Baltimore HealthCare Access, Inc.

1. Baltimore HealthCare Access, Inc. Maryland Children’s Health Program Created by Christopher D. Furner MS, CHES April 2007

2. The Beginnings • State Children’s Health Insurance Program • As part of the Balanced Budget Act of 1997, Congress created Title XXI, the State Children's Health Insurance Program (SCHIP), to address the growing problem of children without health insurance. SCHIP was designed as a Federal/State partnership, similar to Medicaid, with the goal of expanding health insurance to children whose families earn too much money to be eligible for Medicaid, but not enough money to purchase private insurance.

3. SCHIP to MCHP • On April 28, 1998 Governor Parris N. Glendening signed a law that created the Maryland Children’s Health Program, a program that provides health insurance coverage for average to low-income children and pregnant women. Those eligible for the new program were included in HealthChoice - the existing state-wide medical managed care program.

4. Who is Covered? • Uninsured Children, up to age nineteen. • Coverage ends the last day of the birth month at age 19 • Uninsured Pregnant Women of any age.

5. Federal Poverty Level (FPL) and MCHP Eligibility Household income (based on family of four): • Children, must be at or below 200% FPL for no-cost coverage in MCHP.= $41,300 • Children in MCHP Premium must be at or below 300% FPL = $61,950 • Pregnant Women, must be at or below 250% FPL = $51,625 (Two children, unborn child, self ) Effective March 1, 2007

6. What if the household makes slightly too much money? • If the household makes too much money, encourage the family to apply anyway. • Portions of earned income, daycare expenses and child support can be deducted from household income.

7. What if the Children are Insured? • If the children (MCHP applicants) are enrolled in Employer-Sponsored Insurance, (ESI) the children will not be covered in MCHP. • If the children are enrolled in a Private Health Insurance Plan, purchased by the Parent/Guardian/other parties the children may enroll into MCHP if income-qualified. MCHP will pick-up co-pays and co-insurance costs. MR-17 Section 600, page 14

8. How Long does Coverage Last? • Children- coverage lasts one year. • Pregnant Women- up to nine-months for pregnancy and two-months post-partum coverage.

9. Do I have to reapply every year? • Yes. Children must reapply every year. • A redetermination application called the CIF (Case Information Form) will be sent to the address on file 66 days prior to the end of coverage.

10. Is MCHP eligibility retroactive? • Yes, for MCHP only (not MCHP Premium). • How do I determine how far back retroactive eligibility may be determined? • Current month minus three • If an application is received in April, the client may request retroactive coverage as far back as January 1, 2007.

11. Retroactive eligibility continued… • If the client is requesting retroactive eligibility for a child, the name of the child and month(s) the child has bills should be entered in question 4. • Copies of bills must be attached when submitting them for retroactive payment. • Retroactive coverage is paid through a fee-for- service arrangement. The number on the red & white card should be presented for payment of past bills.

12. MCHP Covered Services • Primary care visits • Acute care (hospitalization) • Prescription medicines (including prenatal vitamins) • Prenatal care visits, delivery and hospital charges • Mental health services • Substance abuse services • Dental care – Must choose a Dentist participating in enrolled MCO • Vision care • Injections, blood work and laboratory tests • Home health care

13. Tips for getting an application processed without snags! • Do not leave any box blank! • Be sure to include every member of the household in box 2. • Be sure to answer each question fully. • If willing to pay a premium, tell us.

14. Tips continued… • Do not forget to sign the application! • Be sure to include all income, regardless of the source. • If a parent is self-employed, a copy of the most recent tax return, specifically Schedule C must be attached to the application.

15. Even more tips! • If pregnant, we need your expected date of delivery! • During the application process: If the child already has a Pediatrician, find out what MCO the Pediatrician participates in. This will make the enrollment process easier if the parent knows what MCO the child needs to be registered in.

16. Immigrants –Illegal or Ineligible Aliens = X02 • Persons who are illegal aliens or who are legal but are not federally eligible aliens may receive federally matched Medical Assistance coverage for emergency medical services (EMS) only. • Labor & delivery are considered emergency medical services. • Routine prenatal or post-partum care will not be covered. MR-17 Section 600, page 2

17. Documentation Required for EMS - Labor and Delivery • MCHP application. • Discharge Summary must include: • Date of Admission • Date of Delivery • Date of Discharge • Confirmation of live birth • Name of Mother • Name of Child MR-17 Section 600, page 3

18. Required Documentation continued… • Written or verbal statement to BHCA employee about when they entered the United States. Please write this on the application in red pen and initial. • If documented, photocopies of the following are required: • VISA • I-94 Arrival/Departure Record • Passport

19. Emergency Medical Services (not related to pregnancy) • Immigrant Children (ineligible or illegal) may be covered in an X02 coverage group for emergency medical services. • The BHCA Eligibility Specialist collects the required documentation, and forwards to DHMH for clinical evaluation by a medical professional. MR-17 Section 600, page 3

20. EMS Required Documentation (not relating to pregnancy) • Discharge Summary, containing; • Complete diagnosis • Description of treatment, and; • Dates of treatment MR-17 Section 600, page 3

21. Decision for EMS(not relating to pregnancy) • Will be mailed to the Eligibility Specialist handling the case at BHCA. • The DHMH will give instruction to the Eligibility Specialist re: eligibility status. MR-17 Section 600, page 4

22. Prenatal and Post-Partum care for Permanent Resident Aliens • On November 1, 2006, the State of Maryland reinstated coverage for ineligible aliens who have not met the five-year bar. • Five-year bar = Having been in the United States for less than five (5) years according to the Homeland Security Dept. • Items required – Passport, VISA, Alien Registration Card (Green Card), or Arrival/Departure record.

23. Permanent Resident Cont’d • coverage is paid for by the red and white card only. • All services are provided on a fee-for-service arrangement. • No MCO enrollment is required.

24. MCHP Premium • Individuals complete the regular MCHP application, forwarding it to the local health department (LHD). • The LHD will deny due to overscale income. • An electronic referral will be made to the DHMH, MCHP Premium unit.

25. MCHP Premium, cont’d. • The MCHP Premium case worker will send an enrollment package to the client. • Services will not paid until 10 days after the initial premium is paid and enrollment into the Managed Care Organization has been finalized. • Retroactive bills will NOT be paid for MCHP Premium (if overscale for the free program). • MCHP Premium: (866) 269-5576

26. DRA of 2005 • The Deficit Reduction Act of 2005 requires that all individuals applying for Medical Assistance and/or Maryland Children’s Health Program provide proof of both U.S. Citizenship and Identity. • Please refer to Attachment A for details regarding the new DRA policies.

27. Children’s Health Programs in other States • www.insurekidsnow.gov

28. Medicaid Expansion • Effective July 1, 2008 • Parents and Caretaker Relatives who have dependent children living in the parent’s or caretaker’s home, and • Whose annual income is at or below 116% FPL • And who do not otherwise qualify for Medicaid in other categories; or ARE enrolled in Medicare Shall be eligible for COMPREHENSIVE MEDICAL CARE AND OTHER HEALTH CARE SERVICES!