Transitioning Medicaid Eligibility Systems at the County Level
19
County Commissioners’ Association of Ohio Winter Conference Doug Lumpkin December 9, 2013
Transcript of Transitioning Medicaid Eligibility Systems at the County Level
Title — Times New Roman 28pt, line spacing .85 Title 2 — Times New
RomanDoug Lumpkin
Medicaid Extension
Presumptive Eligibility
Objectives
The Ohio Integrated Eligibility project will transform the state’s health and human services benefit delivery for years to come.
The projects will:
• Redesign business processes helping offices gain efficiencies
• Transform and improve the way over 15,000 county and state workers support Ohioans
• Improve the efficiency of state and local services
• Simplify eligibility following the new guidelines through automated-technology processes
• Support multiple HHS programs servicing millions of Ohioans
• Optimize technology used by health and human services agencies
3
Last updated 12/13
The future vision for Ohio Benefits is to be an enterprise platform for healthcare related programs in Ohio
It gradually replaces the existing self-service portal (eGateway) and CRIS-E platforms
Medicaid applications are the first benefit to be processed through the new Ohio Benefits self- service portal and Ohio Integrated Eligibility system with coverage starting January 1st 2014
Other benefits programs including SNAP and TANF continue to run through eGateway and CRIS-
E, until they are incorporated in future phases of the project
Eventually other income-tested health and human services programs will be transitioned into the Ohio Benefits and the Ohio Integrated Eligibility system
4
Incorporation of Ohio Benefits and Integrated Eligibility system
E-Gateway & CRIS-E
through the Medicaid hotline.
Residents can still visit their local county JFS office to
apply for benefits.
When applying for benefits, there are multiple avenues but a single seamless process. Below are the three different avenues for a resident to apply for benefits in Ohio.
Ohio Benefits enables residents to apply for a variety of services 24/7
through a user friendly self- service website.
Now Online!
Last updated 12/13
NEW Ohio Benefits MAGI applicants
The Ohio Benefits website is secure and integrates with the new Ohio Integrated Eligibility System. It allows residents to create and access their cases.
6
Last updated 12/13 7
Open Lines of Communication
available to offer you support
In-person Representatives County JFS Coordinators – One per county County JFS Readiness Managers – One per region
Two-way communication
Monthly in-person working sessions with County Readiness Managers
Training Ohio customized Web-Based Training (WBT) for
MAGI and non-MAGI workers Ohio customized Instructor Led Training for
MAGI workers Training Environment with exercises for ILT and
training simulation practice Online help available in the new Integrated
Eligibility system
Department of Medicaid Technical Assistance Hotline for policy and technical issues
Readiness Efforts & How We Will Ensure Success
Last updated 12/13 8
Federal Data Hub Verifications
The connection between Ohio and the Federal Data Hub for verifications such as SSN, citizenship, and incarceration status is being finalized.
Integrated Eligibility — Project Update
Ohio Federal government
Ohio will send applications to the federal government for residents that did not qualify for Medicaid. This transfer is expected to begin sometime during December.
Federal government Ohio
Ohio will receive applications from the federal government from residents who applied through the marketplace but may be eligible for Medicaid in Ohio. This transfer is expected to begin near the end of December.
Medicaid Extension
Blue: Current Ohio Medicaid Eligibility
White: Coverage gap that will be covered by the extension of Medicaid
Diagonal lines: Eligible for Ohio Medicaid Spenddown
10
Last updated 12/13
A new group of residents, (childless
adults*) living up to 138% of the FPL,
are now eligible for Medicaid in Ohio.
• This new group includes parents
between 91-138% of the FPL
• This group is also defined as adults
between the ages of 19 to 64, who
are between 0 – 138% FPL and are
not eligible under another category
of Medicaid
Who?
How many Ohioans will be newly eligible under Medicaid extension?
Through the recent eligibility change,
Ohio is expected to see an additional
275,000 low-income residents come
onto the Medicaid rolls.
through 2015
How many?
When can the group newly eligible for Medicaid coverage apply?
The newly eligible population can begin applying on December 9, through Benefits.Ohio.Gov with coverage beginning on January 1, 2014.
When?
12
benefits?
weeks. Further information on when
newly eligible adults can apply will be
provided on the Ohio Benefits
How will Ohio be Impacted by Extension?
In 2010, 593,912 residents (6.9%) statewide were uninsured with income below 138% of poverty.
Source: US Census, Small Area Health Insurance Estimates (2010).
Presumptive Eligibility
Applications? What Type of Coverage is
Available Through PE?
• Federally Qualified Health Centers Look Alike
• Medicaid Participating Hospitals
• Full Medicaid Services
• Ambulatory Prenatal Care
When does PE begin?
Once eligible, PE begins immediately on the date a qualified provider determines eligibility (not the day the PE application was filed)
When does PE end?
1) When the resident is determined ineligible for full Medicaid benefits
2) If a full Medicaid application is not filed, PE ends the last day of the following month in which the individual was determined to be presumptively eligible
Presumptive Eligibility Details
Process in which certain qualified entities are able to perform a simplified eligibility review and grant immediate medical assistance to people applying for Medicaid (or CHIP, if applicable)
Last updated 12/13
The Ohio Integrated Eligibility project is made up of several phases:
• October 1, 2013 – Launch of Ohio Benefits! • December 9, 2013 – Ohio Benefits begins accepting applications for coverage beginning January 1. • January 2014 – Medicaid coverage begins for newly eligible individuals; increased functionality in Ohio Benefits to
support presumptive eligibility. • November 2014 – Increased functionality in Ohio Benefits to support the remainder of Medicaid eligible individuals. • January 2015 – Increased functionality in Ohio Benefits to support SNAP and TANF.
2013 2014 2015
All Medicaid benefits in Ohio Benefits and Ohio IE system
SNAP, TANF, and Medicaid benefits in Ohio Benefits and Ohio IE system
Presumptive Eligibility
Coverage Begins
Accepted
16
Last updated 12/13
• Benefits.Ohio.Gov
Thank you for your continued support!
17
Medicaid Extension
Presumptive Eligibility
Objectives
The Ohio Integrated Eligibility project will transform the state’s health and human services benefit delivery for years to come.
The projects will:
• Redesign business processes helping offices gain efficiencies
• Transform and improve the way over 15,000 county and state workers support Ohioans
• Improve the efficiency of state and local services
• Simplify eligibility following the new guidelines through automated-technology processes
• Support multiple HHS programs servicing millions of Ohioans
• Optimize technology used by health and human services agencies
3
Last updated 12/13
The future vision for Ohio Benefits is to be an enterprise platform for healthcare related programs in Ohio
It gradually replaces the existing self-service portal (eGateway) and CRIS-E platforms
Medicaid applications are the first benefit to be processed through the new Ohio Benefits self- service portal and Ohio Integrated Eligibility system with coverage starting January 1st 2014
Other benefits programs including SNAP and TANF continue to run through eGateway and CRIS-
E, until they are incorporated in future phases of the project
Eventually other income-tested health and human services programs will be transitioned into the Ohio Benefits and the Ohio Integrated Eligibility system
4
Incorporation of Ohio Benefits and Integrated Eligibility system
E-Gateway & CRIS-E
through the Medicaid hotline.
Residents can still visit their local county JFS office to
apply for benefits.
When applying for benefits, there are multiple avenues but a single seamless process. Below are the three different avenues for a resident to apply for benefits in Ohio.
Ohio Benefits enables residents to apply for a variety of services 24/7
through a user friendly self- service website.
Now Online!
Last updated 12/13
NEW Ohio Benefits MAGI applicants
The Ohio Benefits website is secure and integrates with the new Ohio Integrated Eligibility System. It allows residents to create and access their cases.
6
Last updated 12/13 7
Open Lines of Communication
available to offer you support
In-person Representatives County JFS Coordinators – One per county County JFS Readiness Managers – One per region
Two-way communication
Monthly in-person working sessions with County Readiness Managers
Training Ohio customized Web-Based Training (WBT) for
MAGI and non-MAGI workers Ohio customized Instructor Led Training for
MAGI workers Training Environment with exercises for ILT and
training simulation practice Online help available in the new Integrated
Eligibility system
Department of Medicaid Technical Assistance Hotline for policy and technical issues
Readiness Efforts & How We Will Ensure Success
Last updated 12/13 8
Federal Data Hub Verifications
The connection between Ohio and the Federal Data Hub for verifications such as SSN, citizenship, and incarceration status is being finalized.
Integrated Eligibility — Project Update
Ohio Federal government
Ohio will send applications to the federal government for residents that did not qualify for Medicaid. This transfer is expected to begin sometime during December.
Federal government Ohio
Ohio will receive applications from the federal government from residents who applied through the marketplace but may be eligible for Medicaid in Ohio. This transfer is expected to begin near the end of December.
Medicaid Extension
Blue: Current Ohio Medicaid Eligibility
White: Coverage gap that will be covered by the extension of Medicaid
Diagonal lines: Eligible for Ohio Medicaid Spenddown
10
Last updated 12/13
A new group of residents, (childless
adults*) living up to 138% of the FPL,
are now eligible for Medicaid in Ohio.
• This new group includes parents
between 91-138% of the FPL
• This group is also defined as adults
between the ages of 19 to 64, who
are between 0 – 138% FPL and are
not eligible under another category
of Medicaid
Who?
How many Ohioans will be newly eligible under Medicaid extension?
Through the recent eligibility change,
Ohio is expected to see an additional
275,000 low-income residents come
onto the Medicaid rolls.
through 2015
How many?
When can the group newly eligible for Medicaid coverage apply?
The newly eligible population can begin applying on December 9, through Benefits.Ohio.Gov with coverage beginning on January 1, 2014.
When?
12
benefits?
weeks. Further information on when
newly eligible adults can apply will be
provided on the Ohio Benefits
How will Ohio be Impacted by Extension?
In 2010, 593,912 residents (6.9%) statewide were uninsured with income below 138% of poverty.
Source: US Census, Small Area Health Insurance Estimates (2010).
Presumptive Eligibility
Applications? What Type of Coverage is
Available Through PE?
• Federally Qualified Health Centers Look Alike
• Medicaid Participating Hospitals
• Full Medicaid Services
• Ambulatory Prenatal Care
When does PE begin?
Once eligible, PE begins immediately on the date a qualified provider determines eligibility (not the day the PE application was filed)
When does PE end?
1) When the resident is determined ineligible for full Medicaid benefits
2) If a full Medicaid application is not filed, PE ends the last day of the following month in which the individual was determined to be presumptively eligible
Presumptive Eligibility Details
Process in which certain qualified entities are able to perform a simplified eligibility review and grant immediate medical assistance to people applying for Medicaid (or CHIP, if applicable)
Last updated 12/13
The Ohio Integrated Eligibility project is made up of several phases:
• October 1, 2013 – Launch of Ohio Benefits! • December 9, 2013 – Ohio Benefits begins accepting applications for coverage beginning January 1. • January 2014 – Medicaid coverage begins for newly eligible individuals; increased functionality in Ohio Benefits to
support presumptive eligibility. • November 2014 – Increased functionality in Ohio Benefits to support the remainder of Medicaid eligible individuals. • January 2015 – Increased functionality in Ohio Benefits to support SNAP and TANF.
2013 2014 2015
All Medicaid benefits in Ohio Benefits and Ohio IE system
SNAP, TANF, and Medicaid benefits in Ohio Benefits and Ohio IE system
Presumptive Eligibility
Coverage Begins
Accepted
16
Last updated 12/13
• Benefits.Ohio.Gov
Thank you for your continued support!
17
