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CORPORATE OFFICE 425 E. Colorado St., Suite 410, Glendale, CA 91205 800-543-3003 with Satellite offices in Northern and Southern California 1
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Agenda HPE (Hospital Presumptive Eligibility) HPE Application Non-MAGI (Non-Modified Adjusted Gross Income) MAGI (Modified Adjusted Gross Income) Completing the Medi-Cal / Streamline application to ensure: Compliance Continuity of Eligibility Retro Coverage HPE’s Effects on the Revenue Cycle Goals 2
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Hospital Presumptive Eligibility (HPE) The Hospital Presumptive Eligibility (HPE) program provides individuals with temporary, no cost, Medi-Cal benefits for up to 60 days. Those potentially eligible for HPE benefits are: Children (ages 0 – 19) Parent(s), caretaker relatives Pregnant women New adult group (ages 19 – 64) Former foster care children between the ages of 18 – 26 3
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Hospital Presumptive Eligibility (HPE) Eligibility timeframe: HPE period lasts up to 60 days HPE does not go retroactive HPE begins the first day of the month the HPE application is approved and ends the last day of the following month To extend Medi-Cal benefits, applicant must submit a full Medi-Cal application prior to HPE termination 4
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Hospital Presumptive Eligibility Program PROS AND CONS 5
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HPE PROGRAM PROS HPE Medi-Cal determination will be conducted in real-time HPE Medi-Cal provides benefits up to a two month period HPE Medi-Cal minimizes the financial liability for difficult patients types such as homeless and mental health patients HPE Medi-Cal offers immediate coverage to those services that yield higher medical costs such as Trauma patients and NICU 6
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HPE PROGRAM CONS HPE Medi-Cal offers no retroactive coverage HPE Medi-Cal can only be processed once every 12 consecutive months with the exception of children between the ages of 0 – 19, CHDP patient and pregnant women HPE Medi-Cal cannot be performed if there is a pending application 7
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NON - MAGI Non-MAGI (Traditional Medi-Cal) Linkage Under 21 years old Over 65 years old Pregnancy Minors in the home with deprivation (absent or deceased parent, unemployed or underemployed parent or incapacitated parent) A disability that will last a minimum of 12 consecutive months Income Assets 10
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MAGI Medi-Cal Eligibility Ages 19 to 64 Income based on Federal Poverty Level (FPL) – Under 138% of the FPL Residency Citizenship No Asset Test 11
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MAGI Medi-Cal 12 2015 Federal Poverty Level Family Size 100% FPL 138% FPL 150% FPL 250% FPL 300% FPL 350% FPL 400% FPL 1$11,670$16,105$17,505$29,175$35,010$40,845$46,680 2$15,730$21,707$23,595$39,325$47,190$55,055$62,920 3$19,790$27,310$29,685$49,475$59,370$69,265$79,160 4$23,850$32,913$35,775$59,625$71,550$83,475$95,400 5$27,910$38,516$41,865$69,775$83,730$97,685$111,640 6$31,970$44,119$47,955$79,925$95,910$111,895$127,880 7$36,030$49,721$54,045$90,075$108,090$126,105$144,120 8$40,090$55,324$60,135$100,225$120,270$140,315$160,360 For families/households with more than 8 persons, add $4,020 for each additional person
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HPE’s Effect on the Revenue Cycle Goals Increase in eligible patients Increase in revenue Reduction in uninsured visits and charity write-off’s Reduction in ER services and an increase in primary care clinics 13
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CAN WE BE OF FURTHER ASSISTANCE? Bill Haddad President/CEO COMPSPEC, Inc. 425 E. Colorado Street Ste. 410 Glendale, California 91205 Office#: (818) 638-6200 E-Mail: BHaddad@compspec.com Shelle Murph-Mitchell Director COMPSPEC, Inc. 425 E. Colorado Street Ste. 410 Glendale, California 91205 Office#: (818) 638-6133 Cell #: (818) 530-8533 Fax#:(818) 638-6233 E-Mail: SMurph@compspec.com 14
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C OMP S PEC, Inc. Questions? 15
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COMPSPEC, Inc. Thank You. 16
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