Welcome 2015 Open Enrollment, SES and CBMS Training

For all October 2015 build projects, please visit TrainColorado.com for more information. Courses > CBMS Build Training > October 2015> CBMS/PEAK October 2015 Build Project Guide – HCPF

Glossary  SES – Shared Eligibility System  MA - Medical Assistance  APTC - Advanced Premium Tax Credits  CSR - Cost Sharing Reductions  C4HCO or C4 - Connect for Health Colorado

Open Enrollment 2016  Open Enrollment is an opportunity for those who want to apply for Federal Financial Assistance to help purchase private health insurance through C4HCO for the 2016 plan year  Open Enrollment begins November 1, 2015  Open Enrollment ends January 31, 2016  It does not impact current Medicaid or CHP+ clients unless they are no longer eligible for Medicaid or CHP+  Client must receive a MA denial during the Open Enrollment Period in order to enroll in a plan

Applying for Medical Assistance (MA)  No wrong door for applications  Phone, Fax, PEAK/SES, Paper, In person  SSAp, Single Purpose Application (SPA)

Shared Eligibility System (SES)  Applicants applying for MA only through PEAK or C4  MA only application includes CHP+, APTC and CSR results  Eligibility determined individually

Questions?

CBMS C4HCO User Interface/User Experience Updates Project 8764

Current Functionality  Many application questions need to be answered for MA applicants  Many questions from applicants about the MA application and the process

After Build Functionality  PEAK/SES changes  CBMS page changes  MA eligibility changes

PEAK Changes

Mandatory PEAK Questions  Apply for Benefits MA only Applications:  What type of coverage is this person currently enrolled in?  Who else has access to this coverage  Is this person a U.S. citizen?  Is ___ currently enrolled in a health plan offered by (employer)?  Is anyone in your home covered by Health Insurance that you have not already reported above?  Report My Changes/RRR MA only cases:  Is this person a resident of Colorado?  Is this person a U.S. citizen?  Who else has access to this coverage?

RMC/RRR Summary Page

CBMS Changes  Past expenses added for APTC  Private Disability Taxable amount added to income received details page  Qualifying widow(er) with dependent child added to individual tax information page  Ethnicity page changes

CBMS Changes

Questions?

CBMS Connect for Health Colorado Big Rocks Project 8759

Overview of Changes  CBMS and PEAK changes for MA  Add expedited income path for MA only applications  Add avatar to the SES  Add summary page to SES  Allow client to review prior to submitting application  SES changes for life change events  Create Service center portal for customer service representatives

MA Standard Income Path  Standard Income Path  Combo applications (MA, CDHS)  Possible Non-MAGI Household (over 64 years old, disabled, needs care)  HH members not lawfully present  No tax filers  Married filing separately tax filing status

MA Expedited Income Path  Expedited Income Path  Client can reports tax household’s annual income

MA Expedited Income Path cont.  Multiple tax households on same application  FPL thresholds 10% higher than normal FPLs for MA categories  Expedited income not matched with IEVS

AI/AN Expedited or Standard?  AI/AN income = yes than Standard  AI/AN income = no than Expedited

Apply for Benefits (AFB) Expedited Income Path applications If the RTE determination is successful and the eligibility results are mixed meaning there are APTC and MA individuals then the application will be assigned to the C4 caseload If no individuals are approved for APTC/CSR then the application will be assigned to the County of residence If the RTE determination is un-successful the application will be assigned to the State of Colorado inbox where C4 workers will be able to process the application

Report My Changes (RMC) Applications If a client submits a change using Report My Changes within 15 months of the APTC only case being closed and that application is routed down the Expedited Path then the application will be assigned to the State of Colorado inbox. If a client submits a change using Report My Changes within 15 months of the APTC only case being closed and that application is routed down the Standard Path then the application will be assigned to the County Inbox

Meet Kyla

Application Summary Page  Review MA application prior to submitting  Correct/edit information prior to submitting

Eligibility Results Page  Summary page to show client how eligibility was determined  Gross income  HH composition  Denial reason  Non countable income  Deductions that are counted  Expenses that are being counted

Life Change Events (LCE)  LCE’s will be asked in PEAK after the client reports changes  Summary page to confirm changes, add additional LCE(s)

Questions?

CBMS C4HCO Life Change Event Updates Project 8761

Current Functionality  Life Change Events (LCE) based off data entry  Eligible APTC/CSR individuals are not being approved

After build Functionality  CBMS page changes  Life Change Event changes

CBMS Page changes

System Determined LCEs

Questions?

CBMS C4HCO Policy Rules Engine Updates Project 8765

Overview of Changes  Policy and rule changes regarding Pregnancy  Shared Eligibility System(SES) changes  Intercounty Transfer changes

Pregnancy Changes  APTC/CSR individual reporting pregnancy in RMC/RRR  Does the client want to remain on APTC/CSR?

SES Changes  MA closed in past 15 months  User has to go through RMC/RRR

Intercounty Transfer Changes  MA case contains Marketplace eligible (Marketplace only or mixed HH) individual = MA assigned to C4HCO  Ability to push MA case to new C4HCO caseload

Questions?

C4HCO Noticing Updates Project 8762

Current Functionality  MA/APTC summary boxes combined  MA/APTC correspondence is confusing to clients

After build Functionality  MA and APTC are separated  Eligibility Start Date added  Translation page provided  Denver Health contact info in NOA – CHP+

NOA Layout Example

Questions?

Case Assignment

 New office within Denver Health is Colorado Medical Assistance Program (CMAP)  Separate from Denver Health MA Site

Denver Health Colorado Medical Assistance Program (CMAP)  CMAP will receive Department of Corrections (DOC) applications (only) in the PEAK Inbox, including DOC real time eligibility (RTE) exceptions from PEAK. All other PEAK RTE exceptions will be routed to the PEAK Inbox for the Head of Household’s (HOH) County of Residence  CMAP will take phone applications and, upon authorization, the case will be assigned to the HOH County of Residence  CMAP will keep and maintain all DOC and Buy-In (Adult & Children) cases  CMAP will process CHP+ enrollment fees and Buy-In premiums. CMAP will not keep or maintain CHP+ cases

Denver Health MA Site  Denver Health MA Site will process any applications they receive and, upon authorization, they will keep and maintain that case regardless if it is all MAGI, Non-MAGI, or a combination of both

Counties  All PEAK RTE exceptions (not including DOC applications) will now be assigned to the HOH County of Residence  Combo applications and Non-MAGI applications (except those Non-MAGI applications initiated by Denver Health MA Site) will continue to be assigned to the HOH County of Residence

Connect For Health Colorado

Connect for Health Colorado  The C4HCO caseload assignment will remain unchanged  Cases with APTC or MA/APTC will be assigned to the C4HCO caseload

Who Does what?  Certified Health Insurance Agents & Brokers  Help customers with application and enrollment  Advice comparing rates, evaluating benefits and purchasing health plans  Receive commissions from insurance companies  Services are free to the customer  Health Coverage Guides & Certified Application  Educate, engage and enroll customers in health plans through marketplace  In person assistance with the individual application process and enrollment  Act in the best interest of the customers  Customer Service Representatives  Help customers with Financial Assistance and Non- Financial Assistance applications through to enrolling in a health plan  Help address or escalate questions and issues through call-in support, and online chat

Questions?

Additional Resources  Staff Development Center Inbox:  Medicaid Inbox:  Customer contact Center # (800)  Connect For Health Colorado Call Center # PLANS-4-YOU ( )  PEAK Technical issues: