Medicaid Extension

1. Medicaid Extension Dwayne T. Woods January 14, 2014

2. Affordable Care Act • The affordable care act required each state to provide Medicaid coverage for a specific expansion population primarily poor adults under 138% of poverty who do not have either a disability or children at home

3. Supreme Court Decision • The Supreme Court upheld the affordable care act requirement of all states to extend Medicaid coverage but restricted the federal government from enforcing the provisions

4. Ohio • On October 10, 2013 Centers for Medicare and Medicaid Services (CMS )approved Ohio's State Plan Amendment making Federal Funds available to extend Medicaid coverage to begin January 1, 2014. It was approved by the Controlling Board on October 21, 2013.

5. Who is Covered • Extends Medicaid to adult groups: Non-pregnant, ages 19 to 64 with income at or below 138% FPL • This group must not be eligible for part A or B Medicare benefits

6. Extension FPL

7. Income/Resource Requirements • Income is calculated by using the MAGI income methodology • What does MAGI based eligibility mean? • MAGI refers to modified adjusted gross income calculations that are used to decide a person's household and income? • The income on Federal Tax Returns • This income methodology only applies to Covered Families and Children Medicaid. It does not apply to Medicaid for the disabled • There are no resource test for this population

8. Extension in OIES • OIES • Ohio Integrated Eligibility System • Take over current CRIS-E Eligibility System • The Extension programming was entered into the OIES system effect of December 9, 2013 • Prior to implementation (482 applicants) • As of 01/13/14 (1,828 applicants)

9. How to Apply • To see if you are eligible for Medicaid benefits, you should complete an application online at Benefits.Ohio.Gov. • If you cannot complete an application online you can go to your local JFS office and complete an application with a case worker or call the Ohio Medicaid Consumer Hotline at (800) 324-8680.

10. Questions and Answers • Will there be a Retro Medical for the Extension Group? • The extension eligibility took effect January 1, 2014 and will not have a retro period. • What happens to individuals who are already on Medicaid for the disabled with a spend-down but may be eligible for Extension Medicaid? • The eligible resident should be closed in the current system and authorized in the OIES system the day after the effective date of the closure. A new application is needed

11. Questions and Answers (continued) • What additional information is needed for MAGI Medicaid? • Do they expect to file taxes? • What will be their filing status? • Who are they claiming as a dependent? • Will anyone claim them as a dependent? • Do they already have 3rd party insurance? •  Will the providers be able to verify benefits on the JFS web portal? • No. Only the JFS Staff has access to the OIES side of the portal.

12. Questions and Answers (continued) • Who will not be eligible/covered under Medicaid Expansion? • Any individual found eligible as a child, pregnant woman, or parent/caretaker relative is not a part of the extension (expansion) group. • Individuals who meet the expansion eligibility but are also eligible for Medicare

13. Questions and Answers (continued) • If an adult is living with their parents and not working, are they still eligible for Medicaid? • They may be eligible for Extension Medicaid • Eligibility would depend on their tax filing status • Is it true that the majority of children are covered under Medicaid, especially now with the Expansion? • The Expansion has no affect on the children

14. Questions and Answers (continued) • How do people currently get put on a spend down? • If the Medicaid eligible customer has countable monthly income that exceeds the Medicaid need standard applicable to the individual (currently $632 individual and $1,082 couple) they have to spend down to the need standard • SSI recipients not subject to the spend-down process

15. Questions and Answers (continued) • What is the FPL cap for a person to get Medicaid with a spend-down? • (Currently $632 individual and $1,082 couple) • We understand that there will not be spend-downs with expanded Medicaid • If the customer is eligible for Medicare, they will not qualify for Expanded Medicaid • There could be a significant decrease

16. Questions and Answers (continued) • Is there a risk that people who have a spend-down could lose Medicaid coverage and be sent to the Marketplace (with a deductible higher than their current spend down?) • Currently no one will be removed from their Medicaid • There is a waiver for 2014 Medicaid Reapplications • If the above would happen, can the customer opt to keep the coverage they have with the spend-down? • Unable to answer at this time.

17. Questions and Answers (continued) • Who are the people who will be left uncovered by Medicaid that fall within 138% of FPL? • Individuals receiving Medicare • Individuals eligible or receiving Medicaid for the Disabled

18. Internet Websites • Extension FAQ • http://medicaid.ohio.gov/FOROHIOANS/GetCoverage/WhoQualifies/ExtensionFAQ.aspx • MAGI FAQ • http://medicaid.ohio.gov/INITIATIVES/ModernizingEligibility/FrequentlyAskedQuestions.aspx#2.1

19. Questions? Dwayne T. Woods 225-4948