Nebraska Medicaid. Nebraska Healthcare Association June 26, 2018

Transcription

1 Nebraska Medicaid Nebraska Healthcare Association June 26,

2 What is Medicaid? Enacted in 1965 under Social Security Act Administered by states with oversight from the Centers for Medicare & Medicaid Services (CMS) Eligibility and benefits vary from state to state Funding is jointly done between federal and states 2

3 Medicaid Populations in Nebraska FY 2015 Eligibility FY 2015 Expenditures Blind/ Disabled 15.80% Aged, 7.90% PC Adults, 9.50% Children, 66.80% Blind/Disabled, 45.50% Children, 26.50% PC Adults, 7.30% Aged, 20.70% Children PC Adults Aged Blind/Disabled Children PC Adults Aged Blind/Disabled 3

4 Medicaid Eligible Populations Children birth through age ,276 Parent caretakers of children -- 21,966 Blind & Disabled -- 36,382 Aged 65 and older -- 18,186 Monthly average per DHHS Nebraska Medicaid Reform Annual Report for fiscal year July 1 to June 30 4

5 Medicaid Expenditures by Populations Children birth through age $496,914,266 Parent caretakers of children -- $137,159,142 Blind & Disabled -- $853,590,754 Aged 65 and older -- $389,624,456 per DHHS Nebraska Medicaid Reform Annual Report Total vendor expenditures that are categorized $1,877,288,618 5

6 Primary Eligibility Requirements Application Citizenship/Alien Status Nebraska Resident Social Security Number Relative Responsibility Cooperation with Child Support Living Arrangement Assignment of Third Party medical payments (TPL) 6

7 Types of Medicaid MAGI Children s Medicaid Children s Health Insurance Program (CHIP) Parent/Caretaker Relatives Pregnant Woman 599 CHIP SAGA Hospital Presumptive NON-MAGI Aged, Blind & Disabled Medicare Part B beneficiaries Medically Needy Transitional Assistance Program Former Foster Care EMSA Women s Cancer Program 7

8 Aged, Blind or Disabled Aged is 65 or older Blind or Disabled any age group receiving Social Security disability benefits Income limit is 100% FPL for medical coverage Private health insurance expense is an allowable income deduction with some restrictions Resource limits of $4000 for one person, $6000 for two people 8

9 Medicare Part B Premium Benefit Client must be receiving Medicare including Part B Specified Low Income Medicare Beneficiaries (SLMB) SLMB participants receive coverage of Medicare Part B Premium payment AND can also have a Share of Cost Qualified individuals (QI-1) must choose: Medicare Part B Premium Payment OR Share of Cost Part D Medicare coverage but may have co-pays or deductibles Income SLMB = 120% FPL QI-1 = 135% FPL Resources for SLMB and QI-1 1 = $ = $10,930 9

10 Medically Needy--Share of Cost Medical Need with Income Exceeding Medicaid Eligibility Parent/Caretaker Relatives Children Aged or Disabled All other eligibility requirements must be met Share of Cost may vary based on income and deductions Some months client may meet SOC and some months he may not Medicaid may close if SOC exceeds monthly need Income-Income disregards-deductible expenses-mnil ($392 for 1 person) = SOC 10

11 Resource Spend Down Excess resources may be spent down on medical bills to obtain retro Medicaid. If excess resources are spent on anything other than medical bills in the retro Medicaid period, then Medicaid cannot begin until the month the client actually spent down to the allowable resource limit. Example: Application was received in April for John. Outstanding Medical Bills Incurred in January costing $300 (has an excess in resources of $500), in February costing $300 and in March costing $1000. The client can choose to pay the $500 he is over resources with medical bills from January and February. Because he used the funds to reduce his resources, Medicaid eligibility would begin Feb 1st, even though the bills were not actually paid until the month of April. In order to receive the Retro Medicaid, John must pay the amount of the Excess resources from January even though John is below resources in April. 11

12 EMSA (Emergency Medical Services for Aliens) For Undocumented and Ineligible Aliens who are denied Medicaid only because of their citizenship/alien status and have an Emergency Medical Condition. They must meet other eligibility criteria. An emergency medical condition is defined as a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) where the absence of immediate medical attention could reasonably result in Serious jeopardy to the patient s health; Serious impairment to bodily functions; or Serious dysfunction of any bodily organ or part. Medical conditions general covered: Hospitalizations and ER visits, we don t cover doctor s office visits. Labor and Delivery Serious things like Strokes, Sepsis, TBIs, etc are usually covered Reviewed by State Review Team 12

13 Women s Cancer Program Screened by Every Woman Matters Breast and Cervical Cancer only Age 64 or younger Not otherwise eligible for Medicaid No creditable health insurance Meet residency and citizenship requirements 13

14 NEBRASKA S NEW INTEGRATED MANAGED CARE PROGRAM Heritage Health will combine Physical, Behavioral and Pharmacy Services for Medicaid recipients Clients will choose from three state-wide health plans Nebraska Total Care (Centene) UnitedHealthCare Community Plan of Nebraska WellCare of Nebraska Start Date Automated Health Systems (AHS) will serve as the enrollment broker to aid in member choice January

15 Engaging & Protecting Members Member choice Primary Care Physician Care Management Focus on primary and preventive care Health plans are required to have contracts with providers that meet geographic, time and distance standards Coordinate with sister DHHS Divisions to ensure members have access to the services they need 15

16 Ways to Apply for Medicaid Applications found on Paper application can be mailed from or picked up at a local DHHS office Call ACCESSNebraska and ask to complete a phone application. Pre-populated renewal applications are required for MAGI groups when a desk renewal cannot be completed (Children, families, pregnant women, etc.). If a client doesn t have their renewal application, they can call ACCESSNebraska Medicaid to complete a phone renewal. 16

17 Contact Information 17

18 Field Operations Administrator Medicaid & Long-Term Care Heritage Health Website Alvin Zimmerman Kathy Johnson Customer Service Center Supervisor Medicaid & Long-Term Care DHHS HelpLine Modified by: Kathy Johnson 6/