Montana Medicaid expansion and the help plan October 11, 2016 Presented by jade Atkinson & Rebecca corbett

Renewals As of January 01, 2016, the State has an automated renewal process. CHIMES EA identifies all ACA benefit recipients – standard Medicaid and HELP – that are due for Renewal and verifies those which are reasonably compatible with regard to Demographic and Income information. This is completed using our electronic data sources If all demographic and income information are compatible (within 10%), the individual’s benefits are renewed and a notice is sent. If the person cannot be automatically renewed, the individual will be sent a renewal form. The form does not need to be returned, but new information must but sent in to the State along with a signature. The signature can be verbal, electronic, or hand written. Renewals can be completed by mailing or faxing in the information, online at apply.mt.gov, in person, or over the phone by calling the Public Assistance Help Line at 1-888-706-1535. The renewal form does not include information about available assistance from enrollment assisters. The renewal form is for all Medicaid programs and not specific to ACA programs.

Continuous Eligibility For all ACA health coverage programs, there is a 12 month continuous eligibility span. This means changes in income and filing units will not affect the individual’s eligibility unless they request a recalculation of their premium or maximum out of pocket expense. There are eight circumstances where an individual’s health coverage may be terminated during the span: No longer a Montana resident Requests termination of benefits Individual dies Failure to provide or obtain a Social Security Number Individual provides an incorrect or fraudulent Social Security Number Failure to provide citizenship or immigration status documentation Individual found ineligible during Post Eligibility Verification process or Medicaid was determined in error Individual cannot be located

INcome Income is countable towards all other individuals that are included in the income earner’s filing unit. Example: Household is boyfriend, girlfriend, and their child in common; they file separately since they are not married and girlfriend claims the child as a dependent and all are applying for health coverage. Income will count towards boyfriend’s and child in common’s eligibility. Look back period = retro coverage Income for any retro month is counted in full – we use all income received in the retro month to determine eligibility Example: application received 10/01/2016 and individual lost their job on 09/16/2016 and final check was received 09/30/2016. For 10/2016 and ongoing we would not use any income to determine eligibility, but for retro months of July, August, and September we would use all income the individual received in those months. Individuals determined ineligible at application or renewal due to being over the income standard are electronically transferred to the Federal Marketplace in a nightly batch process. There should be no gap in coverage for the individual and the data transfer process from the State to the Marketplace has been working smoothly.

Disenrollment If an individual on the HELP TPA program hasn’t paid his/her premium for 90 days or more, s/he will be disenrolled from services at the 120 day point. Blue Cross Blue Shield of Montana will transfer the individual’s past due premiums and send them to the State (DPHHS). If the past due/delinquent premiums aren’t paid by the end of the quarter, they will be transferred to the Department of Revenue for tax offset. CHIMES EA will evaluate the individual for exemptions and will not disenroll the individual if they have an income less than 100% FPL or meet two exemptions. The individual still owes the past due/delinquent premiums, but remains eligible for services. The individual remains eligible for HELP TPA and will show as eligible in CHIMES EA, however, s/he will show as inactive to providers. Once the individual pays the past due/delinquent premiums or they are transferred to Department of Revenue, the individual is eligible for re-enrollment. The individual must opt-in to re-enroll. Can re-enroll online at apply.mt.gov, via an automated phone line at 1-844-792-2460, or by calling the Health Coverage Unit at 1-888-706-1535 option 5.

Exemptions from disenrollment Individuals can be exempt from disenrollment if: Individual’s MAGI income is less the 100% FPL OR two of the following: Individual was discharged form the U.S. military in the last 12 months Individual is enrolled for credit in any Montana university system, tribal college, or any other accredited college within Montana offering at least an associate degree. Can only use this exemption for 4 years Individual sees a primary care provider who is part of a patient-centered medical home Individual is in a substance use treatment program Individual is participating in the Department of Labor workforce program Individual is participating in the third party administrator (TPA) sponsored wellness program

Health Coverage unit The Health Coverage Unit is a unit of four Health Coverage Coordinators that work with more specialized programs. Presumptive Eligibility Breast and Cervical Cancer Treatment Subsidized Adoption Department of Corrections and Pre-Release Disenrollment & Re-enrollment of the HELP TPA program Please call the Public Assistance Helpline at 1-888-706-1535 and press option 5 to get in touch with someone from the Health Coverage Unit.

By Percent of County Population HELP Program Newly Enrolled By County (as of September 1, 2016) Total Newly Enrolled: 52,817 By Percent of County Population

MEDICAID EXPANSION Standard Medicaid Administered by Xerox HELP Plan Adults, ages 19-64 Incomes 0-138% FPL Montana residents US citizen or documented, qualified alien Not incarcerated Not eligible or enrolled in Medicare Standard Medicaid Administered by Xerox Individuals under 50% FPL Individuals determined to be medically frail American Indians/Alaska Natives Individuals who live in a geographical area with insufficient health care providers Individuals in need of continuity of care that would not be available or cost-effective through the TPA Not subject to premiums Subject to copayments Unless exempt by federal law HELP Plan Administered by Blue Cross and Blue Shield of Montana Individuals with 51-138% FPL Subject to copayments and premiums Unless exempt by federal law

Help plan benefits Services Processed by BCBSMT Behavioral Health (Mental Health and Substance Use Disorder) Convalescent Home (excludes Custodial Care) Durable Medical Equipment/Supplies Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Emergency Hospital Lab and X-Ray (Medical) Medical Vision and Exams Mid-Level Physician Rehabilitative and Habilitative Surgical Therapies (OT, PT, ST) Urgent Care

Help plan benefits Services Processed by Xerox Audiology Dental and Dentures Diabetes Prevention Program Eyeglasses Federally Qualified Health Center Hearing Aids Home Infusion Indian Health Service/Tribal Health Pharmacy Rural Health Clinic Transportation Remember: The participant will have a BCBSMT HELP Plan card, but these claims are processed by Xerox.

Standard Medicaid benefits All Services are Processed by Xerox Audiology Behavioral Health Services Clinic Services Dental Services Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Federally Qualified Health Clinic Hospital Services Immunizations Indian Health Service/Tribal Health Service Lab and X-Ray Services Nurse First Services Nursing Homes Occupational Therapy Pharmacy Physician Rural Health Clinic Tobacco Cessation Transportation Vision

HELP Healthy behavior plan Wellness Programs in the Healthy Behavior Plan Community Based Wellness Programs (DPHHS) Montana Living Life Well Program Diabetes Self-Management Education Arthritis Foundation Exercise Program Walk with Ease Program Diabetes Prevention Program Montana Tobacco Quit Line BCBSMT Wellness Programs Asthma Management Program Diabetes Prevention and Management Hypertension Tobacco/Smoking Cessation Weight Loss and Healthy Lifestyle Individualized Programs Participants may call BCBSMT Participant Services (877) 233-7055 to enroll or learn more about this benefit. Descriptions of these programs are available on the BCBSMT participant portal, and DPHHS Community Based Program page.

Contacts and resources Jade Atkinson ACA Policy Specialist 406-883-7824 jatkinson@mt.gov Christie Twardoski Associate Administrator, Human & Community Services Division 406-444-1917 ctwardoski@mt.gov Rebecca Corbett HELP Program Officer 406-444-6869 rcorbett@mt.gov Renae Huffman 406-444-1355 rhuffman@mt.gov Office of Public Assistance http://dphhs.mt.gov/hcsd/officeofpublicassistance Helpline: 1-888-706-1535 Blue Cross and Blue Shield of Montana http://www.bcbsmt.com/mthelpplan Participant Services: 1-877-233-7055 Provider Services: 1-877-296-8206 Xerox http://medicaidprovider.mt.gov Member Services: 1-800-362-8312 Provider Relations: 1-800-624-3958