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Healthy Families Transition

Healthy Families Transition. Training Overview.

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Healthy Families Transition

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  1. Healthy Families Transition Training Overview

  2. Assembly Bills 1494 and 1468 provide for the transition of children from Healthy Families Program (HFP) to the California Medi-Cal program. Medi-Cal will cover these children under a new optional coverage group known as the Targeted Low-Income Children’s Program (TLICP). This presentation will cover the following:

  3. Transition Phases Phases will include HFP children currently: No Sooner than January 2013 No Sooner than March 2013 No Sooner than April 2013 No Sooner than August 2013 No Sooner than September 2013

  4. Transition Aid Codes The Healthy Families contractor will use these codes: NOTE: HFP children in 9H and AIM-linked infants in 0C remain in their HFP/AIM aid code until their transition phase.

  5. Transition Income Limits • The HFP contractor will move children into the proper code • Transition aid codes will be assigned as follows: NOTE: AIMinfants (ages 0 – 2 yrs of age) with income above the 250% FPL will continue as HFP enrolled infants in the AIM program in aid code 0C.

  6. Transition Process

  7. Backup to Electronic Transfer Process • If the electronic transfer process is not fully automated on your county’s transition date, the HFP contractor will send case information to counties using the current paper-based transmittal process used for Single Point of Entry applications. • This would be a temporary work-around until the case information can be transmitted electronically. • The date by which electronic information can be received will vary based on which computer system your county uses.

  8. Premiums Premiums will continue to be paid to the HFP Payment Section, which will be renamed the Medi-Cal Premium Payment Section Counties will not collect premium payments from customers.

  9. Medi-Cal Determination • The timing of the Medi-Cal determination depends upon the individual circumstances of the child transitioning from HFP. • In general Medi-Cal eligibility determinations must be completed by the county of residence as follows: or but

  10. Open Medi-Cal Case • Transitioned HFP children in an open Medi-Cal Case with other family members will have their Medi-Cal determination completed as follows:

  11. Closed or No Medi-Cal Case • Transitioned HFP children who do not have a Medi-Cal case will have: • Medi-Cal eligibility determined by the county at their HFP AER date, and • A new Medi-Cal case opened at that time by the county.

  12. Medi-Cal Determined by Another Program/Agency • In situations where Medi-Cal eligibility is being determined by Social Security Administration for SSI/SSP or the CalWORKs program, counties may address these scenarios as follows:

  13. Continuous Eligibility for Children (CEC) • If the family Medi-Cal RV, or adding the child to the Medi-Cal case as an “add a child”, results in a change that would otherwise move the HFP child to: • a Medi-Cal share-of-cost (SOC); • premium payment; or • program ineligibility. • The child continues with no SOC Medi-Cal (via CEC) until his/her AER.

  14. Continuous Eligibility for Children (CEC) (cont.) • Continuous eligibility also protects the child from nonfinancial reasons for discontinuance, even if those changes adversely affect other family members, except for: • Death; • when child reaches the age limit; • loses California residency; or • the child/guardian or representative of the child requests disenrollment; • Continuous eligibility ends with the earlier of the time the individual reaches age 19 or the end of a period following initial eligibility or annual RV (not to exceed 12 months). • Non-payment of premium is not a reason for CEC.

  15. Transition Notices • Prior to each phase of the transition, the state will mail notifications to the affected families.

  16. Transition Notices (cont.) • Transitioning children will receive the Medi-Cal Welcome Packets and Beneficiary Identification Cards (BICs) in the month prior to each transition. Those individuals in a managed care health or dental plan will also receive information from these plans. • Proposed contents of the Welcome Packet: • Medi-Cal What It Means To You (PUB 68) • EPSDT Program information (MC 003) • Important Information for Persons Requesting Medi-Cal (MC 219) • Multilingual Notice – Request for Assistance • Important Information About Dental Benefits • List of Counties with telephone contact information for Medi-Cal inquiries. • BIC will be sent separate from, and after, Welcome Packet

  17. References • ACWDL 12-30 (October 31, 2012)Healthy Families Program Transition To Medi-Cal • Healthy Families Program Transition To Medi-Cal DHCS Transition Page

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