Cover VA Script for Advocate and Stakeholder Presentations SLIDE 1 SLIDE 2 SLIDE 3 SLIDE 4 SLIDE 5 Thank you for inviting me to speak to you today. This is an exciting time in Virginia. Thousands of Virginians may now apply for quality, low- and no-cost health care coverage. We are getting many questions about the new coverage options. We want to make sure that everyone has accurate information, and all of you can help us spread the word. You have been an important part of the work that got us to this point, and we hope that you will continue to support the Cover Virginia outreach campaign. You can do that by sharing what you learn today with people in your communities. Here are the topics that we are going to cover over the next few minutes. Until now, few adults in Virginia could qualify for coverage because of the strict rules. You probably have met people who have applied in the past and been rejected. Our greatest challenge is persuading these people to come back and try again, and we need your help to reach out and let them know that the rules will change starting January 1, 2019. This is a major change in our program that will open the door to close to 400,000 Virginia adults. Many of the new people who will join our program work in jobs that do not offer health insurance. o That includes jobs in retail, construction, childcare, landscaping and food service. We believe these individuals should have coverage so that they don t have to worry about getting sick or having an accident. Applications for the new adult coverage are now being accepted. The Number 1 question we get is Who is eligible? There will be an application process to go through all of the requirements, but I can give you the highlights today. First, individuals must be between the ages of 19 and 64 to qualify. This coverage is not for people who are in Medicare now or eligible for Medicare. Second, individuals must meet income requirements, which vary by the number of people in their family. For example, a single adult living alone may be eligible if her or his annual income is at or below $16,754 dollars. A parent living with a spouse and a child may be eligible if the total annual income for everyone in the household is at or below $28,677 dollars. 1
SLIDE 6 SLIDE 7 SLIDE 8 SLIDE 9 The second most common question we hear is What services are covered? As you can see from the list on the slide, this coverage includes a wide variety of services. They include doctor visits, hospital stays, prescription drugs and behavioral health care. There are many more services available than we could include on this list, so people should not be discouraged if they don t see a specific type of medical care that is important to them. The new adults signing up for coverage will be part of the same programs that our existing members are already using. The vast majority of our members today are enrolled in managed care programs, and that will also be true for new members. Most people will be covered through our Medallion 4.0 program. People who have a complex behavioral or medical condition that limits their daily activities will be enrolled in Commonwealth Coordinated Care Plus (also known as CCC Plus), which is our managed longterm services and supports program. The CCC Plus program offers extra support so that these individuals get help with coordinating all of their health care needs. Whether individuals are enrolled in Medallion or CCC Plus, they will be able to choose from the six health plans. The same six plans are available for both programs. Those of you who work with people who have significant health needs are probably already familiar with CCC Plus, our managed long-term services and supports program. If you are helping with outreach to individuals with complex health needs, you will need to have a basic understanding of the term medically complex, because that is the category of new adults who will be enrolled in this program. The important thing to remember is that an individual is considered to be medically complex if he or she has a complex behavioral or medical condition AND functional impairment, meaning the complex condition makes it difficult to handle daily activities on your own. Individuals applying for coverage will be asked about the level of their health needs when they enroll. If they mark yes on the application question, then they will receive a screening to validate their status as medically complex. If you want to ensure that a Medicaid applicant with a chronic condition is initially enrolled in CCC Plus, then please make sure the applicant spends time to answer this question correctly. If individuals do not mark Yes, on the Medicaid application, they can still be determined medically complex by their health plan. The state budget creates a framework for expanding adult coverage as well as making additional changes to our Medicaid program. It s important to understand the timing of these changes. New coverage will be available to adults with incomes up to 138 percent of the federal poverty level beginning January 1, 2019. 2
Several new initiatives will also begin January 1, 2019, such as: o Health and Wellness Incentives that will be offered as a benefit through the health plans; o Referrals by health plans to the Career Works Centers (also known as One Stops) to help with job training, education, and job placement assistance; and o Outreach and care coordination to frequent emergency room visitors. In the future, there will be other employment supports and requirements for certain individuals, but the details for those changes are still in development and will require federal approval through a Section 1115 Demonstration Waiver, which gives a state flexibility to test new ideas within the Medicaid program. As an advocate, you may work with an individual who is interested in applying for the new adult coverage, but that person may have some questions about these proposals. Please encourage people to go ahead and apply so they can have coverage beginning on January 1, 2019. You can let them know that any additional benefits or requirements will happen later, and they will get information in plenty of time to ask questions and understand how they might be affected. SLIDE 10 This slide explains the different categories of Virginia adults who are or may be eligible for the new adult coverage. SLIDE 11 First, individuals with serious mental illness who are in our GAP program are now eligible for full benefits. They will be automatically enrolled in the new coverage that begins January 1, 2019, without having to apply again. Similarly, some individuals in our Plan First program will also be eligible and will be automatically enrolled as well without taking any additional steps. It s important to know that not everyone in Plan First will meet the income requirements for full coverage. Those who are not eligible will continue to receive family planning benefits. Second, we know that some SNAP beneficiaries and parents with children in the Medicaid program will qualify. We already have a significant amount of information on these individuals, so they are being asked to fill out a simplified three-question application to complete the process. Third, some individuals who purchased health insurance on the federal Marketplace will be eligible for Medicaid under the new rules. These adults were asked to visit healthcare.gov during open enrollment, which ran from November 1 to December 15. Healthcare.gov was able to process their application using Virginia s new eligibility rules to determine if they now qualify for Medicaid. Once these individuals receive formal notice from Virginia that they are enrolled in Medicaid, and once they get their Medicaid cards, they should go back to healthcare.gov and cancel their Marketplace plans so they will not be charged for a private insurance plan. Fourth, we are working with partner organizations to make sure specific priority populations are reviewed for eligibility. This includes people served by community services boards and individuals incarcerated in state prisons as well as local and regional jails. And finally, there are many other uninsured Virginia adults who have no relationship with state agencies, and we are working with community partners to reach them with this information. This slide provides a timeline for communications with specific groups of adults who are or may be eligible for streamlined enrollment in the new adult coverage. 3
You may get questions from individuals as they receive letters in the mail, and we want you to be prepared to answer those questions and help the newly eligible adults understand the changes that are happening. Participants with serious mental illness in the GAP program have already received a heads up letter that the Medicaid rules have changed and they will now be receiving full coverage. They are not required to take any additional steps. In late October, members of our Plan First program who are eligible for full coverage were mailed letters letting them know that they also will be transitioned automatically to full coverage. Also in late October, parents of children already on Medicaid and adults in the SNAP program were mailed express applications. Finally, individuals with health plans purchased on the federal Marketplace have received notices from healthcare.gov letting them know that the Medicaid rules have changed. These adults were asked to update their accounts on healthcare.gov during Marketplace open enrollment, which began November 1 and ended December 15. Healthcare.gov processed those applications based on Virginia s eligibility rules. Again, these individuals should wait until they get formal notice from Virginia that they are enrolled in Medicaid, and they should get their Medicaid card in the mail. At that point, they should go back to healthcare.gov and cancel their Marketplace plans. You are a trusted source of information for these people and can help them understand what they need to do to make this transition so they can receive the most affordable coverage available to them. SLIDE 12 This is a summary of the different letters that members received in the mail if they are eligible for streamlined enrollment in the new adult coverage. GAP members and Plan First members were automatically transitioned to the new adult coverage and do not need to take any action to receive new adult coverage beginning January 1, 2019. GAP members received their notice letter on white paper in a white envelope. Plan First members received their notice letter on green paper in a yellow envelope. Both groups will continue to receive their current, limited benefits until December 31st. They will be automatically assigned to a health plan and will have up to 90 days after receiving their health plan assignment letter to change their Medicaid health plan. SNAP beneficiaries and parents of enrolled children received a notice letter and express application in a yellow envelope. SNAP beneficiaries received their letter and express application on blue paper, while parents of enrolled children received their letter and express application on pink paper. Both groups should submit their express application by phone, mail, or online by January 4, 2019, to receive expedited enrollment in new adult coverage. A postcard was also mailed to SNAP beneficiaries and parents of enrolled children on December 7, reminding them to submit their express applications by January 4, 2019. After that date, they can still apply for coverage; they just need to complete the full Medicaid application. Marketplace plan members received a notice from healthcare.gov to update their Marketplace application during open enrollment to see if they would be eligible for low- and no-cost health coverage through Virginia Medicaid. The letter asked them to visit healthcare.gov to update their Marketplace application for 2019 between November 1st and December 15th. After updating their 2019 Marketplace application and submitting it, they were able to review their eligibility results and follow steps for enrollment. If they are eligible for Virginia Medicaid, they must follow the steps to prevent automatic enrollment in Marketplace coverage for 2019. If they are eligible for Virginia Medicaid and 4
still want to have a Marketplace plan, then they will have to pay full cost for their share of the Marketplace plan premium and covered services. If you have questions about streamlined enrollment processes for an individual: Call Cover Virginia, go online to www.commonhelp.virginia.gov, or visit your local Department of Social Services SLIDE 13 SLIDE 14 SLIDE 15 SLIDE 16 SLIDE 17 SLIDE 18 SLIDE 19 You can help support the streamlined enrollment process Please encourage members to look out for the yellow envelope and postcard reminders from DMAS or Virginia Medicaid. You can also help members complete and submit their express applications by January 4th through mail, by calling the Cover Virginia Call Center, or by going online to Commonhelp.virginia.gov If an individual believes that she or he received a letter but may have lost it, then you can call Cover Virginia to verify The recipients of express applications were selected based on eligibility requirements. Newly eligible adults not included in the streamlined enrollment groups may still apply for Medicaid coverage, including the new adult coverage. Medicaid applications are accepted year-round and individuals can apply: o By phone by calling the Cover Virginia Call Center o Online by completing an online application at commonhelp.virginia.gov or healthcare.gov o By mailing or dropping off a paper application to their local Department Of Social Services; or o If they want to apply for other social services benefits, they can apply by calling the Virginia Department of Social Services Enterprise Call Center Applications for new adult coverage are now being accepted If you re interested in learning how to help people apply for Medicaid and FAMIS, then you can participate in Sign Up Now, which is an in-depth training provided by the Virginia Health Care Foundation. Trainings began in early November 2018 and are offered throughout the state, so please visit tiny U-R-L dot com slash sun workshops to learn about workshop dates and locations I am sure that you have additional questions, and you will think of even more questions after you get home. The most important source of information about this new coverage is our Cover Virginia website. That s Cover V-A dot org. When you visit the website, you will have a chance to sign up for regular updates by email and text. When you get to the home page for coverva.org, click on the big green button to get to the page with information on new adult coverage. You ll find a list of Frequently Asked Questions, and we will be adding new information regularly. 5
Be sure to check out the eligibility screening tool and the resources for advocates. SLIDE 20 SLIDE 21 SLIDE 22 When you click on the screening tool, you will get a series of questions that will help you figure out if a person meets the income rules. When you click on the Resources for Advocates link, you ll have access to the Advocates Toolkit, this presentation and script, and other useful materials including posters and flyers. Please take a brochure with you, visit the Cover Virginia website, and please share this information with people in your community. Thanks again for your time. 6