CHP+ 201

1. CHP+ 201 Created for Building Better Health – October 14 & 15, 2014 by the Colorado Department of Health Care Policy and Financing Presented by the Training Specialists from the Denver Department of Human Services

3. What You Will Learn Today • You will learn about the services covered by CHP+ to help you answer customer questions • You will learn about the many resources available to help members gain the services they need

4. What Kinds of Colorado Medical Assistance Programs are There? \ Medicaid Child Health Plan Plus (CHP+) MAGI Non- MAGI

5. Federal Medical Assistance Structure • Agriculture • Independent Establishments & Government Corporations • Commerce • Veterans Affairs • Defense • Treasury • Education • United States Department of • Transportation • Energy • Health& Human Services • State • Labor • Housing and Urban Development • Center for Medicare & Medicaid Services(CMS) • Justice • The Interior

6. Child Health Plan Plus Structure • Center for Medicare & Medicaid Services(CMS) County Departments of Human/Social Services Certified Application Assistance Sites Colorado Department of Health Care Policy & Financing (HCPF) Medical Assistance Sites Healthy Communities Sites Presumptive Eligibility Sites

7. Colorado Department of Health Care Policy & Financing

8. County Departments of Human/Social Services

9. Medical Assistance Sites (MA)

10. Certified Application Assistance Sites (CAAS)

11. Healthy Communities Sites • Receive state funding • 64 counties served by 25 community organizations • Family Health Coordinators: • promote preventive & wellness services for children & pregnant women • Each Healthy Communities site has its own business process: • In person assistance • Phone assistance • Drop off applications • PEAK kiosks/computers • Utilizes CBMS & assists applicants in applying for: • Medical Assistance • Other programs (at certain sites)

12. Presumptive Eligibility Sites (PE)

13. Who Does CHP+ Serve? • Unqualified non-citizens facing emergency medical situations Qualified non-citizens • Citizens People with limited income& resources

14. What is CHP+? • Public Health Insurance for children & pregnant women only • Annual enrollment fees range from $25 - $105 depending on income, population, & number of children enrolled • Max out of pocket expenses/co-pays is 5% of gross annual income

15. CHP+ Benefits What’s Covered?

16. Dental Benefits COVERED!

17. Emergency & Urgent Care COVERED!

18. Over the Counter Vitamins NOTCOVERED

19. Hospital Services COVERED!

20. Behavioral Health Services COVERED!

21. Gym Membership NOTCOVERED

22. Maternity Care COVERED!

23. Prescription Drugs COVERED!

24. School Supplies NOTCOVERED

25. Immunizations COVERED!

26. Primary Care COVERED!

27. CHP+ Benefits

28. Let’s Talk About MAGI & Non-MAGI What is MAGI? Methodology for: • how income is counted • how household composition & family size are determined What is Non-MAGI? • Medicaid categories exempt from applying the MAGI methodology​

29. MAGI at a Glance MAGI Populations • Age 64 & younger • Not eligible for Medicare • Low income: • Children • Adults • Pregnant Women • Parents orCaretakers of a Medicaid eligible child that is under the age of 19

30. Who May Qualify? State of Colorado Residents Pregnant women age 19 & over Children under age 19 Must meet income guidelines

31. How is CHP+ Income Calculated? Start no no yes no Does the individual expect to be claimed as a tax dependent? Does the individual expect to be claimed as a tax dependent? Does the individual expect to file taxes? yes yes • Does the individual meet any of the following exceptions: • The individual expects to be claimed as a tax dependent of someone other than a spouse, biological, adopted or step parent • The individual is under 19 living with both parents, but parents do not expect to file a joint tax return • The individual under 19 & expects to be claimed by non-custodial parent no yes Use Tax Filer Rules Use Tax Dependent Rules Use Non-Filer Rules

32. The Income Rules

33. CHP+ Countable Income Countable Income forMAGI Programs (including CHP+) • Taxable income: • • Salaries, Wages, Tips • • Capital Gains • • Unemployment Benefits equals

34. Federal Poverty Level Measure of income level issued annually by the Department of Health and Human Services Find this @ aspe.HHS.gov/ poverty/14poverty.cfm

35. Program Specific Income Guidelines

36. CHP+ Countable Income Disregard Countable Income forMAGI Programs (Including CHP+) • Taxable income: • • Salaries, Wages, Tips • • Capital Gains • • Unemployment Benefits minus • 5% Income Disregard equals

37. Program Specific Income Guidelines

38. Income Disregard (starting Jan 1, 2015) Income Disregard forMAGI Programs • 5% across the board (only if the disregard drops the applicants to a lower FPL category) equals

39. Enrollment Fees • Annual enrollment fees • (143% - 205% FPL) Annual enrollment fees (205% - 260% FPL) No enrollment fees for Pregnant Women, Native Americans & Alaskan Natives $0 for pregnant woman $0 for pregnant woman $75 for 1 child $25 for 1 child $105 for 2 or more children $35 for 2 or more children

40. CHP+ Co-pay Exemptions • Preventive Care • Native Americans & Alaskan Natives

41. Child Health Plan Plus (CHP+)

42. CHP+ Children • Between 143% and 260% of FPL • Covers children under the age of 19 • Enrollment fee applies between 157% and 260% of FPL • Receive CHP+ Benefits andEPSDT benefits

43. Early Periodic Screening & Diagnostic Treatment (EPSDT) Services • Screenings • Case Management • Behavioral Health Organization • Laboratory Tests • Vision • Oral Health • Assistive Technology • Physical & Behavioral Health Services • Immunizations • Outreach Services(aka Healthy Communities) Age • Children 20 and younger • Pregnant woman of any age Other Requirements • Cannot be on CHP+ • Cannot receive benefits under the Colorado Indigent Care Program (CICP)

44. Healthy Communities Family Health Coordinators (case managers) help with: • Informing families where to submit applications • Educating families on the value of preventive health care services • Linking members to providers • Providing clients with information and referrals to other community programs and resources • Explaining the re-enrollment process to families who continue to be eligible for Colorado Medicaid and CHP+ to eliminate gaps in coverage

45. CHP+ Prenatal • Between 195% and 260% of FPL • Covers pregnant women age 19 and over • Pregnant women under age 19 will be covered in the CHP+ Children category • No enrollment fee for pregnant woman and her household

46. How long does coverage last after delivery? • At least 60 days after last day of the month pregnancy ended • Example: • Give birth June 26th, coverage lasts until August 31st

47. CHP+ Newborn • Babies age 0-12 months who were born to a mother on CHP+

48. Continuous Coverage • For kids under the age of 19 • Continuous enrollment regardless of changes in household income or size

49. Presumptive Eligibility • PE is a Medicaid and CHP+ program • Provides temporary medical coverage to children under 19 and pregnant women • Allows for immediate access to medical care • Provides at least 45 days of coverage while waiting for a full eligibility determination to be made

50. The Need to Know: PE Benefits • Inpatient (hospital) care, labor and delivery are NOT covered for pregnant women under PE. • Dental services are NOT Covered under CHP+ PE.