CMS Update and Dialogue Cheryl Camillo Supporting Families After Welfare Reform Breakthrough Series Collaborative Learning Session #2 New Orleans, LA November 13-15, 2002

Transitional Medicaid (TMA) Update Section 1925 extended through December 31, 2002 (for the first quarter of Federal Fiscal Year 2003) by Public Law , a continuing resolution. If not extended again, will sunset after December 31. If so, TMA under Section 1902(e)(1) of the Social Security Act will go into effect. So: –Families that become eligible for TMA before January 1, 2003 receive TMA under Section 1925 –Families that become eligible for TMA after January 1, 2003 receive TMA under Section 1902(e)(1).

TMA Update There are key differences between TMA under Section 1925 and TMA under Section 1902(e)(1). Under Section 1902(e)(1): –Families must lose Section 1931 Medicaid because of increased hours or earnings from employment of any family member; –Families receive 4 months of TMA; and –A family member must be employed for the family to receive TMA.

QI (Qualifying Individuals) Update QI-1s Public Law (as amended by P.L.s an ) extended this benefit at current funding levels through January 21, State can make January Part B premium payment and should not take any action to notify or terminate QI–1s at this time.

QI (Qualifying Individuals) Update QI - 2s Sunsets after December 31, States should provide advance notice of termination action informing recipients that termination was caused by Federal law. Notice should advise recipients to contact the state if their income has changed, as they may be eligible for other programs. States need not provide a hearing opportunity.

QI (Qualifying Individuals) Update QIs Explanatory State Medicaid Director letter issued on November 6, A copy can be found in each notebook and on CMS’ Web site at:

HIFA (Health Insurance Flexibility and Accountability Demonstration Initiative) Encourages new, comprehensive state approaches that will increase number of individuals with health insurance coverage using current-level Medicaid and SCHIP resources. Emphasizes maximizing private health insurance coverage and targeting populations with income below 200% FPL. Application guidance and template can be found at: 7 waivers have been approved (Arizona, California, Colorado, Illinois, Maine, new Mexico, and Oregon).

HIFA Arizona – Uses Title XXI funds to expand coverage to: (1) adults over 18 without dependent children and with adjusted net family income at or below 100% FPL and (2) otherwise ineligible parents of Medicaid and SCHIP children with adjusted net family income between 100% and 200% FPL Maine – Will cover all individuals with incomes at or below 100% FPL (option to go to 125% FPL) using available DSH funds and a cigarette tax increase for the state share.

HIFA Interested states can contact Theresa Sachs at (410) or

Prenatal Care for Unborn Children Rule Final rule published October 2, 2002 (Fed. Reg. Vol. 67, No. 191, Pg ). A copy can be found in each notebook or at: Allows states to file a state plan amendment (a waiver is not necessary) to use existing SCHIP funding for coverage for children from conception to birth and up to age 19. Allows states to provide this benefit regardless of mother’s immigration status.

Limited English Proficiency (LEP) Guidance August 30, 2000 HHS LEP guidance republished for comment on February 1, 2002 (Fed. Reg. Vol. 67, No. 22, Pg. 4968). A copy can be found in each notebook or on CMS’ Web site at: August 30, 2000 guidance is effective until revised guidance is published.

LEP Guidance In deciding what language assistance services to provide, recipients of Federal funding should conduct an analysis of four factors: –The number or proportion of LEP persons eligible to be served or likely to be encountered, –The frequency with which LEP individuals come into contact with the program. –The nature or importance of the program, activity, or service to people’s lives, and –The resources available to the grantee/recipient and costs.

LEP Guidance There is no “one size fits all” solution. OCR will make assessment on case-by-case basis and recipient will have flexibility in determining how to fulfill obligation. OCR will focus on the end result. Key to providing meaningful access is to ensure that the recipient and LEP person can communicate effectively.

LEP Guidance Recipients have two main ways of providing language services: –Oral, –Written. Quality and accuracy of the language service is critical in order to avoid serious consequences to the LEP person and to the recipient.

LEP Guidance Recipients of Federal funding should develop implementation plan. The following five steps may be helpful: –Identify LEP individuals who need language assistance, –Include information about language assistance measures, –Include staff training, –Include measures to provide notice to LEP persons, –Include process for monitoring and updating the plan.

Electronic Applications States may use electronic applications. Per Federal regulation 42 CFR (b), the application must be “signed under a penalty of perjury.” States may obtain signatures as follows: –Electronically (e.g., using the digital certificate or digitized signature technologies), –Sending postcards to applicants asking them to attest to accuracy of online application, or –Applicant can print application or short statement, sign it, and send it to office via mail, fax, or hand delivery.

Rolling Renewals Use existing providers and community-based organizations to renew eligibility on-site. Successful renewals will receive an additional 12 months of coverage. Massachusetts performed pilot.

Notices Federal regulations at 42 CFR, Part 431, Subpart E and Part 435, Subpart J require that each applicant who is denied, awarded, or terminated from Medicaid receive timely written notice of the agency’s decision. Notices should explain the agency’s decision and the applicant’s/recipient’s rights and responsibilities, including the right to request a hearing.