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Washington Apple Health
Washington Coalition of Medicaid Outreach - Wenatchee Amy Johnson Office of Medicaid Eligibility Policy Medicaid Eligibility & Community Support June 23, 2017
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Topics HCA Updates Enrollments & Renewals
Alien Emergency Medical (AEM) New Mobile Application Correspondence Senate Bill 6430 Update Share your Story Notices Workgroup Resources
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Washington Apple Health
HCA Updates Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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HCA Updates Potential Government Shutdown HCA Director
Federal Government Impact
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Washington Apple Health
Enrollments & Renewals Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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MAGI Renewal Rates Month Total Individuals August 2017 103,364
September 2017 100,064 October 2017 104,274 Auto-renewals remain consistently around 70% each month.
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Washington Apple Health
Alien Emergency Medical (AEM) Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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Let us know how it is going.
AEM Improvements Thank you for your feedback! Some of our improvements to the AEM process include: Streamlined AEM fax cover sheet for faster document imaging Brand new training MACSC assistance with status updates Let us know how it is going. We value your feedback!!
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Washington Apple Health
New Mobile Application Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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WAPlanfinder Mobile App.
Washington Healthplanfinder’s new mobile application is called WaPlanfinder. Some of the features include: View coverage status Upload documents quickly and securely Download the Washington Healthplanfinder Application today! An account is needed to use the mobile application
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Document Center The Action Center is now called the Document Center
The size limit for documentation uploads has been updated from 2MB to 5MB
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Document Center Account Home
Customers can use the Document Center tab for all document requests
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Document Center Upload Documents
Click Upload Documents to upload documentation requested Click on Upload Document for category you are uploading
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Document Center Upload Documents
Category will be auto selected Click Browse Files to upload saved file (1.) Once file attached you can add optional description text (2.) Click Submit to submit documentation Text will appear to say your document was uploaded successfully (3.) 1. 2. 3.
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Document Center Upload Documents
Customers have the option to submit a different document from what is being requested Identify document category from drop down and Submit
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Document Center Upload Documents
Once documents are uploaded the request will move out of the documents needed category into Pending Review As documents are reviewed they would move into Reviewed Documents
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Washington Apple Health
Correspondence Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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Correspondence Customers are taking advantages of the paperless option in Washington Healthplanfinder. Reminder: If customers sign up for correspondence they will receive an notification the next day letting navigators know there is a new notice on the client's dashboard. To read this notice customers have to login to their Washington Healthplanfinder account.
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Washington Apple Health
Senate Bill 6430 Update Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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The Intent of SSB6430 Suspending, not terminating, existing coverage
Allowing individuals to apply for coverage in suspense status Pursuing authority to waive CMS rules Identifying and communicating behavioral health best practices to promote a smooth transition into the community To provide continuity of care for recipients of Apple Health (Medicaid) during periods of incarceration or commitments in a state hospital by:
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Current Situation Center for Medicare and Medicaid (CMS) Policies:
Inmate Exclusion - Prohibits the use of federal funding to provide Medicaid services to persons who are inmates of a public institution The recent CMS State Health Official letter # states the ability to receive Federal Financial Participation (FFP) for approved work release programs Institution for Mental Diseases (IMD) Exclusion – Prohibits the use of federal funds for treatment costs for persons aged who are hospitalized more than 15 days in a calendar month*. * Clarification is being sought regarding how the managed care IMD 15 day rule will affect suspension
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Current Policy Today when an individual is incarcerated or committed in a state hospital for over 30 days their coverage is ended. If an inpatient hospitalization lasting over 24 hours occurs the confinement facility can apply to have that inpatient stay covered by Apple Health (Medicaid).
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What does it mean to Suspend?
Beginning July 2017 incarceration or commitment in a state hospital will not affect eligibility but will determine the scope of coverage. Coverage will not end but will be limited to inpatient hospitalizations lasting over 24 hours. This is called a suspended benefit package. Upon release, full scope coverage is reinstated without the need for action by the individual.
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Why Suspend Rather Than Terminate?
Persons with mental illness and substance use disorders need seamless access to treatment networks, services and health care coverage upon release. Access to care increases the chance of successful re-entry and is critical to reduce recidivism and reduce cost associated with: Suspension allows for quicker and easier reinstatement of coverage resulting in reduced work load and fewer incidences of uncompensated care. Relapse Decompensation Crisis Care
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Rationale Characteristics of Washington Adult Jail Inmates:
Source: DSHS, RDA Behavioral Health Needs of Jail Inmates in Washington State, January 2016
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Scope Setting # of Facilities Average Daily Pop. WA DOC* (Prisons) 12
18,299 WA City/County Jails 59 12,014 Special Commitment Center (SCC) 3 373 Juvenile Rehabilitation 301 State Hospitals 2 Western State: 800 beds Eastern State: 287 beds Tribal Jails 8 Varies by facility * not including work release
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Policies Suspension includes all MAGI and Classic Medicaid programs in all populations (jails, DOC, JRA, state hospitals, etc.) Medicaid will be suspended upon incarceration and coverage will not terminate regardless of the incarceration period, unless other eligibility factors change.
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Suspension Process Example
An Individual is taken into custody 6:00 p.m. Friday night Saturday at 12:00 a.m. HCA receives the statewide jail booking data and full scope coverage is suspended Sunday at 12:00 a.m. HCA receives the statewide jail booking data and full scope coverage is reinstated Saturday night at 5:00 p.m. the individual is released
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Suspension will begin July 5th, 2017
Timeline Suspension will begin July 5th, 2017 Individuals in DOC and City/County facilities will: Have their current Apple Health coverage suspended rather than terminated Be able to apply for suspended Apple Health coverage during incarceration
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Timeline Fall 2017 < Create a separate process to address additional populations: State hospitals (IMDs) Juvenile rehabilitation DSHS Special Commitment Center Tribal jails
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Timeline Identify best practices and pilot opportunities or behavioral health, outreach, and enrollment Create and implement best practices training to support care coordination Continue to gather guidance from CMS regarding care coordination services provided while incarcerated July 2017<
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Contact Us Do you have questions or would you like to get involved?
Visit the Medicaid Suspension Webpage HCA Medicaid Suspension
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Washington Apple Health
Share Your Story Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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Share your story! We are looking for people in Washington whose lives have changed for the better because they have Apple Health coverage. With the individual’s permission, their testimonials could be featured on the Washington Healthplanfinder, Health Benefit Exchange, or Health Care Authority websites and printed materials. If we do use their story, they can get a $50 gift card!
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Share your story! For more information, please visit: "I wouldn't be able to afford health insurance otherwise." Sacha Bliese, Bellingham. "I can't begin to explain how much Apple Health as helped me." Shylo Williamson, Davenport.
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Washington Apple Health
Notices Workgroup Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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Notices Workgroup HCA has launched a monthly consumer notices workgroup to focus on the improvement of Apple Health notices. We need your help! We are still looking for 1-2 Apple Health recipients to participate in our in-person workgroup each month. We are offering a quarterly $50 gift card to consumer participants.
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Notices Workgroup If you would like to participate or have additional questions, please let us know by contacting: Maggie:
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Washington Apple Health
Resources Washington Apple Health Maggie Clay Regional Eligibility Policy Representative Office of Medicaid Eligibility and Policy August 5, 2016
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Additional Resource Information
HCA Training & Education Resources Cross-agency Desk Aid HCA Community-Based Specialists
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Additional Resource Information
Policy questions? Feedback? Would like to be added to our distribution list? Contact your local HCA Area representative:
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