AB 1296 Stakeholder Meeting

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AB 1296 Stakeholder Meeting. Transfer of Coverage. Transfer of Coverage. Transfer of coverage between Medi-Cal and Covered California. - PowerPoint PPT Presentation

Transcript of AB 1296 Stakeholder Meeting


AB 1296 Stakeholder Meeting

Transfer of CoverageTransfer of CoverageDHCS and Covered California are reviewing processes for transferring individuals between programs when a beneficiary loses coverage in their existing program. We want to look at the various ways to transition individuals between the two programs without adversely effecting the beneficiary to the extent possible.We want to ensure we make the best use of the technology available so that the two programs can seamlessly share data back and forth. We would like to solicit stakeholder feedback on these processes as they are developed.

Transfer of coverage between Medi-Cal and Covered California

CalHEERS ReportVerificationsNOAseHIT, Add a person, RenewalsFoster Youth, ImmigrantsProjected IncomeKnown DefectsRIDP

CalHEERS FunctionalitySeveral major areas of functionality will be deployed through June 2014

March 2014April 2014Medi-Cal Effective Dating/Discontinuances/NoticesMEDS Transactions Defect ResolutionMedi-Cal Pre-ACA Conversion Renewals - Report A Change Reporting - Add a person to Pre-ACA Medi-Cal or Non-MAGI caseMedi-Cal Negative ActionMedi-Cal Continuous Eligibility for Children (CEC)Medi-Cal Continuous Eligibility for Pregnant Women

Federal Poverty Level/COLA ProcessingResidency Verification (MEDS & Franchise Tax Board)MAGI-Based Medi-Cal Aid Code Hierarchy (Former Foster Care)eHIT Defect Resolution

CalHEERS FunctionalityMay 2014June 2014Medi-Cal Plan SelectionTransitional Medi-Cal (TMC) Business RulesSplit APTC Subsidized EnrollmentRIDP

PRUCOLFour-Month Continuing Medi-Cal for Parent/Caretaker RelativesInmate ProgramResidency Verification (DMV & EDD)

Medi-Cal Health Plan Selection

Roadmap for ImplementationMedi-Cal Health Plan Selection Functionality in CalHEERSCounty and Certified Enrollment Counselor Training

DHCS ReportMedi-Cal Health Plan SelectionCore Function to be included in Release 4.3:

Selection of Subplans, PCP, IPADisplay correct TLIHP plan costAllow pending applicants to choose planRedesign Medi-Cal Plan choice display: a) suppress cost-sharing information, b) show information about what services are currently offered and covered, c) provide information about carve-outs or what is not covered by the plan

Medi-Cal Health Plan Selection

Plan Enrollment for 1 Member

Medi-Cal Health Plan Selection

Cart Preview

Medi-Cal Health Plan SelectionFind a Plan: Dental

Medi-Cal Health Plan SelectionEnrollment Summary: Combined Medical and Dental

Certified Enrollment Counselor Training ModulesIntroduction to the Affordable Care ActIntroduction into the Medi-Cal ProgramPlan OptionsCompliance StandardsCertified Enrollment Counselor RolePrivacy and SecurityEligibility for Individuals and FamiliesProviding Consumer AssistanceTraining Topics Include:

Certified Enrollment Counselor Training ModulesCEC training on Plan Selection:

DO: DONT: Present plan options fairly and equitablyCoach applicants on what eligibility information to include on the applicationBe impartialInvite or influence an employee to leave employer-based group health coverageOnly provide recommendations regarding specific plans, doctors or hospitals over another where permitted for the role (e.g. Certified Insurance Agents or Plan-Based Enrollers)Accept money or other consideration from 3rd parties (unless as part of an Certified Insurance Agent or Plan-Based Enrollers commission.Coach or recommend one plan or provider over another.

13Open ForumAdditional questions, comments, or requests?