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Transitional MinnesotaCare. 2007 MFWCAA Conference Health Care Training Jen Gerber. Agenda . Renewal vs. HCAPP Retro MinnesotaCare Coverage and Premium Payments Financial Control Basics Health Plan Enrollment Who answers MinnesotaCare questions? Resources. Renewal vs. HCAPP.
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Transitional MinnesotaCare 2007 MFWCAA Conference Health Care Training Jen Gerber
Agenda • Renewal vs. HCAPP • Retro MinnesotaCare Coverage and Premium Payments • Financial Control Basics • Health Plan Enrollment • Who answers MinnesotaCare questions? • Resources
Renewal vs. HCAPP
Timely T-MCRE Renewal • Was an MA basis of eligibility gained – if so, determine for MA. • If not, determine eligibility for MCRE.
Timely T-MCRE Renewal • Apply all MCRE eligibility criteria and program rules. • If eligible, approve pending awaiting payment. • Subject to all MCRE rules and policies. • Must pay monthly premium. • Note: There is no penalty or barrier to future GAMC or T-MCRE eligibility for these applicants.
Timely T-MCRE Renewal • If the enrollee is not eligible for MCRE, do not require a new application. • Example: Enrollee now has access to ESI.
Late Renewals • Consider renewal forms submitted in the renewal month as applications for MCRE if there is no MA basis of eligibility. • Juan’s renewal month is February, his coverage ended the end of January. We receive his renewal on February 15. What do we do with the renewal?
Late Renewals • Applicant sends in a renewal after the renewal month. • Find out what program the applicant wants to apply for.
Late Renewal • If MCRE: • Use the renewal as a new application. • They will have a gap in coverage. • Not eligible for retro. • Can be forwarded to MCRE Ops is county is not a MCRE enrollment site. • If all programs: • Need a new HCAAP. Send one out.
Require a new application • Any time a former T-MCRE enrollee wants to reapply for MA, GAMC, or T-MCRE. • John’s T-MCRE ended the end of last month and he did not reapply. Now wants T-MCRE again. Do we need a new app? Can we use a renewal for T-MCRE?
Examples – When to require a new application • After the effective date of T-MCRE closure. • While MCRE is pending. • After failing to transition to MCRE after having been determined eligible at renewal. • After transitioning to MCRE and then having coverage closed for any reason. • Etc.
Retro MinnesotaCare And Premium Payments
Retro MCRE • Eliminate gaps in coverage. • All T-MCRE/GAMC/MA clients are eligible if they apply for MCRE within 30 days of their coverage closing. • Don’t assume there is enough time left in the month.
Retro MCRE • On August 1st , you close T-MCRE for September 1st, and approve MCRE for September 1st. • Household has until August 31st to make initial premium payment. • Set up retro for September, ongoing for October. • Send Retro Notice – DHS-3446.
Making first premium payment • Must be paid before noon on the last business day. • Always paying the ongoing premium only. • Can be made online, mailed or in person in St. Paul.
Retro Premium Payments • To be eligible for retro coverage, clients must pay the initial and optional (retroactive) MCRE premiums by the end of the month following the month of premium billing. • Must be paid for the entire retro period.
Retro Premium Payments • The Retro Premium is mailed to the enrollee after the ongoing premium is paid. • Contact the MMIS Help Desk to get funds moved if applied to the incorrect month.
Retro Coverage Example • Eligibility determined and initial premium mailed on January 14. • Initial premium must be rec’d by last working day in Feb. to be considered for retro coverage. • Premium rec’d Feb 20, retro months will be Jan. and Feb. • Premium rec’d March 1, denied retro.
Initial and Retro Premium Payments If the initial premium for ongoing eligibility: Is received by the end of the month following the billing month: • MMIS will send the option premium notice if they were set up for retro eligibility. • The enrollee must pay the optional premium by the end of the month following the optional billing month.
Initial and Retro Premium Payments If the initial premium for ongoing eligibility: Is not received by the end of the month following the billing month: • MMIS will deny retroactive MCRE. • Ongoing MCRE will remain pending for up to three additional months on MMIS.
Initial and Retro Premium Payments If the optional premium: Is received before the due date: • MMIS will approve retroactive MCRE from the date that MA or GAMC closed to the date ongoing MCRE began. • Enrollees must accept retroactive coverage for all available months.
Initial and Retro Premium Payments If the optional premium: Is not received by the due date: • MMIS will deny retroactive MCRE. • Ongoing MCRE remains active.
Financial Control
Health Plan Enrollment
Health Plan Enrollment • Case is processed and made P41. • MMIS creates and enrollment form and assigns a default health plan. • Enrollment packet mailed to household. • Household fills out info and mails back. • DHS receives form and the info is entered onto RCHP.
Health Plan Enrollment After the 15th of the month: • Worker fills out the form with enrollee. • Map of health plans on Countylink under Managed Health Care Programs. • Fax it to DHS. Fax # 651-431-7464.
Fee-for-Service There are two exceptions when an enrollee will not be enrolled in a health plan. • Retro MCRE months. • Any Reinstatement month.
Who Answers MCRE Questions? • County MCRE case, the County servicing the case, answers the questions. • MCRE Operations case, MCRE Operations answers the questions.
Resources Helpful Resources: • Health Care Programs Manual • MMIS User Manual • MMIS User Services • 651-431-3930 • 1-800-366-7894 • HealthQuest