Hands on PE/ MOSAA refresher for you!

1. Hands on PE/ MOSAA refresher for you! Head to Toe April 2010

2. Today we will.. • Review the importance of school base PE/ MOSAA determiners in Medicaid enrollment • Review Medicaid programs • Review PE/ MOSAA process • Practice PE/ MOSAA paperwork

3. Outreach and enrollment in SBHCs and schools:Critical to the health insurance safety netLeads to important source of revenue

4. 3 important questions: • What is your system for assessing health insurance status of every student/ client? • and re-assessing and re-assessing and re-assessing • What is your system for ensuring eligible students are enrolled? • What is your system for reaching out to parents about PE/ MOSAA services?

5. Insurance and children in NM • ¼ of our children live in poverty (we are 47th in the nation)1 • 93,000 uninsured children (17%). 3rd in nation. • 85.9% uninsured children come from families where at least one parent works • 64.6 % come from low-income families who are likely eligible for Medicare or New Mexikids

6. NMASBHC • We offer support on outreach and enrollment strategies • Purchase your outreach materials such as banners and provide enrollment incentives • Resources on website • http://www.nmasbhc.org/pages/medicaid_outreach.htm

7. NMexiKids and NMexiTeensno cost or low cost health care coverage for children and young adults under 19 years of age • Medicaid 133% to 185% FPL- no co-pay • CHIPRA 185% to 235% FPL- possible low co-pay • Premium Assistance for Kids 235% FPL and above PAK pays a portion of the premium for commercial, comprehensive health insurance for eligible children under the age of 12 or up to age 18 if part of a sibling group that includes a child under the age of 12.

8. Categories • ISD office determines category of eligibility • 32- Medicaid for children under 19 • 35- Medicaid for Pregnant Women • Pregnant teens will get category 32 • SBHC determiner must have indicated on PE/MOSAA determiner application that you will process category 35. If you are not sure if you noted this on app., call Dina Lopez 505-476-6821. Provider must do EDC. • 35F- Medicaid for family planning • 72-”Jul” Medicaid for the family • 80% FPL • Family may receive a letter saying child was denied cat 32 but whole family may be eligible for 72. Check portal.

9. Checking Medicaid status • http://nmmedicaid.acs-inc.com. • Cannot get on portal call ACS provider help desk 1-800-299-7304 • Provide your determiner number

10. FPL • Updated April 1 every year, EXCEPT THIS YEAR • Income must be counted for individuals who are: • Living with the person who is applying for benefits AND • Have financial responsibility for those who will receive the benefits. Financial responsibility, in general, is created by marriage or conceiving children. Income of person applying is always counted as well as income being made available to him / her (ex- child support)

11. 1st step- screening • Is the child a citizen or legal resident? • Parent’s citizenship not an issue • New as of 7/09- for children- the day an application for legal residence is submitted is eligible to apply for Medicaid • Is the child a resident of NM? • For example if live across a border but go to school in NM • How many people live in your household? • What is your income before taxes? • Read FPL • Slightly over may be ok with income disregards

12. Let’s practice Determining family size for income purposes: • Single mom, 3 kids, living with grandma • Pregnant teenage girl and boyfriend living without either of their parents • Mom, dad, 2 kids, living with auntie and her 2 kids • Not pregnant teenage girl living with friend’s parents • Pregnant teenage girl living with boyfriend, his parents, his brother • 2 children living with grandmother, parents not involved

13. Prepping the client • Appointment can take up to 45 minutes • Client needs to bring: • A birth certificate(s) for child(ren) • Social security number(s) for child(ren) • The last 4 weeks of pay stubs (most recent 4 weeks) • If child is on Medicaid and they are recertifying, bring their Medicaid card • Proof of insurance, if applicable • Child’s picture ID or Shot record (for identity) • Daycare/ babysittting receipts

14. PE • PE • Temporary Medicaid. PE is good through last day of following month. • PE is immediate insurance and will cover medical bills (during coverage period) even if MOSAA is denied. • Covers children and youth up to age 19, pregnancy services only for pregnant women • Effective March 19, 2009, Presumptive Eligibility (PE) applications can be processed electronically via the Medicaid portal http://nmmedicaid.acs-inc.com (50% are being done this way) • DO NOT SEND IN A PE WITHOUT A MOSAA

15. MOSAA • MOSAA • Regular Medicaid that last for 12 months • Covers- Children and Youth up To Age 19 , Medicaid for Pregnant Women, Full Medicaid for Pregnant Women, Family Planning Services for Women • If there are uncovered medical bills MOSAA is retroactive for 90 days prior to the month of application but pay stubs for the months the bills occurred must be provided

16. STARTING AN APPLICATION • Use your cheat sheet • Reviews ALL PE/MOSAA forms • Covers special situations • Cheat sheet is updated and posted at www.nmasbhc.org/pages/medicaid.html • It all starts with MAD 023 (JUST REVISED 12/09) • Forms are in your determiner binders and updates should be mailed to you • If you are not getting updates in the mail contact: Dina Lopez, 505-476-6821

17. Let’s start… • Start with the MAD 023, client completes • Part 1- Legal name. The name is whoever signs the application and also the case name • Part 2- • List everyone living under a roof, note: this is different than household size for income • Parent’s citizenship irrelevant

18. Part 3- Who’s income counts, see slide #10 • Part 4- If there are absent parents list them here AND on TPL Inquiry Form, MAD 009 • Signature needs to match name on application

19. Completed MAD 023

22. Let’s practice • Take 10 minutes to complete a MOSAA narrative, MAD 071

23. MOSAA narrative, MAD 071 • Top part of 071 needs to match 023. Duplicate information. • Back of 071. New information. Narrative- opportunity to explain extenuating circumstances

24. Completed MAD 071

26. Income • Use income data for the 4 weeks prior to the date of application. • Income can be verified using copies of check stub, an employer statement, or requesting a faxed statement. • If self employed copy of schedule C of Federal income tax • Countable income is the amount that remains after all applicable deductions and disregards have been deducted.

27. Calculating income • Income is averaged based on how it is paid (weekly, bi-weekly) • If paid weekly= take 4 stubs, add them, divide by 4, multiply by 4.3 • If paid bi-weekly (every other week, 26 paychecks a year)= add 2 stubs, divide by 2, multiply by 2.15 • If paid semi- monthly OR monthly (twice monthly, 24 paychecks per year)= no averaging necessary

28. Let’s practice • Take 10 minutes to complete a PE for Children Eligibility Worksheet, MAD 076

29. Completed MAD 076

30. Let’s practice • Take 5 minutes to complete a TPL Inquiry Form, MAD 009

31. Completed MAD 009

32. Completed MAD 068

33. Completed MAD 070

34. Completed MAD 398

35. Completed MAD 441

36. Completed MAD 160

37. Checking on status of application/ denials • By calling the Medicaid Solutions Center at 1-888-997-2583/ 505-476-6800 • Have your PE/ MOSAA determiner number ready and give it to the customer service representative. • Encourage parent to call in to check status.

38. Recertifying process • Clients will get letter in mail telling them to re-cert by: • Phone: 1-866-586-0002 • Fax: 505-476-6280 • Mail: Medicaid Renew Project Po Box 6910, SF, NM 87502 • Email: Medicaid.renew@state.nm.us SBHC staff can help client with this process OR do a MAD023 plus submit copies of last 4 weeks pay stubs and copy of current Medicaid card

39. Where to go if you need help…. • Attend determiner training every 2 years to stay current • SBHCs call Nissa for outreach and enrollment support • Call Medicaid School Health Office if confused about application process

40. Resources HSD, MAD, School Health Office www.hsd.state.nm.us/madHSchoolHealthDetail.html NMASBHC Medicaid resources webpage www.nmasbhc.org/pages/medicaid.html New “Insure NM” Website: www.insurenewmexico.state.nm.us/default.aspx To attend a PE/ MOSAA determiner training contact: Robyn Reede,  robyn.reede@state.nm.us On-line PE/ MOSAA determiner training modules http://learning.nmpca.org/, create login and password, look for last item under “other”

41. Contact Us Angela Medrano, Manager HSD/ MAD School Health Office,505-476-7123, Angela.Medrano@state.nm.us Suzy Whitehead MSN, RN, HSD/ MAD/ School Health Office Nurse Consultant, 505-827-6229, SuzyC.Whitehead@state.nm.us Nissa Patterson MPH, Program Manager NMASBHC, 505-259-2074, nissa@nmasbhc.org