Transitional MinnesotaCare 2007 MFWCAA Conference Health Care Training Jen Gerber

2 Agenda Renewal vs. HCAPP Retro MinnesotaCare Coverage and Premium Payments Financial Control Basics Health Plan Enrollment Who answers MinnesotaCare questions? Resources

3 Renewal vs. HCAPP

4 Timely T-MCRE Renewal Was an MA basis of eligibility gained – if so, determine for MA. If not, determine eligibility for MCRE.

5 Timely T-MCRE Renewal Apply all MCRE eligibility criteria and program rules. If eligible, approve pending awaiting payment. –Subject to all MCRE rules and policies. –Must pay monthly premium. –Note: There is no penalty or barrier to future GAMC or T-MCRE eligibility for these applicants.

6 Timely T-MCRE Renewal If the enrollee is not eligible for MCRE, do not require a new application. Example: Enrollee now has access to ESI.

7 Late Renewals Consider renewal forms submitted in the renewal month as applications for MCRE if there is no MA basis of eligibility. Juan’s renewal month is February, his coverage ended the end of January. We receive his renewal on February 15. What do we do with the renewal?

8 Late Renewals Applicant sends in a renewal after the renewal month. Find out what program the applicant wants to apply for.

9 Late Renewal If MCRE: 1.Use the renewal as a new application. 2.They will have a gap in coverage. 3.Not eligible for retro. 4.Can be forwarded to MCRE Ops is county is not a MCRE enrollment site. If all programs: 1.Need a new HCAAP. Send one out.

10 Require a new application Any time a former T-MCRE enrollee wants to reapply for MA, GAMC, or T-MCRE. John’s T-MCRE ended the end of last month and he did not reapply. Now wants T-MCRE again. Do we need a new app? Can we use a renewal for T-MCRE?

11 Examples – When to require a new application After the effective date of T-MCRE closure. While MCRE is pending. After failing to transition to MCRE after having been determined eligible at renewal. After transitioning to MCRE and then having coverage closed for any reason. Etc.

12 Retro MinnesotaCare And Premium Payments

13 Retro MCRE Eliminate gaps in coverage. All T-MCRE/GAMC/MA clients are eligible if they apply for MCRE within 30 days of their coverage closing. Don’t assume there is enough time left in the month.

14 Retro MCRE On August 1 st, you close T-MCRE for September 1 st, and approve MCRE for September 1 st. Household has until August 31 st to make initial premium payment. Set up retro for September, ongoing for October. Send Retro Notice – DHS-3446.

15 Making first premium payment Must be paid before noon on the last business day. Always paying the ongoing premium only. Can be made online, mailed or in person in St. Paul.

16 Obligation ID/Invoice Number

17 Obligation ID/Invoice Number

18 Retro Premium Payments To be eligible for retro coverage, clients must pay the initial and optional (retroactive) MCRE premiums by the end of the month following the month of premium billing. Must be paid for the entire retro period.

19 Retro Premium Payments The Retro Premium is mailed to the enrollee after the ongoing premium is paid. Contact the MMIS Help Desk to get funds moved if applied to the incorrect month.

20 Retro Coverage Example Eligibility determined and initial premium mailed on January 14. Initial premium must be rec’d by last working day in Feb. to be considered for retro coverage. Premium rec’d Feb 20, retro months will be Jan. and Feb. Premium rec’d March 1, denied retro.

21 Initial and Retro Premium Payments If the initial premium for ongoing eligibility: Is received by the end of the month following the billing month: –MMIS will send the option premium notice if they were set up for retro eligibility. –The enrollee must pay the optional premium by the end of the month following the optional billing month.

22 Initial and Retro Premium Payments If the initial premium for ongoing eligibility: Is not received by the end of the month following the billing month: –MMIS will deny retroactive MCRE. –Ongoing MCRE will remain pending for up to three additional months on MMIS.

23 Initial and Retro Premium Payments If the optional premium: Is received before the due date: –MMIS will approve retroactive MCRE from the date that MA or GAMC closed to the date ongoing MCRE began. –Enrollees must accept retroactive coverage for all available months.

24 Initial and Retro Premium Payments If the optional premium: Is not received by the due date: –MMIS will deny retroactive MCRE. –Ongoing MCRE remains active.

25 OSEL with Retro Obligation

26 Financial Control

27 OBLG

28 OSLT

29 OACT

30 Health Plan Enrollment

31 Health Plan Enrollment Case is processed and made P41. MMIS creates and enrollment form and assigns a default health plan. Enrollment packet mailed to household. Household fills out info and mails back. DHS receives form and the info is entered onto RCHP.

32 Health Plan Enrollment After the 15 th of the month: –Worker fills out the form with enrollee. –Map of health plans on Countylink under Managed Health Care Programs. –Fax it to DHS. Fax #

33 Fee-for-Service There are two exceptions when an enrollee will not be enrolled in a health plan. 1. Retro MCRE months. 2. Any Reinstatement month.

34 Who Answers MCRE Questions? County MCRE case, the County servicing the case, answers the questions. MCRE Operations case, MCRE Operations answers the questions.

35 Resources Helpful Resources: –Health Care Programs Manual –MMIS User Manual –MMIS User Services –HealthQuest