Enrolling Families and Children in Medicaid and Child Health Plan Plus

1. Enrolling Families and Children in Medicaid and Child Health Plan Plus

2. Department of Health Care Policy and Financing The Department of Health Care Policy and Financing is the state department that administers Child Health Plan Plus (CHP+) and other medical programs for low income families, persons who are blind or persons with disabilities and the elderly.

3. What we will cover Medical Assistance (MA) Sites Presumptive Eligibility (PE) Sites CertifiedApplication Assistance sites (CAAS) • Responsibilities • Expectations • Application and certification

4. Responsibilities for all sites • Must meet all Federal and State criteria • Adhere to all Department of Health Care Policy and Financing (Department) rules, regulations, and agency letters. To view these documents, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/1226307681414 • Assist families with the completion of the Public Health Insurance for Families Application and other Medical programs

5. Responsibilities for all sites • Participate in required trainings • Display current site location and contact information on the Department Web site • Inform the Department of any changes made to the primary site contact in a timely manner

6. Responsibilities for all sites • Abide by all applicable HIPAA Privacy and Security requirements regarding health information • As defined in 42 U.S.C. 1320d – 1320d-8, and implementing regulations at 45 C.F.R. Parts 160, 162 and 164

7. Responsibilities for all sites • Offer voter registration at the time of initial application • Pursuant to the National Voter Registration Act of 1993, 42 U.S.C.S 1973gg-5(a)(2)(H) • Track the number of voter registrations offered

8. National Voter Registration Act • Congress enacted the National Voter Registration Act (NVRA) in 1993 • Requires voter registration opportunities to be offered at each agency that: • Provides public assistance (including food stamps, Medicare and Medicaid, WIC, and Colorado Works/unemployment assistance) • Provides state-funded programs primarily for persons with disabilities • Recruits for the armed forces

9. Complying with NVRA • Voter registration must be offered: • Upon initial request for services • At service renewal • Upon address change • Applicants must be: • Provided a voter registration form including a declination section • Offered assistance in completing the forms • Each agency is required to transmit forms to the appropriate county clerk

10. Agency-Based Voter Application

11. Implementing NVRA • The Department will inform all PE and CAAS sites with requirements and implementation dates. • Each site will be responsible for implementing a NVRA process to be in compliance with NVRA.

12. Voting Registration Supplies Blank agency voter registration forms, agency voter registration reporting forms and special envelopes may be ordered directly from the Secretary of State’s office or through your local county clerk.

13. Additional NVRA Information Elections Questions and Answers:www.elections.colorado.gov Voter Information:www.govotecolorado.com County Elections Offices:www.elections.colorado.gov NVRA E-mail Address:elections@sos.state.co.us

14. Medical Assistance Sites (MA)

15. Medical Assistance (MA) Site Designated site that: • Accepts and processes applications for Medical Assistance Programs • Uses the Colorado Benefits Management System (CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Medicaid programs • Transfers the cases to the appropriate County Department of Human/Social Services for ongoing case maintenance

16. MA Site expectations • Self-funded (non-monetary contract) • Have capacity and capability to process all Medical Assistance applications submitted to include: i.e., staff, workspace, equipment • Provide and maintain adequate hardware and software to access the CBMS application through the Department’s secured Web Portal

17. MA Site expectations • Process and authorize the eligibility determination within the processing timelines; 45 days for family and children’s applications and non-disability applications, and 90 days for disability applications • Resolve any applicant/client issues in a timely manner • Respond to requests from the Department in a timely manner

18. MA Site expectations • Accept and process all walk-in and mail-in applications in a timely manner • Explain the benefits of the programs that are administered by the Department • Conduct internal quality improvement reviews on a monthly basis

19. MA Site expectations • Respond to any audit or Medicaid Eligibility Quality Control (MEQC) requests for case files and client information • Maintain copies of the active case files and non-active case files for three years after the discontinuation or denial of eligibility

20. How to apply to be an MA site Submit a Letter of Interest (LOI) to the Department The LOI should address the following: • Why is your organization interested in becoming an MA Site? • What population will benefit from your organization becoming an MA Site? • What are the benefits to your organization in becoming an MA Site? • What are the anticipated staffing levels and location(s) if your organization becomes an MA Site? • How is your organization going to fund your ability to function as an MA site?

21. Address • Health Care Policy and Financing (HCPF), at 1570 Grant Street, Denver, CO 80203, Attention: Monica Owens, MA Site Contract Manager, or via email to Monica.Owens@state.co.us

22. Presumptive Eligibility (PE) Sites

23. Presumptive Eligibility (PE) Site • Temporary health care coverage for children 18 and under and pregnant women while their eligibility is being determined • PE Coverage is no less than 45 days • PE Site list available: CHPplus.org/materials/PESiteList.pdf

24. What does a PE site offer? • Immediate access to health care • Medicaid PE for children: includes all Medicaid-covered services • Medicaid PE for pregnant women: includes only outpatient services • CHP+ PE: includes all CHP+ covered services - except dental benefits

25. PE Site qualifications Sites must meet specific federal and state criteria: • Federal Criteria A “qualified provider” may grant Presumptive Eligibility to pregnant women if all of the following criteria is met: • Be eligible to receive payments through the State; • Provide outpatient hospital services, rural health services, or clinic services; and • Be determined by the state agency to be capable of making PE determinations.

26. PE Site qualifications A “qualified entity” may grant presumptive eligibility to children if any one of the following criteria is met: • Be eligible to receive payments through the State; • Provide health care items or services; and • Be determined by the State agency to be capable of making PE determinations.

27. PE Site expectations • State Criteria • Have appropriate internet access that is capable of supporting the Colorado Benefit Management System (CBMS); • Be a Medicaid and/or CHP+ provider OR be affiliated with a Medicaid/CHP+ provider; • Routinely be able to provide pregnancy testing or assure referral to prenatal care and/or children’s routine medical care;

28. PE Site responsibilities • Make necessary referrals to practitioners for continued care for normal and high-risk patients; • Have client contact personnel available to determine eligibility; • Accept the Colorado Public Health Insurance for Families Application and forward to the appropriate county; • Maintain at least a 90% accuracy rate of eligibility determinations;

29. PE Site responsibilities • Participate in initial and ongoing PE trainings; • Agree to fulfill all the responsibilities of a qualified provider as stipulated by the Department; and • Be capable of assisting non-English speaking clients. • CAAS trained and approved

30. How to apply to be a PE site • Download the application from the Department website, colorado.gov/hcpf • Contact Corinne Lamberson PE.Eligibility@hcpf.state.co.us

31. Certified Application Assistance Sites(CAAS)

32. Certified Application Assistance Sites Agencies that assist families in completing the “Colorado Public Health Insurance for Families Application” Certified to verify citizenship and identification documentation

33. CAAS responsibilities A certified agency must: • Train all staff on the process for completing an application and how to verify citizenship and identity documents.

34. CAAS responsibilities A certified agency must also: • Complete an “Certification Site Application” aka Certified Application Assistance Site Application, visit: Colorado.gov/cs/Satellite/HCPF/HCPF/1226307681414 • Submit completed applications and all documentation to local county within five business days.

35. What are Medicaid and CHP+? • Medicaid – Low-cost health insurance for Colorado children, pregnant women, parents with dependent children, the elderly, and people with disabilities • CHP+ – Low-cost health insurance for Colorado children and pregnant women who exceed the income guidelines for Medicaid eligibility

36. Who is eligible for Medicaid? • Children who are 18 years old and under • Parents caring for dependent children who are enrolled in Medicaid or CHP+ • Pregnant women • Within income guidelines • Colorado residents • US citizens or legal permanent residents for at least 5 years • Some exceptions to 5 year ban • Okay to have another form of insurance

37. Who is eligible for CHP+ ? • Children who are 18 years old and under • Not eligible for Medicaid • Within income guidelines • Colorado residents • Not covered by other health insurance • US citizens or legal permanent residents for at least 5 years • Unable to access employee health insurance through the State of Colorado

38. 2010-2011 Income Guidelines for CHP+ and Medicaid Slide updated: 07/13/2010

39. Financial Responsibility Self Self Spouse Spouse Parent Child Sibling Sibling Child Parent Others Child

40. What expenses should be listed on the application? • Child care and elder care expenses • Medical/prescription expenses • Health insurance premiums • Outgoing and incoming child support and alimony • Expenses must be from the same month as the income being reported • Some or all of these expenses will be deducted from the family’s income to determine eligibility

41. What is acceptable proof of income? • Paycheck stubs • At least one paycheck stub with pay date in previous or current month OR • Signed written document from employer • Exact gross income from previous month OR • Exact hourly wage, hours worked, how often paid, and date of last paycheck

42. What about self-employed applicants? • Profit and loss statement for previous or current month must be included OR • Complete self-employment section - the ledger - on the application

43. Joint Application • Determines eligibility for Medicaid and CHP+ • Applications are checked for Medicaid eligibility first, then CHP+ • Available in English and Spanish • Available at CHPplus.org or Colorado.gov/hcpfor Department of Human/Social Services Offices or by calling toll free: 1-800-359-1991

44. Points of Clarification Question 1: • Use legal names • Include mailing address if different from physical address • Must include at least 1 phone number Question 3: • List all members of the household even if the person is not a family member • Make a copy of this page if more than 8 people live in the household

45. Points of Clarification Question 4: • This information is for any child in the family Question 5: • If anyone in the household is pregnant, be sure to complete this entire section

46. Points of Clarification • Complete one page for each child applying; if needed, make a copy of this page for each additional child • Add child’s full name including middle initial • Include only natural or adoptive parents living in the home (don’t include step-parents in this section) • Alaskan Native or Native American applicants: check box in order to receive fee exemptions

47. Points of Clarification Question 2: • If applicable, write alien registration number on the line and make a copy of both sides of resident card to include with the application Question 4: • Medicaid will allow up to 3 months of backdated coverage; CHP+ does not back date and enrollment begins the day an application is date-stamped and received by a CHP+ partner organization

48. Points of Clarification Question 5: • Applicants who have access to Colorado State Government health benefits do not qualify for CHP+ but may qualify for Medicaid Question 6: • Pre-existing conditions do not impact eligibility • If yes, child may qualify for other programs

49. Points of Clarification ONLY Pregnant women and adults 19 years and older in the household applying for health insurance will complete this form Permanent legal residents must include a copy of both sides of the resident card with the application

50. Points of Clarification Questions 1 and 2: • Only refer to those applying for benefits • If anyone applying is/ was covered by other health insurance, complete ALL fields in the appropriate section • Include a copy of both sides of the health insurance card for question 1 if available