Transitional MinnesotaCare

transcript

2007 MFWCAA Conference

Health Care Training

Jen Gerber

Agenda

Renewal vs. HCAPP Retro MinnesotaCare Coverage and

Premium Payments Financial Control Basics Health Plan Enrollment Who answers MinnesotaCare questions? Resources

Renewal

Timely T-MCRE Renewal

Was an MA basis of eligibility gained – if so, determine for MA.

If not, determine eligibility for MCRE.

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.

If the enrollee is not eligible for MCRE, do not require a new application.

Example: Enrollee now has access to ESI.

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?

Late Renewals

Applicant sends in a renewal after the renewal month.

Find out what program the applicant wants to apply for.

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.

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?

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.

MinnesotaCare

And Premium

Payments

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.

Retro MCRE

On August 1st , you close T-MCRE for September 1st, and approve MCRE for September 1st.

Household has until August 31st to make initial premium payment.

Set up retro for September, ongoing for October.

Send Retro Notice – DHS-3446.

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.

Obligation ID/Invoice Number

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.

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.

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.

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.

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.

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.

If the optional premium:

Is not received by the due date:– MMIS will deny retroactive MCRE.– Ongoing MCRE remains active.

OSEL with Retro Obligation

Financial

Control

Health

Enrollment

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.

Health Plan Enrollment

After the 15th 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 # 651-431-7464.

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.

Who Answers MCRE Questions?

County MCRE case, the County servicing the case, answers the questions.

MCRE Operations case, MCRE Operations answers the questions.

Resources

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

• 651-431-3930• 1-800-366-7894

– HealthQuest

Transitional MinnesotaCare

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