Wyoming State Family and Wyoming State Family and Children’s ProgramsChildren’s Programs

May, 26th 2015

Providing Vital Health Care AccessProviding Vital Health Care Access

Medicaid & the Children’s Health Insurance Program (CHIP) are important access points for

families who traditionally received services from public programs and more recently for families who

only need access to medical coverage.

These two public health insurance programs serve different people & populations

Medicaid & Kid Care CHIP are two entirely separate programs with separate federal and state legislation,

rules, and policies.

First, we will discuss Medicaid.Second, we will discuss Kid Care CHIP. Then we will look at how they work together.

Today, we will discuss the eligibility process for

each program in order

to explain the differences and show how

the programs coordinate.

Medicaid provides health care services to many different populations

Medicaid Medicaid AuthorizationAuthorization

Medicaid is authorized by Title XIX of the Social Security Act to provide medical assistance to low income persons who are age 65 or over, blind, disabled, or members of families with dependent children, qualified pregnant women or children.

Within broad Federal rules, each State determines eligible groups.

Medicaid provides health care services to many different populations

Medicaid currently covers approx. 88,000 Wyoming residents in more than 50 different eligibility groups during a year. The average monthly enrollment is approximately 77,000. Approx. 50,000 of clients are children.

Medicaid is a joint federal and state government program that pays for medical care.

Medicaid is funded by federal and state dollars (50%/50%) for most programs.

Legal AuthorityLegal Authority

Wyoming Department of Health Wyoming Department of Health

The Wyoming Department of Health (WDH) is the State Agency designated to administer

Medicaid and is responsible for all eligibility policy.

Legal AuthorityLegal Authority

WDH also conducts eligibility determinations and case maintenance for individuals throughout the state

through the use of a Customer Service Center.

For the purposes of today’s discussion, we will focus on the eligibility process for the Medicaid

Family and Children’s Programs.

Medicaid provides health care services to many different populations

The CustomersThe Customers

Who are they?

Family and Children’s Programs

Newborns Child MAGI 6 – 18 Family MAGI

Pregnant Women Child MAGI 0 - 5 Foster Care

Children

Newborn – Baby born to a Medicaid eligible mother until age one

Child MAGI– Children 0 through 5 with family income at or below 154% of the Federal Poverty Level (FPL). Children 6 through 18 with family income at or below 133% of the FPL.

Foster Care – Children in DFS custody including some who enter subsidized adoption or who age out of foster care

Pregnant Women

Income at or below 154% FPL

Family MAGI

Adult(s) caring for a child under the age of 18 with income at or below approximately 55% of the FPL

Categories of Eligibility for Family &

Children’s Programs

Eligibility Requirements

Eligibility determination is dependent upon family size, income, tax filer status and

family relationships.

Eligibility is not tied to Economic Assistance

programs, unpaid medical bills or medical diagnosis.

Eligibility Details

Eligibility for Medicaid begins on the first day of the month of application

when a person is found eligible.

A person may qualify for up to three months of retroactive coverage if they

are found eligible.

Once found eligible, a child receives 12 continuous months of Medicaid

coverage.

Income Guidelines forIncome Guidelines forKid Care CHIP & EqualityCareKid Care CHIP & EqualityCare

Income Range for Families, Children & Pregnant Women

What Income Counts?What Income Counts?

• Total tax filer household income and the size of the household are used to determine income eligibility for a program. The income of some household members may not be included if they are not related to or financially responsible for the child or pregnant woman. Some types of income are not counted.

• Five percent of gross monthly income is deducted when the 5% would make a difference in the eligibility determination.

How are families notified?

Eligibility is determined within 45 days.

Written notices are sent and may include retroactive coverage for up to 90 days.

Families then receive a Medicaid card in the mail.

Current Eligibility System

The Current Eligibility System is called WES (Wyoming Eligibility System)

Medicaid eligibility determinations are made by the system which contains the Medicaid and CHIP rules.

Interface with Claims Processing

An electronic interface is transmitted from WES to MMIS (Fiscal system) on a daily basis. Xerox

is the fiscal agent contracted to process claims for Medicaid.

The Eligibility process differs for Aged, Blind or Disabled Medicaid programs due to additional eligibility requirements

and the need to determine medical necessity.

Medicaid provides health care services to many different populations

Kid Care CHIPProvides health insurance to children age birth through age 18

The Children’s Health Insurance Program is authorized by Title XXI of the Social Security Act to provide health insurance to the children of low-income families.

Kid Care CHIP is also governed by Wyoming statute 35-25-101 through 35-25-108; the Code of Federal Regulations; Wyoming CHIP State Plan and the

Kid Care CHIP Rules.

There is a CHIP program in every state in the United States. Programs differ by whether the state chose to expand Medicaid, create a separate program (usually partnering with private insurance companies) or do a combination (Medicaid

expansion and separate program).

Kid Care CHIP is the name for Wyoming’s Children’s Health Insurance Program or CHIP

• Kid Care CHIP is Wyoming’s Children’s Health Insurance Program

Separate State Program

Recreated as a Public/Private Partnership in 2003 by the Wyoming Legislature

•Provides health insurance to uninsured children in families with incomes too high to qualify for Medicaid but too low to afford private health insurance

• Kid Care CHIP is not Medicaid or an entitlement program

• Funded by federal and state dollars (65%/35%)

• There are an average of 3,683 children enrolled in Kid Care CHIP over the last 9 months

What is Kid Care CHIP?

Kid Care CHIP is a Partnership….

The Department of Health has partnered with Blue Cross Blue Shield (BCBS) and Delta Dental of Wyoming to provide the

medical, vision and dental coverage to all children enrolled in Kid Care CHIP.

Children enrolled receive BCBS and Delta Dental Identification cards.

Income Guidelines forIncome Guidelines for

AgeUp to 133% FPL

134% to 154% FPL

155% to 200% FPL

Birth to 5

Kid Care Plan A

6-18 years

Kid Care Plan AKidKid Care Care

CHIPCHIP

Medicaid

Income Range

• Eligibility for Kid Care CHIP is determined by the Department of Health, Customer Service Center.

• Any family applying for Kid Care CHIP, must be screened for eligibility for Medicaid first (Federal Law). This is done within WES.

• Children eligible for Kid Care CHIP are eligible the first of month following the month the application is received (as long as the application is received by the 25th of the month). Kid Care CHIP is not retroactive.

• An eligibility interview is not required.

 

Eligibility Details

Kid Care CHIP Eligibility Requirements

Kid Care CHIP covers children in families with incomes up to 200% FPL (Family of 4 = $4042 per month/$48,504 yr)

To be eligible, a child must be:o Uninsured for 30 days prior to applying (with some exceptions)o A U. S. Citizen or Lawful Permanent Resident who has lived in the U.S. for 5 yearso A Wyoming residento Age birth through 18

Once eligible, the child will be on for 12 continuous months unless:

oThe child moves out of stateoTurns 19oBecomes institutionalizedoEnters into Foster CareoChild becomes Medicaid eligible because of a decrease in family income

How does the customer apply?

Complete an application online at www.wesystem.wyo.gov

Mail or drop off completed application to/at WDH Customer Service Center

6101 Yellowstone Rd., Suite 259DCheyenne, WY 82002

Print an application off of the websites at:

http://health.wyo.gov/healthcarefin/medicaideligibility/index.htmlhttp://health.wyo.gov/healthcarefin/chip/apply.html

Call the WDH Customer Service Center at:

1-855-294-2127

Email scanned applications to wesapplications@wyo.gov

Fax applications to 1-855-329-5205

Enrollment Process

Application received via online web portal, mail,

phone call, fax, email or walk-in

Application electronically or

manually entered into

WES

WES determines

eligibility for Medicaid and

Kid Care CHIPeligibility and

generates a notice to the

familyIf Medicaid eligible, the

child and any eligible adults

are auto enrolled.

If Kid Care CHIP eligible, child is auto

enrolled for 12 months

How long is someone eligible?

12 months_________________________________________________

After 12 months, a review is completed and eligibility

is re-determined

This policy is intended to prevent eligible individuals from moving on and off the program (churning), thus reducing administrative costs and improving the likelihood of individuals finding a medical home with continuity of care. Adults can be discontinued before the twelve continuous months if changes in income make them no longer eligible.

How the ACA changed Medicaid and

Kid Care CHIP

Coordination with the Federally Facilitated Marketplace:

• One application for Medicaid, Kid Care CHIP and Health Insurance subsidies

• Seamless eligibility determination and referral process

• Interfaces to share eligibility information

• Real Time Eligibility—applicants may receive an immediate determination (if interfaces are able to verify eligibility factors) when submitting an application for Medicaid, Kid Care CHIP or Health Insurance subsidies

How the ACA changed Medicaid and

Kid Care CHIP

• Presumptive Eligibility—hospitals that are Medicaid providers will be able to determine temporary eligibility for many Medicaid programs in the near future

• Maintenance of Effort for Children through Sept 30th, 2019—states are not permitted to have eligibility standards, benefits, cost sharing or procedures that are more restrictive than those in effect on March 23, 2010

• Kid Care CHIP has been funded through 2017 and authorized through 2019

• Modified Adjusted Gross Income(MAGI)- a new way of calculating income eliminating the use of income disregards

THANK YOU…

Contacts

Heather Gifford Eligibility Program Analyst 307-777-5379

Jeff Oliver Chip Eligibility & Benefits Manager 307-777-3590