MeHAF Grantee Meeting, January 16, 2014 Enrolling Kids and Families: MaineCare and the ACA Roll-Out

Transcription

1 MeHAF Grantee Meeting, January 16, 2014 Enrlling Kids and Families: MaineCare and the ACA Rll-Out Jack Cmart, Maine Equal Justice Partners Mary Hendersn, Hendersn Cnsulting fr the Maine Children s Alliance maryhendersn55@gmail.cm 1

2 Maine Equal Justice Partners (MEJP) MEJP wrks t find slutins t pverty and imprve the lives f peple with lw incme in Maine by fcusing n issues related t health care, fd and incme security, supprts fr wrking families and higher educatin and training pprtunities. We accmplish ur missin thrugh: Public plicy advcacy in the legislature and with gvernmental agencies Legal representatin and impact litigatin n systemic issues Statewide utreach and training n issues affecting peple with lw incme and the supprts that can help them prevent r mve ut f pverty The Maine Children's Alliance (MCA) MCA prvides nn-partisan leadership with legislative advcacy, cmprehensive data n the health and well-being f Maine children, and cllabrating with partners at the state, reginal and natinal levels. Fr 20 years, MCA has wrked t imprve health care, cverage and access; early childhd develpment & educatin; ecnmic well-being and stability; and safety fr Maine children. 2

3 MaineCare: Maine s Medicaid Prgram Medicaid: Title XIX f the Scial Security Act established in 1965 t prvide medical and health related services t individuals, children and families with lw incme, including the elderly and disabled. Traditinal Medicaid is means-tested. Strict eligibility criteria varies frm state t state. Incme restrictins apply. Cvers a wider range f services: including hspitalizatin, x-rays, lab services, clinic treatment, pediatrics care, family planning, nursing services and in-hme nursing facilities fr 21+ years, medical and surgical dental care. Medicaid is funded by bth federal and state gvernment: In Maine the federal financial participatin (FFP) cntributin is abut 67% - the state pays 33% fr mst health care services. 3

4 MaineCare applicants/members deal with 2 separate DHHS ffices Department f Health and Human Services (DHHS) Office f Family Independence (OFI) Office f MaineCare Services (OMS) Determines eligibility fr MaineCare and ther prgrams including the Fd Supplement Prgram and the TANF/ASPIRE prgram Oversees MaineCare, Drugs fr the Elderly and MaineRx Plus Determines benefits cvered Bill payment and ther accunt activity MaineCare Member Services at

5 MaineCare Cverage Categries effective 1/1/14 Categry Benefit Level Incme Limit Asset Limit Children age 0-18 Full-benefit MaineCare 200% FPL Nne 19- and 20-year lds Full-benefit MaineCare 150% FPL $2,000 (many are excluded) Parents r guardians Full-benefit MaineCare 133% FPL (100% as f 2014) $2,000 (many are excluded) Pregnant Wmen Full-benefit MaineCare 200% FPL Nne Adults with disabilities and senirs age 65 and lder Adults with disabilities and senirs age 65 and lder wh have Medicare Nn-Cats : adults wh d nt fit int ne f the categries fr fullbenefit MaineCare: Wait list pen but new enrllments CLOSED; cverage grup ends January 2014 Adults medically eligible fr nursing care Adults living in residential care facilities ther than nursing facilities Wmen wh have breast r cervical cancer (r pre-cancerus cnditin) HIV-psitive adults Medically Needy r spend dwn : persns whse incme is t high fr full-benefit MaineCare Adults with disabilities and senirs age 62 and lder Persns wh d nt qualify fr fullbenefit MaineCare Full-benefit MaineCare Limited-benefit MaineCare (Medicare Savings Prgram) Partial-benefit MaineCare Full-benefit MaineCare Full-benefit MaineCare Incme 100% FPL 175% FPL Nne 100% FPL 300% f SSI benefit level must be belw the private pay rate fr the residential care facility Full-benefit MaineCare 250% FPL Nne MaineCare drug cverage and ther limited benefits Full-benefit MaineCare, after a large deductible is met Lw Cst Drugs fr Elderly and Disabled (DEL) 250% FPL Nne Nne 175% FPL (incme limit is increased by 25% if drug csts are high) $2,000 ($3,000/cuple) (many are excluded) $2,000 ($3,000/cuple) (many are excluded) $2,000 ($3,000/cuple) (many are excluded) $2,000 ($3,000/cuple) (many are excluded) $2,000 ($3,000/cuple) (many are excluded see Asset Rules) Nne Maine Rx Plus 350% FPL Nne 5

6 Family Eligibility: Quick Review! MaineCare = Medicaid (61% federal $) + CHIP (75% federal $) CubCare premiums required Eligibility fr premium subsidy in Marketplace frm 100% t 400%. FPL *Childless adults belw the pverty level in Maine are nt eligible fr either MaineCare r premium subsidies yet. ** CubCare is Maine s separate CHIP prgram cvering children, 1-18, frm 161% - 213% FPL and infants, 0-1, frm 191% - 213% FPL. Separate CHIP prgrams allw premiums and ther limits n cverage. Expanded Medicaid financed with CHIP is fr children under 161% but ver the Medicaid limit when CHIP was enacted in

7 MaineCare and Children s Health Insurance Prgram (CHIP): Children age 0-18 Children in Maine living in families with incme up t 213% FPL are eligible fr MaineCare ($41,598 grss annual incme fr a family f 3) infants under age 1 and children under age 18 up t 161% FPL ($31,443 grss annual incme) n cst MaineCare Children between 162%-213% FPL ($31,442-$41,598 annual grss incme) eligible fr lw-cst MaineCare ($8-$64/m. Premiums, per family); als referred t as Cub Care 7

8 Katie Beckett fr Disabled Children MaineCare categry fr children with severe health cnditins which require a high level f care but wh are nt in a medical facility. The csts f prviding needed services can t be mre than the annual cst f institutinal care. Financial guidelines: Parents incme and assets d NOT cunt when applying fr Katie Beckett. Only the incme and assets f the child are lked at. In mst cases, this means there are n assets r incme t lk at. A child may get Katie Beckett if the child is 18 years ld r yunger, and Is NOT eligible fr MaineCare in anther categry; Des NOT live in a medical institutin; and, Meets the Scial Security definitin fr disability: Yu d NOT have t get a Scial Security disability decisin in rder t apply. MaineCare s medical review team can lk at a child s medical histry t see if they meet the definitin fr disability. Private Insurance: A child can get Katie Beckett MaineCare even if they have private insurance. In sme cases MaineCare will pay the premium fr private insurance if the child is eligible fr Katie Beckett. MaineCare can wrap arund private cverage, cvering imprtant services nt cvered by private insurance. D I have t pay fr Katie Beckett? There are lw cst premiums fr Katie Beckett cverage. The mnthly premium will depend n husehld incme and if yu have private insurance with the Katie Beckett, r just have Katie Beckett. 8

9 Health care services cvered by full-benefit MaineCare Dctrs Visits: Well-child check-ups, sick care, specialist care, including surgery, prenatal care Dental Services: Full cverage fr children (with limits fr adults) Hspital Care: In-patient, utpatient, and emergency rm Lng-Term Care: Cverage fr care in a nursing hme, r ther residential care. Services may als be prvided in the hme. Therapies: Speech therapy, Physical therapy, Occupatinal therapy Early and Peridic Screening, Diagnsis and Treatment: Federal Medicaid law requires States t cver Early and Peridic Screening, Diagnsis and Treatment (EPSDT) services fr children and adlescents under age 21. And Mre This is just a partial list f services cvered by full-benefit MaineCare. Fr mre infrmatin, call MaineCare Member Services at (if yu are deaf r hard f hearing and have a TTY machine, call ). Services: Shts t prevent illness (immunizatins) Prescriptin drugs Mental health services Substance abuse services Lab tests and x-rays Medical equipment and supplies Ambulance services Chirpractic care Family planning Midwife services Schl-based health centers Interpreters Transprtatin t medical and cunseling appintments Eye exams and eye glasses (with limits fr adults) Hearing tests (with limits fr adults) and hearing aids (fr children age 20 and yunger) 9

10 New Financial Eligibility Rules fr Parents, Children, Adults (if Medicaid expands) and Pregnant Wmen Befre January 1, 2014: Medicaid and CHIP had unique financial eligibility rules fr: 2) What types f incme and assets cunt r shuld be disregarded. (MaineCare disregarded $90/m in wrk related expenses and up t $200/m fr child care csts), and 2) Wh is in the husehld January 1, 2014 and thereafter: Medicaid and CHIP must align with advanced premium tax credit eligibility n the Marketplace, and thus MAGI (Mdified Adjusted Grss Incme) was brn! MAGI = Adjusted Grss Incme (line 37 f the 1040) + Scial Security incme. Only disregard is 5 percentage pints f the applicable pverty level. Eligibility based n disability r age 65+ has nt changed, BUT, a persn with a disability may be eligible based n a MAGI categry --ie as an adult (with expansin) r parent -- while waiting fr disability determinatin. 10

11 MAGI Cuntable Incme Cuntable Incme: Grss taxable incme (wages, unemplyment cmpensatin, alimny received) minus certain payrll deductins that are taken ut as pre-taxed (e.g.: mst health insurance premiums, cntributins t sme retirements plans such as deferred Cmpensatin and 401K plans, and ME State emplyees retirement cntributins) Pre-tax deductins are usually marked in sme way n the emplyee s check stub (ex: state emplyee pre-tax deductins are marked with a P ) Child supprt will n lnger be cunted as incme r an expense VA service-cnnected disability will nt be cunted Certain expenses (e.g. health savings accunt deductins, alimny paid) will als be deducted frm a persn s grss incme 11

12 MAGI: Treatment f Certain Incme Types Schlarships, fellwship grants and awards used fr educatin purpses and nt fr living expenses: Mnies received fr tuitin and curse related expense are nt cunted. Incme assciated with Rm and Bard expense is cunted American Indian/Alaskan Native incme derived frm distributins, payments, wnership interests, and real prperty usage rights are excluded Lump sum incme (fr example, retractive scial security check r persnal injury settlement) is cunted nly in the mnth received 12

13 Determining MAGI Husehld Size: One individual at a time! Start Yes Is the individual claimed as a tax dependent by anther? A. Des the individual expect t file taxes? Yes N B. Des the individual expect t be claimed as a N dependent? NOTE: If a taxpayer cannt prve that anther individual will be a tax dependent fr the year in which Medicaid cverage is sught, nn-filer rules apply fr the ther individual. N N Yes Is the individual: Other than a spuse, bilgical, adpted r step child Under age 19 & claimed by a nn-custdial parent Living with bth parents wh will nt file a jint tax return C. The individual is a nn filer N Yes The individual s husehld size is the individual PLUS all f his/her tax dependents END NOTE: Married cuples filing a jint tax return are included in the husehld f the spuse even if NOT living tgether The individual s husehld size equals the husehld size f the taxpayer wh claims the individual as a tax dependent END NOTE: In Maine, unbrn children are included in the husehld size fr the pregnant wman nly. Als, married cuples wh live tgether are ALWAYS included in each ther s MAGI husehld regardless f filing status r any ther rule. The individual s husehld size cnsists f the individual and (if living with the individual): (1) the individual s spuse; (2) the individual s children under age 19 ; (3) if the individual is under 19, the individual s parents and siblings wh are als under age 19. END

14 New Situatins where MaineCare Eligibility May be Gained in 2014 Situatin Explanatin Timing Veterans with Service-cnnected disability benefits. child supprt is received. These VA benefits n lnger cunt in deciding MaineCare eligibility under the MAGI rules, pssibly making sme veteran s husehlds eligible fr MaineCare when they wuld nt have been befre. MaineCare can wrap arund TriCare and may cver services that might nt be available frm TriCare. Under MAGI, families with child supprt incme will n lnger have that incme cunted, pssibly making them eligible fr MaineCare even if they previusly were nt. Effective January 1, Effective January 1, N mre Asset limit Alimny that is paid. T align with the Marketplace, the ACA des nt allw states t impse asset limits as a cnditin f Medicaid eligibility fr parents, children r pregnant wmen. Cnsistent with the IRS rule, alimny will n lnger cunt as incme t the persn wh pays it. This may allw sme husehlds that include payers f alimny t becme eligible fr MaineCare wh had nt been befre. Effective January 1, Effective January 1,

15 Situatins where MaineCare Eligibility May be Lst in 2014 Situatin Explanatin Timing Parents, 100% - 133% FPL cut. (Children in the husehld remain eligible). Sme Stepparent husehlds (MaineCare husehld with a stepparent at hme that was nt n MaineCare.) Tax-filing, custdial parents, when the nncustdial parent claims the child as a tax dependent. Parent eligibility was cut by the Gvernr and the 125 th Legislature in 2012 t 100% f the pverty level. Parents with incme between 100 and 133 percent f the pverty level were prtected frm the cut by a clause in the ACA until January 1, 2014, when that prtective clause expired. A stepparent wh was previusly nt part f the MaineCare husehld is nw required under MAGI rules t be included in the husehld, regardless f tax filing status. Absent a change in the stepparent s incme, this will prbably make the husehld ineligible fr MaineCare. Parents wh plan t file incme taxes fr the current year with a child wh is claimed as a tax dependent by a nncustdial parent may lse eligibility because the child wn t be cunted as part f the custdial parent s husehld. But, if the parent des nt plan t file incme taxes, then, as a nn-filer, any children living with the parent wuld still be cunted in the custdial parent s husehld and her MaineCare wuld nt be affected. (Hwever, this parent may be required t r may want t file taxes ) Nte: the child s MaineCare husehld is nt affected. The child is part f the custdial parent s husehld regardless f the custdial parent s tax filing status. Effective January 1, 2014.* Effective March 1, 2014 r the husehld s next regularly scheduled review, whichever is later. * Effective March 1, 2014 r the husehld s next regularly scheduled review, whichever is later. * 15

16 Mre Situatins where MaineCare Eligibility May be Lst in 2014 Situatin Explanatin Timing Husehlds with an individual wh pays child supprt. Families with significant child care csts. Under MAGI, child supprt paid t anther husehld is n lnger disregarded, but fully cunted as incme, and culd cause the payr s husehld t becme ineligible fr MaineCare. Befre MAGI, families culd disregard frm their incme child care csts f up t $175 per mnth per child ver ne year ld and up t $200 per mnth per child under ne. Under MAGI, this child care disregard (r deductin frm incme) was eliminated. States used a frmula t cnvert t MAGI that used an average f state s previusly existing disregards, including the ne fr child care. Husehlds that received a significant child care disregard in 2013 whse incme is near the limit will lse their disregard and culd find themselves nt eligible fr MaineCare. March 1, 2014 r the husehld s next regularly scheduled review, whichever is later.* March 1, 2014 r the husehld s next regularly scheduled review, whichever is later.* *Husehlds with earnings may then receive fur, six, r twelve mnths f Transitinal Medical Assistance (TMA), depending n circumstances. TMA has been temprarily reauthrized by Cngress t perate thrugh March 31, It will have t be reauthrized by Cngress again in rder t cntinue beynd that date. If Cngress takes n actin, a fur mnth prvisin wuld cntinue t apply because f earlier permanent law, but the six and twelve mnth prvisins wuld nt. CMCS Infrmatinal Bulletin, 2 (December 27, 2013). 16

17 The Legislature rlled back cverage fr parents frm 200% FPL t 100% FPL Parents % FPL: MaineCare benefits fr these parents was terminated n March 1, Hwever, many f these parents with incme between 133% FPL ($2,164 per mnth fr family f 3) and 150% FPL ($2,441 per mnth fr a family f 3) were fund eligible fr Transitinal MaineCare if they were wrking r receiving child supprt when they lst their regular MaineCare benefits. This cverage transitin shuld have happened autmatically. Any family that thinks they shuld receive Transitinal MaineCare, but did nt, shuld check with their case wrker. Transitinal MaineCare lasts fr 4, 6, r 12 mnths depending upn a family s circumstances. Parents % FPL: The legislature reduced MaineCare Cverage fr parents frm 133% t 100% FPL as f December 31, Parents with earned incme r child supprt will get Transitinal MaineCare (4-12 mnths). Parents % FPL: MaineCare benefits fr these parents was terminated n March 1, These parents are nt eligible fr Transitinal MaineCare. Imprtant Nte: Any parent wh lst cverage as a result f this cut wh is pregnant shuld reapply fr MaineCare. Pregnant wmen remain eligible fr MaineCare if their incme is 214% FPL r belw. 17

18 An Opprtunity t Expand Access t Health Care in Maine The Affrdable Care Act (ACA) allws states t prvide Medicaid cverage t all adults with incmes up t 138% f the federal pverty level ($15,856/year fr an individual; $26,951/year fr a family f three) beginning January 1, Fr states that expand cverage, the federal gvernment pays 100% f the cst fr cvering all newly eligible individuals fr the first 3 years. After that, the State s share wuld still be cnsiderably smaller than under the current MaineCare prgram. 100% funding last until January 2017, and then ver the next 7 years slwly drps t 90% federal funding. Unfrtunately legislatin that wuld have allwed the state t accept federal funds t expand Medicaid in Maine was veted last year. Because Maine did nt pass this legislatin, 10,000 childless adults (nncatagrical) and 14,500 lw incme wrking parents lst regular MaineCare n January 1, New Legislatin is being taken up this sessin. 18

19 Cver Mre Children Nw T! Abut 6,000 Maine children under 200% FPL were eligible fr MaineCare, but unenrlled in Abut 8,000 Maine children at r abve 200% FPL were uninsured in (Maine Kids Cunt Databk, 2013) 19

20 Oct-11 Nv-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nv-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Cuts t Parents Meant Cuts t Kids 3900 CubCare cases 150%-200% CubCare cases (with premium)

21 Help Mre Kids? Enrll Their Parents! When Massachusetts expanded cverage t parents, their rate f uninsurance amng children was cut in half. Cverage fr public insurance amng children already eligible but nt enrlled increased by 5%. Recently, Arkansas s ACA adult expansin immediately prvided Medicaid t ver 2500 children wh were eligible but nt enrlled. When parents are healthier, their children are healthier: Fewer gaps in cverage, better preventive care, less ecnmic and family stress. Parents can t enrll unless their children are enrlled. (Gergetwn University, Center fr Children and Families, Medicaid Expansin: Gd fr Parents and Children) 21

22 Strategies Educate and utreach t pregnant wmen between 100% and 214% FPL and their prviders that Mm will lse MaineCare 60 days pstpartum and must be prepared t, hpefully, find an alternative. Critical fr infants that Mm have care. (Hspitals; dctrs). Outreach t parents (eg schls, child care prviders) wh have been cut (between 100% - 213%). Are they getting TMA? Are their kids still cvered as they shuld be? If anyne is nt insured, reapply fr MaineCare. BIG Message: Educate all parents and prviders that even if the parent is nt eligible, the children prbably are! Try t reduce churn fr parents between Medicaid and the Marketplace, fr example, by educating parents t use TMA (nt the marketplace) as much as pssible when incme increases (issue n premiums fr last 6 m.s) Sme parental rights and respnsibilities curt rders may be wrth revisiting t maximize health cverage. Fr families ver 213% caught in the family glitch find ut abut child nly plicies n the marketplace. 22

23 Enrllment inf: Big Changes at DHHS Sme DHHS ffices are strained and case wrkers caselads are way t big. DHHS is making sme changes t address this issue. They are switching frm a case wrker mdel t a statewide call center mdel. Here are sme f the ways it is ging t wrk: Clients will n lnger have a single case wrker.* Instead, all DHHS casewrkers will be able t assist with each case. All mail sent t DHHS will be scanned int a statewide database that all wrkers will be able t access. When peple call DHHS they may talk with a wrker at their lcal ffice r they may talk with a wrker in anther part f the State. Clients will still be able t g t their lcal DHHS ffice but they will nt necessarily meet with the same persn every time. * Peple in the TANF prgram will cntinue t have an ASPIRE casewrker assigned t their case. 23

24 Kisks anther way t apply fr benefits DHHS is setting up kisks in all f their ffices. Peple wh g int a DHHS ffice will have the ptin f using a kisk if they dn t want t wait t meet with a casewrker. DHHS staff shuld be available t assist peple if yu have any questins using the kisk. The kisks are ptinal. Peple d nt need t use them. They can still pt t meet with smene in persn. 24

25 Apply fr Benefits Online: My Maine Cnnectin DHHS launched a new nline applicatin and screening tl fr public prgrams: Peple can fill ut a screening tl annymusly t find ut if they are eligible fr TANF; Fd Supplement; MaineCare; WIC; Child Care; and/r EITC OR they can g directly t an nline applicatin t apply fr TANF; Fd Supplement; MaineCare; and/r Child Care. Peple are nt required t apply nline. Everyne will still have the CHOICE f applying in persn r requesting an applicatin ver the phne. 25

26 Enrllment Issues MaineCare Eligible applicants applying thrugh HealthCare.gv What s up? Pr ntice frm DHHS leaves them hanging? Have them apply thrugh the state! Hw is My Maine Cnnectin wrking? there was n place n the screening tl t be screened fr MaineCare. Reprt and dg these and similar systemic issues. 26

27 Thank Yu! 27