CHILD HEALTH PROGRAM Webinar Training Session Charitable Health Coverage Operations (CHCO)
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1 CHILD HEALTH PROGRAM Webinar Training Session Charitable Health Coverage Operations (CHCO) February 14, 2014 Raphael Hoch Sr. Project Manager
2 Agenda Introductions/Webinar Overview Transition to Child Health Program Child Health Program Applications Process KP Individuals and Families (KPIF) Application Community Benefit Subsidy Application Appendix/Q&A After our webinar, you may also questions re: completing Child Health Program applications to: (Subject line must read: Application Question) 2 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
3 Why the Change from Child Health Plan to Child Health Program? KP had to change the way we structured and administered our Child Health Plan in order to comply with Affordable Care Act (ACA) requirements: ACA guaranteed issue requires KP accept every individual who applies for coverage within KP service areas. This means Child Health Plan eligibility limitations (e.g., under 19, low household income, etc.) were no longer allowed. 3 February 14, 2014
4 4 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
5 Child Health Program Applications Instructions KP Individuals & Families (KPIF) application & Community Benefit Subsidy application 5 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
6 Child Health Program - 2 Applications Required KP Individuals & Families (KPIF) application For regulated Health Plans offered by KP. Applicant can get same plan on the exchange (Covered CA), but our Community Benefit subsidy is not be available there. 6 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
7 Child Health Program - 2 Applications Required Community Benefit Subsidy application For eligibility determination for our Community Benefit subsidy which reduces Health Plan premiums and copays. 7 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
8 Child Health Program Applications Instructions 8 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
9 9 February 14, Kaiser Foundation Health Plan, Inc. For internal use only. Instruction Sheet
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29 29 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
30 30 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
31 31 February 14, Kaiser Foundation Health Plan, Inc. For internal use only.
32 Q & A Thank You 32
33 33 February 14, Kaiser Foundation Health Plan, Inc. For internal use only. APPENDIX
34 RESOURCES You may questions re: completing Child Health Program applications to: (Subject line: Application Question ) Child Health Program Community Partner site: Specifically designed for our Community Partner agencies in our Northern and Southern California service areas. This site provides information and resources to help you assist parents and legal guardians applying to Kaiser Permanente Child Health Program. Check often for updates (please do not share link with clients). Child Health Program - Updated Public site: info.kp.org/childhealthprogram This site contains new program information, applications, forms, etc. (our former site, info.kp.org/childhealthplan, will redirect you to our new Child Health Program site). To request Child Health Program Enrollment Application Kits chco@kp.org and include: Quantity of English and/or Spanish Child Health Program Enrollment Application Kits requested Your name, Agency/Organization, Street Address, City, State Zip, Phone Number Charitable Health Coverage Operations (TTY users dial 711) Hours of Operation: M,W,F - 8:AM 3 PM (closed from 11:30 p.m. - 12:30 p.m.); T, TH - 12:30 p.m. 3 PM. For escalations only (regarding an issue with your client s application status): John Trotman California Lead - john.trotman@kp.org Karlynn McCane California Lead - karlynn.e.mccane@kp.org Lupe Gutierrez California Lead - guadalupe.x.gutierrez@kp.org (Please do not share our Leads contact information with applicants, applicant family members, or prospective members) 34
35 Child Health Program Overview KP s Charitable Health Coverage Operations in Oakland, CA determines eligibility and enrolls children in the Child Health Program (CHP), formerly Child Health Plan, and similar KP programs in Colorado, Georgia, Mid-Atlantic, and Ohio. The Child Health Program is a low-cost health insurance plan for uninsured children. More than 80,000 children in California are covered In existence for more than 12 years Monthly Payment: $0, $10 or $20 per child for up to three children No copays at KP facilities Includes medical, dental, vision and mental health coverage What makes CHP unique? Non-citizen and undocumented children are eligible to apply for membership Family income up to 300% of the Federal Poverty Level 35 February 14, 2014
36 KP Northern California Service Areas The following counties are in the Northern California service area: Alameda Contra Costa Marin Sacramento San Francisco San Joaquin San Mateo Solano Stanislaus Portions of the following counties are in the Northern California service area: Amador El Dorado Fresno Kings Madera Mariposa Napa Placer Santa Clara Sonoma Sutter Tulare Yolo Yuba 36
37 KP Southern California Service Areas The following counties are in the Child Health Program Southern California service area: Imperial Riverside Kern San Bernandino Los Angeles San Diego Orange* Ventura *All Zip Codes in Orange County are eligible. A complete list of eligible zip codes is available at info.kp.org/childhealthprogram Counties Currently Open: Los Angeles (except Antelope Valley) Orange Riverside San Bernandino San Diego 37
38 Key Changes in 2014 Why are we changing Child Health Plan? Child Health Plan Community Benefit subsidy embedded in plan $8 or $15 premium Low copays / out of pocket expenses Ability to enroll throughout the year Two-year plan Child Health Program Health Plan (KPIF) and Community Benefit Subsidy are separate $0 or $10 or $20 premium No copays when visiting KP facility Enrollment limited to open enrollment period once per year. Qualifying events allow for enrollment outside of open enrollment period Two-year plan (up to 12/31/2015) 38 February 14, 2014
39 About Child Health Program CHILD HEALTH PROGRAM Available only outside of Covered California Exchange Applications accepted only during open enrollment periods KP Individuals and Families (KPIF) Platinum Plan KP CA health plan Platinum (metal tier) plan offers the most comprehensive coverage. Separate application Community Benefit Subsidy (premium & copay) Administered separately from KPIF Lowers KPIF monthly premiums Reduces KPIF copay amounts to $0 (at KP facilities) Pediatric Dental DeltaCare USA Comprehensive dental services as per ACA No separate premium Applicants must meet eligibility criteria Separate application 39 February 14, 2014
40 Who is Eligible for Child Health Program? Up to age year olds may apply for themselves and/or their child(ren) In families with income < 300% FPL With no other access to health insurance Most documented children in families with income < 300% FPL will be eligible for either Medi-Cal or a federal subsidy from Covered California Note: Eligibility for California Children s Services (CCS) no longer disqualifies child from program 40 February 14, 2014
41 Child Health Program - Eligibility Eligible income guidelines for applicants 18 years of age applying for themselves. $0 premium 0-138% FPL Income range: $0 - $15,970 $10 premium % FPL Income range: $15,971 - $22,980 $20 premium % FPL Income range: $22,981 - $34,470 41
42 Premium Rates Have Changed* Current Child Health Plan 2 payment rates based on income 2014 Child Health Program 3 payment rates based on income Membership FPL% Premium Membership FPL% Monthly Payment 0 250% $ % $ % $ % $ % $20 *Aligns with Medi-Cal premiums 42 February 14, 2014
43 Child Health Program Summary of Benefits Families can choose a personal physician for their child. Monthly payment are $0, $10 or $20 per month, per child, depending on the family s income. Program includes medical, dental, vision and mental health coverage. The plan s monthly payment is for up to 3 children. After 3 children, there is no cost for each additional child. No copays for services at KP facilities. 43
44 Child Health Program Summary of Benefits 44
45 Supporting Documents EMPLOYED Submit Paystubs Must be within 4 weeks from application date and must include the name of parent working and paystub dates. Proof of Income SELF-EMPLOYED Complete Profit & Loss Statement (included in the enrollment kit) 3 month history OR 1040 tax return with schedule page CASH SALARY Submit letter from employer Company letterhead and statement How much applicant is paid and how often OR Complete an Affidavit form (please find attached in post 45 training follow-up ) Form in your binder Company Letterhead Statement that applicant works for XYZ employer How much applicant is paid How often applicant is paid Form in your binder
46 Supporting Documents If a child has been denied health coverage or does not qualify for health coverage due to citizenship issues, please ask applicant to supply either a copy of child s birth certificate (preferred), copy of child s passport, or affidavit* (see below). *Affidavit or signed letter stating the same information found on a Birth Certificate including the Child's Name, Sex, Birth Date, Birth Country, Birth Location (City, County, Province etc.), and Parents Names. 46
47 Supporting Documents Proof of Guardianship (if required) Kaiser accepts any one of three kinds of guardianship documents: Form GC-250, Letter of Guardianship Document Applicant provides this form, has to be approved by the court OR Power of Attorney for a Minor Child Applicant provides this form, requires notary signature California Caregiver Authorization Affidavit (Does not require an attorney or a notary) See form in your binder or go to: OR 47
48 What Causes Denials and Delays? Application Denials Over age limit Over income limit Resides out of service area Application comes from a county closed to new enrollment Has other active group coverage Application Delays No proof of non-u.s. citizenship No signature or incorrect signature (Example - unmatched signature or single signature) No date on application or outdated app Lack of income documentation Lack of guardianship documentation (if required) Home address with P.O. Box (P.O. Box okay for mailing documents to) Missing date of birth of child Applying for an unborn child Unclear documentation (Example - unreadable handwriting) 48
49 Special Enrollment Period: April 1, Nov 15, 2014 Qualifying Events Birth Adoption (or placement for adoption) Marriage Permanently moved into a KP service area from out of state Loss of minimum essential coverage (loss of eligibility, loss of employer contribution, or exhaustion of COBRA) Becomes a citizen If enrollment or non-enrollment was unintentional, inadvertent, or erroneous If a carrier violated a material provision of the contract in relation to the enrollee If an individual is determined newly eligible or ineligible for advance payment of the premium tax credit or cost sharing reductions If coverage through an employer will no longer be affordable or provide minimum value for the upcoming plan year If an individual meets other exceptional guidelines in accordance with HHS 49
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