Special Populations and Review

1. Special Populations and Review February 6, 2015

2. Need More HIP Resources? Visit www.IN.HIP.gov AND www.indianapca.org/?page=OEHIP2HUB

3. IPHCA’s Annual Conference When: May 3-5, 2015 Where: Indianapolis Marriot North Join us for an exciting two-day Outreach & Enrollment track open to all interested individuals! Can't attend the whole conference? Come for one day at a discounted price, or attend the Indiana Navigator CE Course for just $50!

4. Questions? Use the chat function or email edaw@indianapca.org Select who you want to receive the message (IPHCA Host to send to Jessica and Emily) Type and send message

5. Learning Objectives Discuss HIP 2.0 eligibility for special populations like: • Pregnant women • Native Americans • Medically frail individuals • Low-income Parents and Caretakers • Low-income 19- and 20-year-olds

6. SPECIAL POPULATIONS

7. Medically frail Special population:

8. Medically Frail • Who is considered medically frail? • Individuals with certain serious physical, mental and behavioral health conditions • Required to have access to standard Medicaid benefits • Includes individuals with: • Disabling mental disorders (including serious mental illness) • Chronic substance use disorders • Serious and complex medical conditions • A physical, intellectual or developmental disability that significantly impairs the ability to perform one or more activities of daily living • Activities of daily living include bathing, dressing, eating, etc. • A disability determination from the Social Security Administration

9. Medically Frail • What coverage does a medically frail individual receive? • Medically frail individuals receive HIP State Plan benefits • No visit limit for home health • Coverage for Temporomandibular Joint Disorders (TMJ) • Chiropractic services • Bariatric surgery • Requires authorization for physical, speech and occupational therapies—but unlimited • No limit for skilled nursing facility • Early periodic screening diagnosis and testing (EPSDT) services for 19 & 20 year olds • Pregnant women receive access to all pregnancy-additional benefits on HIP Plus or HIP Basic plan and full State Plan benefits

10. Medically Frail • Can an individual lose their medically frail status? • If an MCE cannot confirm on-going medically frail status, it will remove the designation • If a member reports themselves as medically frail to their MCE and findings show they do not meet definition of medically frail, then the individual will receive notification of finding and appeal rights • If member disagrees with the MCE’s medically frail appeal decision, he or she may appeal to the State

11. Medically Frail Verification *Verification time frame is 60 days in 2015 and 30 days in all following years

12. Low-income parents, caretakers and 19- and 20-year-olds Special population:

13. Low-Income Parent or Caretaker and 19-20-year-olds • Who is considered a low-income parent or caretaker? • Individuals below 19% FPL: • Who is considered a low-income 19- or 20-year-old? • A child age 19 or 20 who lives in the home of a parent or caretaker relative and meets the income requirements above • A parent includes biological, adopted or step-parent

14. Low-Income Parent or Caretaker and 19-20-year-olds • What coverage does a low-income parent/caretaker or 19-20-year-old individual receive? • These individuals will receive HIP State Plan benefits • No visit limit for home health • Coverage for Temporomandibular Joint Disorders (TMJ) • Chiropractic services • Bariatric surgery • Requires authorization for physical, speech and occupational therapies—but unlimited • No limit for skilled nursing facility • Early periodic screening diagnosis and testing (EPSDT) services for 19 & 20 year olds • Pregnant women receive access to all pregnancy-additional benefits on HIP Plus or HIP Basic plan and full State Plan benefits

15. TRANSITIONAL MEDICAL ASSISTANCE Special population:

16. Transitional Medical Assistance (TMA) • What is Transitional Medical Assistance (TMA)? • Medicaid program that offers continued coverage of benefits for certain low-income parents and caretakers who would otherwise lose Medicaid coverage due to increased earnings • Available up to 185% FPL (during 2nd 6 months) • How long is an individual eligible for TMA? • 6-12 months • Quarterly reporting required to maintain TMA

17. Transitional Medical Assistance (TMA) • Individuals with TMA coverage before February 2015 will not transition to HIP 2.0 • Individuals newly eligible for TMA will receive HIP State Plan Plus or HIP State Plan Basic benefits • Regardless of income, individuals receiving Transitional Medical Assistance (TMA) may not be dis-enrolled from the program for at least 6 months • May receive TMA up to 12 months if individual complies with required quarterly reporting • For TMA members with income over ~138% FPL: • May not be dis-enrolled in the first 6 months • May be eligible for a second 6-month benefit period if: • Comply with required reporting • Income under 185% FPL

18. Pregnant women Special population:

19. Pregnancy Determination

20. HIP Coverage for Pregnant Women Woman becomes pregnant while enrolled in HIP • No cost-sharing during pregnancy/post-partum period • OPTION: May request to move to HIP Maternity (MAGP) • No cost-sharing during pregnancy/post-partum period • May have coverage gap when reentering HIP after pregnancy if end of pregnancy not reported on time Woman is pregnant at application or renewal RECOMMEND: Report end of pregnancy promptly to guarantee continued HIP coverage without a gap

21. HIP Maternity (MAGP) Coverage

22. Pregnancy Benefits • Pregnant women receive benefits only available to pregnant women, regardless of selected HIP plan • Exempt from cost sharing • Additional benefits continue for a 2 month (60-day) post-partum period

23. Pregnancy Question • Can pregnant women above ~138% FPL still get coverage from an Indiana Health Coverage Program (IHCP)? • Yes, women between ~138% FPL and under ~208% can still get coverage through MAGP (Medicaid pregnancy category). These individuals will receive Hoosier Healthwise Package A benefits.

24. Native Americans Special population:

25. Native Americans • By federal rule, Native Americans are exempt from cost sharing • Receive HIP Plus • Do not have POWER account contributions or emergency room copayments • May opt out of HIP Plus and into fee-for-service coverage as of April 1, 2015 • May be eligible for HIP State Plan benefit option if also: • Medically frail, • Low-income Parent/Caretaker, • Low-income 19-20 year olds Native American status subject to verification with DFR. Acceptable forms of verification include: tribal card, tribal letter, previous use of Indian Health Services, etc.

26. Quick review of hip 2.0

27. Indiana Application for Health Coverage (IAHC) • Completing the application online is the easiest and fastest method • Electronic sources are used to verify income, citizenship, alien status and other eligibility factors • Faxing documents might speed up the application process • Write the name and Social Security Number on each item you fax or mail FAX 1-800-403-0864 MAIL FSSA Document Center PO Box 1810 Marion, Indiana 46952

28. HIP Plus Initial plan selection for all enrollees * Exception: using ER for routine care

29. HIP Basic Fall back option for members

30. HIP Basic Copayments for HIP Basic members

31. HIP State Plan • Qualifying individuals include: • Low-income (<19% FPL) Parents and Caretakers • Low-income (<19% FPL) 19 & 20 year olds • Medically Frail • Transitional Medical Assistance (TMA)

32. HIP (Employer Benefit) Link For people with access to “unaffordable” insurance through an employer Employer must sign-up and contribute 50% of member’s premium Members make PACs and receive defined contribution from the state • Enrollment in HIP Link is optional • Coming Soon!

33. Gateway to Work • As part of enrollment in the Healthy Indiana Plan, if the member is not a full time student or work more than 20 hours per week he or she may be referred to Indiana’s Gateway to Work program. • Gateway to Work provides members with general information on the state’s job search and training programs that could help connect them to potential employers. • While participating in the Gateway to Work could help members find employment opportunities, failure to do so will not affect their HIP eligibility.

34. POWER Account • Like an HSA, members use first $2,500 to pay for services • Members receive monthly statement • Preventive services will not be used against $2,500 POWER account • Employers & not-for-profits may assist with contributions • Employers and not-for-profits may pay up to 100% of member POWER account contribution (PAC) • Payments made directly to member’s selected managed care entity • Spouses split the monthly PAC amount

35. Non-payment Penalties • Members remain enrolled in HIP Plus as long as they make PACs and are otherwise eligible Penalties for members not making PAC contribution:

36. Reporting Changes Members must report the following changes in within 10 days of when the change occurs: • Moving to a new address or change mailing addresses • Family income or family size changes • Losing a job, change jobs or get a new job. • Becoming pregnant, delivering baby or when pregnancy ends • Becoming insured under other health insurance (Private or Medicare) • Members should call or fax information to the FSSA Document Center at 800-403-0864, mail to FSSA Document Center, PO Box 1810, Marion, IN 46952 or submit online • Changes must also be reported to MCE

37. Managed Care • Health coverage is provided by one of the three managed care entities (MCE) • Dental coverage is through DentaQuest • Vision coverage is through Vision Service Plan (VSP)

38. Dental

39. Questions or Comments? Chat your questions now! Check out our online HIP 2.0 Hub for more great resources: www.indianapca.org/?page=OEHIP2HUB (317) 630-0845