Commonwealth of Kentucky

Transcription

1 Commonwealth of Kentucky

2 Kentucky HEALTH Covered Populations Medicaid Populations NOT included in Kentucky HEALTH Traditional Medicaid (Aged, Blind & Disabled) Medicaid Populations INCLUDED in Kentucky HEALTH Non-Disabled Adults & Children (Individuals covered before expansion, pregnant women, children, former foster youth up to age 26 & adult expansion population) Home and Community Based Waiver (c) Michelle P Waiver 1915(c) Model Waiver II 1915(c) Supports for Community Living 1915(c) Traditional Medicaid Adults Eligible Prior to Expansion Premiums or Copays in Benefits (continue to get vision and dental through MCO) Community Engagement required, unless primary caretaker of dependent Medicaid Expansion Adults Premiums or Copays State Employee Benefits Vision and Dental available through My Rewards Account Community Engagement required, unless primary caretaker of dependent Acquired Brain Injury 1915(c) Acquired Brain Injury, Long Term Care 1915(c) Pregnant Women & Children (Traditional Medicaid and KCHIP) Medically Frail Adults & Former Foster Youth up to age 26 Nursing Facility and ICF/MR Residents Qualified Medicare Beneficiaries No Premiums or Copays in Benefits Community Engagement initiative not required Optional Premiums (for access to My Rewards) in Benefits Community Engagement initiative not required 2

3 Benefit Type by Population Kentucky HEALTH Alternative Benefit Plan Benefits and limitations similar to the Kentucky State Plan Non-medical vison/dental services covered through Kentucky HEALTH My Rewards Account Kentucky HEALTH Medicaid State Plan/CHIP No change in benefits All vision/dental services covered by MCOs Population Adult Group Benefit Package Kentucky HEALTH Alternative Benefit Plan Medically Frail Adults Medicaid State Plan (No change in benefits) Former Foster Youth to age 26 Parents and Caretakers & TMA Pregnancy Category Children Medicaid State Plan (No change in benefits) Medicaid State Plan (No change in benefits) Medicaid State Plan (No change in benefits) Medicaid State Plan (No change in benefits) Note: Someone is considered a parent/caretaker until a dependent child is age 18. 3

4 My Rewards Overview

5 What is the My Rewards Account? The My Rewards Account provides incentives for beneficiaries to improve their health while actively participating in the community. Commercial Design Can be used to access certain additional benefits in a manner similar to a Health Spending Account available through many commercial plans. Services Available My Rewards can be used to pay for vision and dental services. My Rewards Account Incentivizes Health Encourages beneficiaries to maintain and improve their health by providing incentives for preventive care and healthy behaviors. Earning Rewards My Rewards can be earned by completing activities such as taking educational courses, or participating in preventive health services. 5

6 My Rewards Account By rewarding health, job training and community engagement, the My Rewards Account provides incentives for beneficiaries to improve their health while becoming active members of the community. My Rewards Account Breakdown Policy My Rewards Account allows beneficiaries to earn dollars to spend on additional benefits The account is available to beneficiaries in an active status (not in a penalty period) Kentucky HEALTH What s Changing? Expansion adults may use My Rewards Account for vision and dental services Who is Impacted? Expansion Adults* Parents/Caretaker relatives Medically Frail & Former Foster Youth (up to age 26) Pregnant Not Impacted Note: Expansion Adults may use their My Rewards Account for nonmedical vision/dental services. Other impacted groups will NOT need to use their My Rewards Account for vision/dental services. Children Non-Kentucky HEALTH Medicaid beneficiaries 6

7 Who Has Access to My Rewards Account? Populations That May Have a My Rewards Account Medicaid Expansion Adults Medically Frail Adults & Former Foster Youth up to Age 26 Adults Eligible Prior to Expansion Pregnant Women Switch to Alternative Benefits Plan (ABP) Non-medical vision/dental services paid for by funds in the beneficiary s My Rewards Account Must pay premiums to stay enrolled in Kentucky HEALTH and have access to My Rewards Account No change to benefits plan All vision/dental services paid for by the beneficiary s MCO Must pay optional premiums to have access to My Rewards Account Note: Children do not have access to a My Rewards Account. 7

8 Beneficiaries May Earn My Rewards Dollars 6 Months Before Kentucky HEALTH Benefits 6 months to earn My Rewards Dollars 1/1 January 2018 Qualifying beneficiaries are able to earn dollars for their My Rewards Account by receiving preventive services Includes going to the dentist, taking a child in for a check-up, getting a mammogram and any other type of preventive service 4/1 April 2018 Dollars earned from January to April are credited to the My Rewards Account Beneficiaries have the opportunity to continue earning dollars by participating in My Rewards education & training activities 7/1 July 2018 From July onward, qualifying beneficiaries are able to earn for all qualifying activities, and use the dollars in My Rewards Account to pay for dental and vision services. FYI On July 1, MCOs will continue to cover vision and dental services for adults eligible prior to expansion, pregnant women, children, former foster youth (up to age 26), and those determined to be Medically Frail. These citizens will not need to use My Rewards Accounts for these services. 8

9 My Rewards Qualifying Activities Examples of some of the activities that individuals may complete to earn money towards their MRA are mentioned below. Education & Training Courses Preventive Activities Community Engagement Healthy Behaviors Complete health risk assessment with MCO Complete Health Access Nurturing Development Services (HANDS) program intended for any new or expectant parents Participate in Moving Beyond Depression (MBD) intended for mothers suffering from depression needing assistance to function optimally and support their child s development Participate in Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) Complete a My Rewards qualifying course Take part in health screenings and preventive services, such as mammograms, pap smears, prostrate screenings, colonoscopies, & flu shots Get an annual physical, including biometric screening Take a dependent child for a well-child physical, preventive dental exam, or vision screening Complete an adult preventive dental exam Complete an adult preventive vision exam Register with a Kentucky Career Center and complete a goal needs assessment Participate in a qualifying community activity for at least 80 hours a month (including community service) Complete job skills training or training with a Career Coach Conduct job search activities Complete employment - related education or GED - prep classes Pass the GED exam Participate in a smoking cessation activity Participate in drug addiction counseling (including for alcohol) Complete the First Step Program Avoid inappropriate Emergency Room visits Follow-up with a physician after an ER visit This is not a complete list of qualifying activities, but it is meant to give you an idea of the types of activities that may help individuals earn My Rewards. This list is subject to change. 9

10 My Rewards Account Courses on Citizen Connect As of April 1st, 2018, there are 5 available courses on Citizen Connect. Available Courses on Citizen Connect My Rewards Overview Course My Rewards Overview Course (Spanish Version) Deductible Account Overview Course PATH Community Engagement Overview Course Cost Sharing Overview Course Kentucky HEALTH Overview Course 10

11 Checking the My Rewards Account Balance Individuals may view their account transaction details and real-time My Rewards balances via the following methods: Citizen Connect and benefind website Individuals may view their account balance on benefind Individuals may view their account balance and and activities they have completed on Citizen Connect DCBS may view an individual s My Rewards balance in Worker Portal Kentucky Career Centers may view this information in Staff Connect Via Phone Individuals may check the balance and the status of their My Rewards Account by calling (benefind/conduent help desk) Annual My Rewards Account Summary Citizen Connect mails or s an annual summary containing My Rewards Account balance and the year s transaction history Citizen Connect only sends this statement for Active accounts after Deductible Account funds have been rolled over to the MRA 11

12 Possible Penalties In Kentucky HEALTH, there are 5 possible penalties: Cost Sharing, PATH, Voluntary Withdrawal, Recertification, and Report a Change (RAC). As part of Kentucky HEALTH, individuals may be subject to penalties and/or suspension for not complying with policy. Penalties and Suspensions do not always cause termination or denial of benefits, but they may suspend coverage or lock-out an individual from re-enrolling. 12

13 My Rewards Account Payout Former individuals who have left Kentucky HEALTH, who remain commercially insured without Medicaid in the State of Kentucky for at least 18 months, may apply to receive up to $500 of the remaining balance in their My Rewards Account. Steps for System Payout Process Calculated the pay-out amount based on the remainder of the My Rewards Account balance and communicated to the benefind system Issued a check to the beneficiary for the calculated amount Send an additional communication to the beneficiary confirming the payout was successful 13