CMS Update and Dialogue

1. CMS Update and Dialogue Cheryl Camillo Supporting Families After Welfare Reform Breakthrough Series Collaborative Learning Session #2 New Orleans, LA November 13-15, 2002

2. Transitional Medicaid (TMA) Update • Section 1925 extended through December 31, 2002 (for the first quarter of Federal Fiscal Year 2003) by Public Law 107-229, a continuing resolution. • If not extended again, will sunset after December 31. If so, TMA under Section 1902(e)(1) of the Social Security Act will go into effect. So: • Families that become eligible for TMA before January 1, 2003 receive TMA under Section 1925 • Families that become eligible for TMA after January 1, 2003 receive TMA under Section 1902(e)(1).

3. TMA Update • There are key differences between TMA under Section 1925 and TMA under Section 1902(e)(1). Under Section 1902(e)(1): • Families must lose Section 1931 Medicaid because of increased hours or earnings from employment of any family member; • Families receive 4 months of TMA; and • A family member must be employed for the family to receive TMA.

4. QI (Qualifying Individuals) Update QI-1s • Public Law 107-229 (as amended by P.L.s 107-240 an 107-244) extended this benefit at current funding levels through January 21, 2003. • State can make January Part B premium payment and should not take any action to notify or terminate QI–1s at this time.

5. QI (Qualifying Individuals) Update QI - 2s • Sunsets after December 31, 2002. • States should provide advance notice of termination action informing recipients that termination was caused by Federal law. • Notice should advise recipients to contact the state if their income has changed, as they may be eligible for other programs. • States need not provide a hearing opportunity.

6. QI (Qualifying Individuals) Update QIs • Explanatory State Medicaid Director letter issued on November 6, 2002. A copy can be found in each notebook and on CMS’ Web site at: http://www.cms.hhs.gov/states/letters/smd11602.pdf

7. HIFA(Health Insurance Flexibility and Accountability Demonstration Initiative) • Encourages new, comprehensive state approaches that will increase number of individuals with health insurance coverage using current-level Medicaid and SCHIP resources. • Emphasizes maximizing private health insurance coverage and targeting populations with income below 200% FPL. • Application guidance and template can be found at: http://www.cms.hhs.gov/hifa/hifagde.asp • 7 waivers have been approved (Arizona,California, Colorado, Illinois, Maine, new Mexico, and Oregon).

8. HIFA • Arizona– Uses Title XXI funds to expand coverage to: (1) adults over 18 without dependent children and with adjusted net family income at or below 100% FPL and (2) otherwise ineligible parents of Medicaid and SCHIP children with adjusted net family income between 100% and 200% FPL • Maine – Will cover all individuals with incomes at or below 100% FPL (option to go to 125% FPL) using available DSH funds and a cigarette tax increase for the state share.

9. HIFA • Interested states can contact Theresa Sachs at (410) 786-0307 or tsachs@cms.hhs.gov

10. Prenatal Care for Unborn Children Rule • Final rule published October 2, 2002 (Fed. Reg. Vol. 67, No. 191, Pg. 61956). A copy can be found in each notebook or at: http://cms.hhs.gov/providerupdate/regs/cms2127f.pdf. • Allows states to file a state plan amendment (a waiver is not necessary) to use existing SCHIP funding for coverage for children from conception to birth and up to age 19. • Allows states to provide this benefit regardless of mother’s immigration status.

11. Limited English Proficiency (LEP) Guidance • August 30, 2000 HHS LEP guidance republished for comment on February 1, 2002 (Fed. Reg. Vol. 67, No. 22, Pg. 4968). A copy can be found in each notebook or on CMS’ Web site at: http://www.cms.hhs.gov/states/letters.lepguide.pdf • August 30, 2000 guidance is effective until revised guidance is published.

12. LEP Guidance • In deciding what language assistance services to provide, recipients of Federal funding should conduct an analysis of four factors: • The number or proportion of LEP persons eligible to be served or likely to be encountered, • The frequency with which LEP individuals come into contact with the program. • The nature or importance of the program, activity, or service to people’s lives, and • The resources available to the grantee/recipient and costs.

13. LEP Guidance • There is no “one size fits all” solution. OCR will make assessment on case-by-case basis and recipient will have flexibility in determining how to fulfill obligation. OCR will focus on the end result. • Key to providing meaningful access is to ensure that the recipient and LEP person can communicate effectively.

14. LEP Guidance • Recipients have two main ways of providing language services: • Oral, • Written. • Quality and accuracy of the language service is critical in order to avoid serious consequences to the LEP person and to the recipient.

15. LEP Guidance • Recipients of Federal funding should develop implementation plan. The following five steps may be helpful: • Identify LEP individuals who need language assistance, • Include information about language assistance measures, • Include staff training, • Include measures to provide notice to LEP persons, • Include process for monitoring and updating the plan.

16. Electronic Applications • States may use electronic applications. • Per Federal regulation 42 CFR 435.907(b), the application must be “signed under a penalty of perjury.” • States may obtain signatures as follows: • Electronically (e.g., using the digital certificate or digitized signature technologies), • Sending postcards to applicants asking them to attest to accuracy of online application, or • Applicant can print application or short statement, sign it, and send it to office via mail, fax, or hand delivery.

18. Rolling Renewals • Use existing providers and community-based organizations to renew eligibility on-site. • Successful renewals will receive an additional 12 months of coverage. • Massachusetts performed pilot.

19. Notices • Federal regulations at 42 CFR, Part 431, Subpart E and Part 435, Subpart J require that each applicant who is denied, awarded, or terminated from Medicaid receive timely written notice of the agency’s decision. • Notices should explain the agency’s decision and the applicant’s/recipient’s rights and responsibilities, including the right to request a hearing.