Family Planning Coverage Limited Benefit Program Presentation to HUSKY Health Certified Entities

1. Family Planning CoverageLimited Benefit ProgramPresentation to HUSKY Health Certified Entities March 2012 DSS/UCONN Partnership

2. Patient Protection & Affordable Care Act (PPACA)provides for: • New Medicaid coverage which: • Provides for family planning • and family planning-related services and supplies to individuals • For anyone of child bearing age • Income limit is 250% FPL • No Asset test

3. Limited Covered Services • Family planning services and supplies covered under full-benefit Medicaid (HUSKY Health.) • In addition, family planning-related services defined as “medical diagnosis and treatment services that are provided in a family planning setting as part of or as follow-up visit.”

4. Definition of Family Planning • For the purpose of preventing pregnancy or spacing children • Only services rendered during the course of a family planning visit will be paid for. • Please help inform your client of this and do not refer cases where the client is not of a child bearing age.

5. Examples ofFamily Planning Related Services • Drugs for treatment of sexually-transmitted diseases (STD) or sexually-transmitted infections (STI) when the STD/STI is identified/diagnosed during a routine/periodic family planning visit. • Follow-up visit may be covered

6. More… • Drugs for the treatment of lower genital tract and genital skin infections/disorders, and urinary tract infections, when the infection/disorder is identified/diagnosed during a routine/periodic family planning visit. • Follow-up may be covered

7. Continued… • Other medical diagnosis, treatment, and preventive services that are routinely provided pursuant to a family planning service in a family planning setting. • Example – preventive service could be a vaccination to prevent cervical cancer.

8. Treatment of Major Complications • Treatment of perforated uterus due to an intrauterine device insertion • Treatment of severe bleeding caused by a Depo-Provera injection requiring a dilation and curettage • Treatment of surgical or anesthesia-related complications during a sterilization procedure. Follow-up

9. Transportation Services • Must be covered to the extent they are under full Medicaid (HUSKY Health) benefits.

10. All applications must be screened for full HUSKY Health • If client qualifies for full Medicaid under any HUSKY group, must be placed on full Medicaid. • This is not optional. • This includes HUSKY B.

11. HUSKY Health Certified Entities (Facilitated Enrollment Organizations) • QEs or QPs are both HHCEs. • Partnering with DSS ☺ • HUSKY Health CEs are expected to help enroll clients not only in PE, but ongoing Family Planning Limited Coverage Benefit. • In addition, cases are reviewed annually and clients need help completing the renewal form and returning along with necessary verifications.

12. Application Form • W-1HUS, W-1E, W-1F • Box to indicate interest in family planning program • Will be a form to indicate good cause for confidentiality if under age 21 • Until then, CE should flag case confidential.

13. Presumptive Eligibility • Applications may be initiated at HUSKY Health Certified Entities • PE process is the same as that for PE for Kids or PE for Pregnant Women • Allows for immediate coverage – CE gives voucher good for ten days which is promise of payment under Medicaid • HUSKY Health CE gives voucher by end of business day following application date and sends packet to RPU within 5 days. • RPU grants presumptively within 24 hrs • PE may be used twice a year

14. Process • Date of presumptive eligibility is date CE determines applicant as eligible. • Cases will be granted within 24 hrs from receipt of complete faxed package of materials presumptively using coverage group M07 • Once found eligible for ongoing family planning coverage M08, case will move to M08 • Retroactive eligibility may be explored from M08 back three months when requested by applicant. No retro coverage from M07

15. Non-Financial Requirements • No age requirement – ‘child bearing age’ (does the client need to prevent pregnancy or space children?) • Pregnant individuals do not qualify • Both parents in a household may qualify • Follow assistance unit composition rules for programs most closely related to applicant’s category (HUSKY A, C, D)

16. Confidentiality • The Department shall protect the confidentiality of certain minors and certain young adults applying for or receiving this coverage group. These individuals must inform the Department that their safety is at risk if the knowledge of their applying for this program were to become known by others living in their household. • Validity of claims is determined by the Dept. which includes HUSKY Health Certified Entity partners.

17. Confidentiality • Indicator on DEM2 would prevent other third party insurer from seeking payment • Confidentiality is available to those under age 21. • Staff and anyone with access to EMS needs to keep M07/M08 cases strictly confidential. May not discuss with family members – even parents or spouses.

18. Individual may use address other than primary for reasons of confidentiality Town 025 DO 60 EW ID 0485 Client ID 003803414 Prev DO HOH F Name BETTY MI L Name BARNES Authorized Rep N Prim Lang E Impairments Accommodations Residential Address Address Line 1 Line 2 Apt Street Number Dir NAME Type City Dir 1 OAK AVE City CHESHIRE ST CT Zip 06410 Phone Cell Phone Mailing Address Del Address Line 1 Line 2 Apt Street Number Dir Name Type City Dir SAME City ST Zip

19. Share TPL indicator on DEM2 Client Name JACKI          TYLER                 Client ID 003807455           Ctzn  Idnty  Stdnt  Stkr  Share   ------ IPV -------   CL AU   -Diversion-     Cd V   Ver   Sts V  Sts    TPL   Ind  Ctr  Dec Date    Ctr    Ctr  Date       C US   US                   N Health    Entitled     -------------------- Disability ------------------------  Insur   Medicare A    Disab     Approval    Approval    Begin Date    End Date                        Type       Source      (MM YY)      (MM YY)      (MM YY) Joint    Potential    LLR  Vet    Military        Death  Death Felon  Disaster SSI/FS  Asset Assign       Stat   Serv Num        Date   State Stat    Cd  St                              N                                                  Educ        School       School   Dep Care  Grad Date    Good    Highest Grade Level        Name         Town     Respon   (MM CCYY)  Standing    Completed

20. STAT screen flagged Month 02 12                     1713   01 03 12                       01       CONFIDENTIAL COVERAGE GROUP!  AU ID 051666067    Prog MA    Prog Type M    Med Cvrg Grp M08   Pending Beg?     Town 089   DO 52   Ew Id 1713   Conv Date          AU Ctr       Wvr Type        AU    AU Status   AU Stat    Appl    Begin    Pd Thru  ---Penalty----   Appeal  Stat    Reasons      Date     Date     Date     Date    Type  End Date    Ind    A                  010312   010112   010112                                    -------------------------------------------------------------------------------  First  Last Rel V Mand Finl -Stat-  Rsn Per. Appl   Begin  PdThru -Penalty  MCO  Name   Name       Incl Resp  Date       Code Date   Date    Date  T  Date    St  JACKI  TYL              RE A 010312         010112 010112          

21. Assistance Unit Composition • Individuals who are categorically eligible for either HUSKY A (Family Medicaid), HUSKY C (Medicaid Aged, Blind, Disabled), or HUSKY D (Medicaid Low Income Adult) shall use the assistance unit composition rules that is most finally advantageous to the individual.

22. Gives minors (under 18) the opportunity to be treated as an adult. Minor would be unit of one Minor’s parents income not requested or counted Therefore, screening them for full HUSKY not possible. Minors who are married are legally liable for one another. Gives minors and anyone under 21 the right to use a different mailing address and prevents third party insurers from billing and therefore no statements send to parents. Young adults between 18 and up to 21 already have the option of being treated as an adult and unit of one under HUSKY D What confidentiality means for certain age groups

23. Examples • Minors – Normally if under 18, parent’s income must be provided and counted to determine child’s eligibility for HUSKY (F25 and F07) • If a minor (under 18) asks for and is afforded confidentiality, they will be treated as a unit of one. • We won’t count or request parent’s income.

24. Another example: • Ages 19-21 have the choice of being considered as an adult (HUSKY D) and therefore a unit of one. • Or they may be considered part of the family unit (HUSKY A.) • Suppose the applicant has significant earnings over 250% for one. It could help to consider the family to increase the needs group size. So if an applicant had 2 siblings under 21 and two parents, we using 250% FPL for family of 5, but would consider income of all family members.

25. Financial Requirements • Income under 250% FPL after allowable disregards and deductions based on coverage most closely related. • Income may be self declared • EXCEPT SELF EMPLOYMENT • No asset test (Assets typically savings, checking, real estate, bonds, motor vehicles)

26. Family Medicaid (HUSKY A) Treatment of Income • For Family Planning, may deduct the following for ‘family related’ applicant. • $90 monthly work expense deduction • 100 of child support is disregarded • SSI is disregarded • Out of pocket day care up to maximums allowed and for F07 – even the day care paid for by the state.

27. MAABD (HUSKY C)Treatment of Income • For Family Planning, if applicant is related to Aged, Blind, Disabled program, use the following: • Standard unearned disregard of $302 • Earnings deduction of $65 and half the remainder for disabled and $85 and half the remainder for the blind. • Variations of this budgeting occurs when individuals live with others. Others include family members or unrelated roommates. • Policy allows for a categorical needs limit or a medically needy income limit • Other potential deductions include impairment related work expenses and work expenses for employed spouses.

28. HUSKY D (Medicaid LIA) Treatment of Income for Family Planning • For Family Planning, use the following: • Earnings deduction is $150/mo • There is no unearned disregard. • Having no unearned income disregard is a big difference from HUSKY C

29. Presumptive - M07 CE may consider all factors of eligibility to be verified by information stated on the W1-HUS or W-1E, W-1F. Signed and completed application Nice to have: Proof of identity Alien # if non-citizen Disclose SS # Ongoing - M08 Verification of income – may be self- declared Self employment is an exception – must be verified Social Security # Citizenship and Identity for US citizens – generally we can verify in house with SS match Residency (unless confidentiality given) Alien # for Non-Citizen status Necessary Verifications

30. Self Declaration of Income • Individuals may self declare their income. • As usual, self employment will not be self declared and DSS will require, tax records, business records or completion of W-38 form. • All income calculations will be done outside the EMS system.

31. Review on some recent changes • Children under 21 no longer subject to the five year citizenship rule due to CHIPRA legislation. • Children under 21 also not subject to sponsor deeming • Above also pertains to pregnant women but pregnant women are not eligible under the family planning group – they may qualify for full Medicaid under the P02 group.

32. Other info • Currently no cost sharing (premiums or co-pays) under this group • Citizenship and Identity rules for US citizens applies – hopefully the SSA match will continue to verify high percentages – if client fails the match, they must verify C&I – continue to use the 90 day reasonable opportunity process. • Third Party Liability – Individuals must report other medical insurance. There are good cause reasons which help protect client confidentiality.

33. Retention • Remind your clients that health insurance must be renewed every year. • Ask that they pay attention to the mail and send back required forms and verifications promptly. • Thank you!

34. Lois.filek@ct.gov • 860-424-5394 • Ida.harris@ct.gov • 860-424-5182