households will not necessarily match people s actual living situation Household rules could split families into different coverage programs Medicaid households are not always equal to the tax unit

26 The Big Three Tax Filer Not a Dependent Tax Filer Spouse Tax Dependents Non Tax Filer Not a Dependent (Adult >19) Individual Spouse Natural, Adopted & Step Children Under the Age of 19 (or under 21 if full time student) Tax Dependent Household of the person claiming them, unless (page 13) o Tax dependent who is not a o o child or spouse of the taxpayer Children living with both parents who are not expected to file a joint return Children claimed as tax dependent by a non-custodial parent

27 Household Example 1 Bob and Mary are married. Mary is the mother of Jane, age 22. Jane attends college in Ohio. Bob is the tax filer and claims Mary and Jane as tax dependents. Tax rules apply to all Group is 3 for all individuals

28 Household Example 2 Kayla is a grandmother who claims her 20 year old daughter (Samantha) and 2 year old granddaughter (Joy) as tax dependents. Samantha is a full-time student. Kayla is the tax filer. Tax rules apply to all. Kayla and Samantha s group is 3 Joy s group is 2 (Samantha and Joy)

29 Assets Assets are not considered in determining MAGI eligibility Assets include cash, personal property (e.g. savings accounts and vehicles) and real property (e.g. homes)

30 Income Common sources of income which count in MAGI eligibility determination include: Wages/Salary Self-Employment Income Business Income RSDI / SSDI (Social Security excluding SSI) Unemployment Benefits Spousal Support (Alimony) Taxable Amounts of Pension, Annuity, IRA etc. Note: Lump sum income counts in the month it is received.

31 Income Common sources of income which do not count in MAGI eligibility determination include: Child Support Workers Compensation American Indian Payments Veteran s Benefits SSI TANF Adoption Subsidies Disaster Relief Payments

32 Healthy Michigan Plan Enrollment

33 Enrollment Timeline

34 Selecting a Health Plan 1. Do you have a doctor you would like to continue seeing? 2. Do you have any current health conditions you need treatment for? Use Medicaid Health Plan Provider Directories and Category Ratings to choose a health plan at Confirm by phone that providers in the network are accepting new patients if needed. Return enrollment form or call MI Enrolls to select a health plan.

35 HMP Follow-up Form

36 Healthy Michigan Plan Application

37 Following-up with Problem Cases DHS will only speak to a client or authorized representative about his/her case _ ,00.html

38 Problem Cases Plan First! Plan First! enrollment interferes with HMP eligibility Report to caseworker and ESO Incorrect assignment to ESO Report to caseworker or appeal 5% Disregard Applicants between % FPL not being approved Appeal and send cases to

39 Problem Cases Counting Self-Employment Income Automatic 25% cap on deductions for selfemployment income Appeal and report to No Correspondence following application Applicant receives HMP eligibility determination through MI Bridges but doesn t receive follow-up letter or enrollment packet Report to enroll@mpca.net

40 MI Bridges

41 Community Partner ID Number You do not need to log-in as a Community Partner when assisting clients. Inserting your Health Center Partner ID number will track the application.

42 Retroactive Coverage Healthy Michigan Plan will cover medical bills retroactively up to three months but not prior to April 1 st. The month you are requesting retroactive coverage should be checked in the application. A DHS-3243 (retroactive Medicaid application) will be sent to the client. The client needs to complete this application and return it to the local DHS office.

43 Citizenship Although the citizenship question is not required, the first question needs to be answered for U.S. Citizens to avoid ESO coverage. A tax identification number should not be entered as a replacement for the alien, naturalization or citizenship number.

44 Retirement Survivor Disability Insurance RSDI is not referring to one type of Social Security. RSDI includes all three categories of Social Security : Retired Worker (including spouse or child), Survivor (including child, young/aged/disabled widower or parent) and Disabled Worker (including spouse or child).

45 Other Income Students should record scholarship or grant income in Other Income. You must click on the individual in the family who receives a scholarship or grant in the previous screen. Previous screen

46 Self Employment Report a negative or positive amount in the net income box and include whether it is a profit or a loss in the following question. You must report income in both the Yearly Income and Self-Employment sections.

47 Reporting Changes The Report My Changes button can take a day or two to appear in the system.

48 Discussion: Sharing Strategies and Best Practices

49 MPCA O/E Network Resources

50 Outreach and Enrollment Toolkit

51 Outreach and Enrollment Peer Communication Network Bookmark it!

52 Outreach and Enrollment Network Upcoming Events Bi-weekly Conference Calls (ongoing) O/E Survey (June) Monthly webinars (June-September) Regional Conference Calls (July) New Federal CAC Training (August) O/E Toolkit Relaunch (October) Statewide O/E Meeting (October)

53 Questions? Julie Tatko, MSW Program Specialist Lydia Ormsby, MSW Program Coordinator