For the MOSSA Worker

1. For the MOSSA Worker MEDICAID New Mexico Primary Care Association Walter Blea Medicaid Coordinator (505) 855-6966

2. Test Your Knowledge 1. What is the difference between Medicare and Medicaid 2. If a pregnant woman under age 19 applies for Medicaid what category should she file for? 3. Name the four Salud Plans?

3. Questions 4. What does QMB and SLIMB stand for? 5. Income must be counted for those who have what in a Medicaid application? 6. Category 035 F is what and what ages are involved?

4. Questions 7. Category 035 is what and when does coverage end? 8. What does SSI stand for? 9. Name four eligibility criteria in order to get Medicaid?

5. Questions 10. What is the phone number for the Medicaid Solutions Center? 11. How often does the FPL change? 12. What is EMSA?

6. Medicaid eligibility categories • 032 – Children’s Medicaid 0-5 New Mexikids 6-19 (CHIP) • 031 – Newborn Medicaid Birth – 1yr • 035F – Family Planning 18-50 years of age • 035P – Pregnancy Medicaid No age requirements (Covered till 2 months after birth) • 030 – Medicaid for Pregnant Women No age requirements (Covered till 1 month after birth) • 072 – Family Medicaid (JUL) Dependent child under 19

7. Medicaid Eligibility Categories • Medicare Savings Plans • EMSA • SSI • SCI • PAK/PAM

8. HOW TO DETERMINE ELIGIBILITY • CITIZENSHIP & IDENTITY • RESIDENCY • CANNOT HAVE DUAL STATE MEDICAID • INCOME • EARNED • UNEARNED • INSURANCE COVERAGE • DAYCARE COSTS

9. ELIGIBILITY CRITERIA The following Eligibility requirements must be met in order to receive Medicaid • Proof of Citizenship • Proof of Identity • Social Security Number • Residency • Assignment of Support Rights (JUL) • Assignment of Medical Support Rights

10. 8.200.410.12 RESIDENCE: To be eligible for Medicaid, applicants/recipients must be living in New Mexico on the date of application or final determination of eligibility and have demonstrated an intention to remain in the state. A Establishing residence: Residence in New Mexico is established by living in the state and carrying out the types of activities associated with normal living, such as occupying a home, enrolling child(ren) in school, getting a state driver’s license, or renting a post office box. An applicant/recipient who is homeless is considered to have met the residence requirements if he/she intends to remain in the state. B .Recipients receiving benefits out-of-state: Applicants/recipients who receive financial or medical assistance in another state which makes residence in that state a condition of eligibility are considered residents of that state until the ISD office receives verification from the other state agency indicating that it has been notified by an applicant/recipient of the abandonment of residence in that state.

11. INCOME CALCULATION Income must be verified in writing by: Paycheck Stubs If paid weekly – 4 current stubs If paid bi-weekly – 2 current stubs Employer Statement If just starting a new job and have not received enough pay stubs Income Tax forms for self-employment Schedule C or K of current filing year Current OASDI/SSI Award Letter Current Child Support/Alimony Copy of CSED pay stub for one month Letter from Absent Parent or Ex-Spouse with amount and how often it is paid Earned Income: • Wages and Salaries • Sick Pay • Military Personnel • Training Allowances • Seasonal Income • Tips Unearned income: • Federal Assistance (SSI, TANF, GA) • Annuities • Pensions (Retirement) • Veterans Benefits • OASDI • Foster Care • Child Support or Alimony • Trust Funds • Rental Property / Roomer

12. We use conversion factors to account for the 52 week year: • Monthly Gross income is multiplied by 1 • Semi-monthly Gross income is multiplied by 2 • Bi-weekly Gross income is multiplied by 2.00 • Weekly Gross income is multiplied be 4.00 Conversion Factors

13. In order for an eligible benefit group to exist, there must be at least one dependent child in the home: Must be under the age of 19 Must be enrolled in school for those aged 18 A pregnant woman in her 3rd trimester qualifies as having a dependent child The father of the unborn child is included in the benefit group, but will not receive benefits until after birth The specified relative and dependent children within the 5th degree of relationship are eligible for JUL Medicaid. If the relative is not the parents of the child, then their income will not be counted. But if the parents are living in the home, then we count their income. For JUL Medicaid, it is a ‘all or nothing’ category. In other words we cannot open that category if we do not have all the required information. Relationship must be proven before category can be open JUL MEDICAID (072)

14. 035F / 035P / 030 • 035 Family Planning • 18 – 50 years of age • Must meet Citizenship/Identity • Does not have current credible health insurance coverage • Yearly recertification • 035 Pregnancy • Medically verified • Will continue for 2 months after birth. If eligible for 035F then category will automatically switch • 030 Medicaid • Full Medicaid coverage • Meets TANF eligibility • $320 income limit • $1,000 resource limit

15. Category 031 Category 032 • Children under the age of 19 may be eligible for Medicaid coverage under category 032 if the countable limit is less than 235% FPG for the size of the Assistance Unit. • A child is not required to live with a specified relative to receive a category 032. Children in the following substitute care arrangements are eligible to receive 032: • Foster Homes • Accredited and non-accredited residential treatment centers • Group Homes • Treatment Foster Care Any child born to a mother who is eligible for and receiving New Mexico Medicaid on the date the child is born, or to a woman who is deemed to have been eligible for and receiving at the time of birth, is eligible for Medicaid coverage under Category 031 for up to 12 months, providing: • The mother remains eligible for Medicaid, or would be if she were still pregnant • The infant remains a member of the mother’s household • Both mother and infant continue to reside in New Mexico No application is necessary, only notification of the birth of the child. Income and resources are not factors.

16. 0 - 5 YRS 6 - 18 YRS • Name changed from SCHIP to CHIP (Children’s Health Insurance Program) • This program looks at children (6 Years of age and older) with income levels between 185 – 235% FPG (If under 185%, then it remains regular Medicaid with no co-pays) • Will share the costs of Medicaid by making co-payments for services (Native American children are exempt from co-pays) • Prohibits eligibility for families that have existing health insurance for their children • An individual whose medical insurance was voluntarily dropped will be ineligible for coverage for six months, starting with the first month that the coverage was dropped • Full Medicaid • Family income is under 185% FPG • Health insurance does not affect eligibility • No co-pays

17. Medicare Savings Plans • Qualified Medicare Beneficiary-QMB • Specified Low Income Beneficiary-SLIMB • Qualified Individual-QI • Working Disabled Individual-WDI Comparison Chart

18. SSI • Supplemental Security Income • For the Blind, Disabled or Elderly • Based on Income, Resources and Living Arrangements • Federal Welfare • General Revenue Funds • SSI eligibility…automatically get Medicaid

19. Social Security vs SSI Social Security SSI Based on earnings Benefits based on need Paid Taxes-FICA General Revenues No income limit Limited Income No Resource limit Limited Resources Must have enough work credits No work credits required Retirement, Survivors, Disability Aged, Blind, Disabled Benefits for Family Members No Family Benefits Amount based on average earnings Based on Federal or State law Other income does not affect benefits Other income counted Work/Taxes Federal Welfare

20. EMSA Category 085 Emergency Medical Services for Undocumented Aliens (EMSA) is available to aliens who are undocumented, illegal, and non-immigrant. These individuals must meet all eligibility criteria for a Medicaid category except for citizenship or legal alien status. The Medicaid coverage under this category is only for “life threatening” emergency services and only for the duration of that emergency

21. There is a question on all of the application forms to alert you to check on retroactive coverage. The question asks the applicant if there are unpaid medical bills in the last three months? Retroactive Medicaid Retroactive Medicaid coverage is available on most Medical categories. We will look back at whether a person would have been eligible for Medicaid for up to 3 months prior to the month of application. For example: if a person applies for benefits in May, we look back at April, March and February Retroactive eligibility is determined separately for each retroactive month. An infant is not eligible for retroactive coverage prior to birth. We do not need bills or copies of bills to evaluate eligibility for retroactive Medicaid If the Medicaid is approved at the same time as the ongoing month, the approval notice will list the approved retroactive months Retroactive Medicaid will be handled on a fee-for-servicebasis rather than by SALUD!

22. Important Facts • Processing Guide for PE/MOSAA • Medicaid Solutions Center 1-800-997-2583 • Social Security 1-800-772-1213 • Aging/Disability Resource 1-800-432-2080 • Medicare-1-800-Medicare • Law Access of NM-1-800-340-9771 • www.benefitscheckup.org check eligibility • BEST-Best Eligibility Screening Tool-SSA website

23. Additional Handouts • PE/MOSAA Table of Contents Forms • Reference Guide • Salud Matrix • Benefit Counseling Guide • Medicare Saving Plan Comparison Chart • CD with Forms • Important Facts

24. Thank you Walter Blea