Washington Apple Health

WCOMOAmy Johnson, Eligibility Policy and Service DeliveryDecember 5, 2014

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Conversion of MAGI Medicaid

Even with efforts made by HCA, individuals continued to struggle to complete their conversion of health coverage into Healthplanfinder and the renewal rate was at 28%

• Extension of renewals for 3 months• Sending of a 4th notification letter• Conversion letters mailed through 9/30/14

As of September 2014, the renewal rate has returned to pre-ACA levels

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Apple Health (Medicaid) Renewals

For individuals receiving Apple Health MAGI Medicaid* through Healthplanfinder:

• 60 days prior to an Apple Health recipient’s renewal due date, the Healthplanfinder system captures the individual’s original application and determines whether he or she is eligible for auto-renewal

• Individuals will be notified whether they have been auto-renewed or that they could not be auto-renewed and must complete a manual renewal

*MAGI Medicaid: Family, Children, Pregnancy and Adult medical programs

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Auto-Renewal Vs. Manual

Auto-Renewal• Data-match finds household under the Medicaid

standard • No data-match found and income on file under the

Medicaid standard • No additional information needed by recipient • Recertified for twelve months

Manual• Data-match finds household above Medicaid standard• Individual must manually complete their renewal

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December Renewals

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Total Individuals

Auto-Renewed

% RequireManual Renewal

%

241,775 148,453 62% 93,322 38%

Estimated Renewals

• Roughly 56% of total MAGI Medicaid households up for renewal over a 4 month period (December – March)

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Month Total Assistance UnitsDecember 2014 194,549January 2015 88,133February 2015 124,857March 2015 73,471

Auto-Enrollment Waiver

• 1115 Waiver currently under development to auto-enroll individuals in the following programs:

ABD Cash/HEN TANF Cash

Pending Subpopulation of SNAP

• An individual receiving ABD/HEN/TANF assistance would be auto-enrolled into MAGI-based health care coverage during an overnight batch process (similar to SSI process)

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Hospital Presumptive Eligibility

As required under the ACA, the Health Care Authority (HCA) has established guidelines and standards for implementing the Hospital Presumptive Eligibility (HPE) program. HCA goals include:

• Provide a pathway to regular Apple Health coverage• Expand Apple Health eligibility training on the

Washington Healthplanfinder to hospital staff• Implement HPE as a safety net to ensure appropriate

access to care by eligible populations

HPE training of hospital staff scheduled to begin in early January 2015.

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Health Coverage Form 1095-B

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Purpose: To report information to the IRS and about individuals who are covered by Minimal Essential Coverage (MEC).

• Optional in 2014• Required for tax year

2015 (when filing in 2016)

More information related to the ACA: www.irs.gov/ACA

Resource Information

HCA Medicaid Expansion www.hca.wa.gov/hcr/me

• Training & Education www.hca.wa.gov/hcr/me/Pages/training_education.aspx

HCA Community-based training Resources & workarounds Reference guides Apple Health webinars Apple Health outreach materials

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Questions?

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