Jeanelle Romero PE Program Manager

NM Medicaid PE Program JUST Health System & Customer Service Updates HSD Forms & Applications

Presumptive Eligibility (PE) Short-term Medicaid coverage for eligible individuals Provides access to immediate coverage to eligible recipients Ensures assistance with submitting an application for possible ongoing Medicaid coverage Based on self-attestation MAD Certified PEDs determine eligibility If screened correctly, applicant will most likely be approved for ongoing Medicaid coverage Individuals may only receive one PE approval in a 12 month period (or one PE per pregnancy)

Presumptive Eligibility (PE) coverage Begins on the day the PE is granted by PED Retroactive coverage not available during PE span Ends on the last day of the following month unless ongoing Medicaid application is submitted PE will continue until final determination has been made for ongoing eligibility PE coverage ends on the last day of the month that final determination is made If more information is needed to determine ongoing eligibility, ISD will send a Help Us Make A Decision (HUMAD) form to client Client must supply information within the timeframe specified on the HUMAD

Presumptive Eligibility Determiners (PEDs) PEDs are employees of participating hospitals, clinics, FQHCs, DOH, schools, IHS providers, jails, prisons and community organizations Two types of PEDs 170 – Determine PE for Children and pregnant women (clinics, FQHCs, DOH, CYFD, schools and community organizations) 171 – Determine PE for children and pregnant women but also for COEs 100 & 200 (employees of hospitals, IHS facilities and prisons and jails)

PE Program Trainings PED Certification Trainings Second Tuesday of the month – full day webinar 8:30am to 4:30pm PED Certification Trainings for Jails\Prisons Two-day training at one of our HSD training labs – trainings conducted at request YESNM-PE Demos YES Fridays: 3rd Friday of each month

PE Program Tools NM Medicaid Web Portal YESNM-PE Used to check Medicaid eligibility YESNM-PE Used exclusively by certified PEDs Allows PEDs to screen, grant PE and submit ongoing Medicaid applications After YESNM-PE screening, if PE is granted, there is a direct data feed from YESNM-PE to ASPEN PED is notified immediately of applicant’s MCO enrollment If applicant is not immediately enrolled with an MCO, a task is generated for our PE Processors to work Our PEDs are getting the job done! Screening effectively for ongoing eligibility via YESNM-PE and submitting an app for ongoing coverage AND that is the ultimate goal.

YESNM-PE Check Client Benefits Click “Check Clients’ Benefits; Takes you to Linking Account page. Enter the SSN or ASPEN ID of the individual who want to view Medicaid benefits for. **Reminder, you will only be able to view Medicaid benefits**

YESNM-PE Check Client Benefits After you successfully link to the client’s account, you will see their account information, the status of the case, current client contact information (mailing address, phone number), authorized representative (if one exits on case); and if any HUMADs have been sent with details on what has been requested. Click on “Learn More”

YESNM-PE Check Client Benefits You will be able to review 3 months of potential benefit issuance. If you click on the hyperlink In this example, the client is not receiving any Medicaid benefits for the month of February 2018, March 2018 and or April 2018. We are still waiting for proof of income to be received.

YESNM-PE Check Client Benefits You can see if an individual has been sent a HUMAD, what the HUMAD is requesting, when the HUMAD was sent and when it’s due. If you are able to get the requested documents from the client, you can upload them directly into client’s case through YESNM-PE by clicking “upload”.

YESNM-PE Check Client Benefits This individual has been approved for Medicaid. When viewing eligibility, the client’s status will always show for the current month. This screen shot shows the individual is getting Medicaid for March 2018. To get more details on that eligibility you would click “Learn More” The next screen will give you benefit details like the COE the client is receiving and the MCO. In this scenario the client has MAGI for Adults and the client is enrolled with United Health Care.

JUST Health Justice-Involved Utilization of State Transitioned Healthcare HSD enters into an agreement with agency/county for data sharing HSD receives daily interface with correctional facilities to suspend rather than close Medicaid eligibility for individuals defined as inmates (per NMAC) Release information sent to HSD to reinstate benefits upon release JUST Health implemented June, 2016 with NMCD; other entities phased in

JUST Health Program Numbers Currently participating counties/agencies: CY 2017 7,324 suspensions; 5,876 reinstatements 128 Presumptive Eligibility determinations 3,285 ongoing applications filed 3,005 ongoing application approved New Mexico Department of Corrections (all facilities) San Juan County Bernalillo County Sandoval County Children Youth and Families Department (juvenile justice facilities) Santa Fe County Dona Ana County New Mexico Department of Health -Forensic Unit Rio Arriba County

11/15/2018 Suspended Benefits The suspension will be viewable in the New Mexico Medicaid Portal with the original Category of Eligibility (COE) the individual is eligible for. Suspensions in the Portal The example shows the suspension effective 04/02/2017 – meaning that the individual had been incarcerated for more than 30 days so the Booking date for this individual is 03/03/2017. Now in this example, we can also see that the suspension was from 4/2/17 through 8/31/2017. Well, we’re in October, so this individual’s suspension has ended meaning he has been released from incarceration. If the individual were still in a suspended status, the date 8/31/2017 would instead show today’s date, meaning they are currently suspended as of today.

Suspended Benefits MCO Enrollments 11/15/2018 Suspended Benefits MCO Enrollments Another way you’ll see when an individual has been or is currently Suspended is by looking at their MCO enrollment information. Here you can see this individual was enrolled in BCBS from 8/1/16 through 3/31/2017 when their benefits were suspended due to being incarcerated for more then 30 days. But now you can see that coverage began again 9/1/17 and is currently ongoing. This means the individual was released, and their benefits resumed.

Short Term Medicaid for Incarcerated Individuals (STMII) Program 11/15/2018 Short Term Medicaid for Incarcerated Individuals (STMII) Program The incarcerated individual must be approved for Medicaid and have benefits suspended for services to be covered under STMII program STMII claims may only be Medicaid-covered services for inpatient hospital stays of 24 hours or more STMII claims: the individual may be eligible for STMII multiple times a year STMII is only covered for correctional facilities that have a GSA contract with HSD contact MAD PE Program Staff for STMII questions Regular PEDs don’t grant PE or submit app for Incarcerated individuals. This is only for those who are contracted. HSD will not pay for STMII claims for individuals who are incarcerated in a facility that is not contracted with HSD.

JUST Health New Counties Next Phase “Live” Spring/Summer, 2018 Chaves County Curry County Eddy County Roosevelt County Quay County Discussions have occurred; verbal commitment for counties; MOA in process

PE Program Numbers January – December, 2017 Access to YESNM-PE is ONLY available to certified PEDs 635 Current PEDs statewide PE Type 170: 359 PE Type 171: 276 2,661 PEs Granted in 2017 2,593 PEs (or 97%) of all PEs granted had an ongoing Medicaid application submitted 23,519 individuals have been assisted with Medicaid applications through YESNM-PE 19,981 individuals (84.96%) were approved for ongoing Medicaid YESNM-PE utilized for PE screening and application submission; Number of PEDs includes correctional facility-based PED

NM Systems & Customer Service Updates System Updates: November through December 2017 – Expanded Conduent Call Center to assist with ISD Customer Service Center calls Medicaid Call Center 888-997-2583 ISD Customer Service 800-283-4465 December 2017 – Movement of Medicaid enrollment functions to ASPEN PE approvals feed directly into ASPEN instead of Omnicaid

NM Systems & Customer Service Updates Medicaid ID Cards Hard-plastic, blue Medicaid ID Card no longer issued FFS clients Receive heavy-weight paper version of card Request replacement cards through YESNM or the Conduent Call Center Managed Care enrollees Only receive MCO-issued cards Request replacement cards directly from MCOs

HSD Forms & Applications PED & Provider Forms Current forms should always be utilized Most up to date versions of forms on the NM Medicaid Web Portal: https://nmmedicaid.portal.conduent.com/static/index.htm

Applications & Information for Clients YESNM www.yes.state.nm.us Apply for benefits Renew Benefits Request Change of MCO (if in allowable switch period) FFS Clients may Request Replacement Medicaid ID card HSD Paper Applications MAD 100 (Medicaid Only Application) HSD 100 (All HSD Programs) Available on the HSD web site http://www.hsd.state.nm.us/LookingForAssistance/apply-for- benefits.aspx

PED & JUST Health Information Request YES-NM demo session schedules Request PED Training session schedules For information on PED enrollment status Questions regarding JUST Health HSD.PEDeterminers@state.nm.us

Opt In/Out of MCO Enrollment Conduent Call Center 1-888-997-2583 HSD/MAD/CEB Armando Muñoz Orlando Vasquez HSD.PEDeterminers@state.nm.us

MAD/CEB PE Program Staff PE Program Unit Jeanelle Romero – PE Program Unit Manager Vanessa Medina – PE Program Trainer\Auditor Edmundo Barraza – Enrollment\Reporting Specialist Roberta Roybal – Enrollment Specialist Pam Champion – PE Program Auditor Kimberly Lucero – Application Processing Manager Esli Ornelas- Application Processor Elaine Martinez- Application Processor Carol Baca – Application Processor HSD.PEDeterminers@state.nm.us

Questions?