MinnesotaCare Case Maintenance and Beyond

2008 MFWCAA Conference

Health Care Training

Mark Proctor and Ge Her

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Agenda

Transitional MinnesotaCare Retro MinnesotaCare Coverage Case Maintenance

– Important Dates– Changes– Renewals

Resources

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Transitional MinnesotaCare

A program for adults without children who meet all GAMC eligibility criteria, but do not have a GAMC qualifier.

Eligibility is approved for one six-month period at a time.

The last month of eligibility determines if the enrollee will be redetermined for MA, GAMC with a qualifier or MinnesotaCare.

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Timely T-MCRE Renewal

Determine eligibility for MA if basis exists. 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.

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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 if county is not a MCRE enrollment site.

If all programs:1. Need a new HCAAP. Send one out.

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Retroactive

MinnesotaCare

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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.

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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.

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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.

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Obligation ID/Invoice Number

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Obligation ID/Invoice Number

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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.

Retroactive premiums cannot be paid online.

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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.

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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.

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Initial and Retro Premium Payments

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.

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Initial and Retro Premium Payments

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.

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Initial and Retro Premium Payments

If the optional premium:

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

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OSEL with Retro Obligation

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Health

Plan

Enrollment

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Health Plan Enrollment

Case is processed and made P41. MMIS creates an 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.

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DEMA Email

A DEFAULT MATCH MAXIS email to DEMA is not required for new MinnesotaCare cases.

A DEFAULT MATCH MAXIS email to DEMA is required if a client is being added to an old or existing MinnesotaCare case. – Email must be sent when the MinnesotaCare

case is set to P41 status.

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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.

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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.

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MCRE Case Maintenance

Important Dates

Changes

Renewal Basics

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Important Dates – Billing Cutoff

11 business days from the end of the month.

Next month’s premium must be paid to avoid a cancellation notice for non-payment, C22.

Premiums are mailed for current month plus two.

Renewals are mailed for cases with a redetermination date of next month.

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Important Dates - Capitation

6 business days from the end of the month. All health plans are paid for next month’s

coverage. Before capitation, cases can be closed for the

end of the current month with a 10-day notice. After capitation, cases must be closed for the

end of the following month as we have already paid for their next month’s coverage.

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Important Dates – Reinstatement (Managed Care)

Last business day of the month. MinnesotaCare pays health plans for

enrollees who have become active after capitation.

MCRE will pay the health plan at Managed Care Reinstatment for any enrollee whose coverage starts after May 24, but on or before May 31.

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Important Dates – Reinstatement (Coverage)

If a household’s coverage ends due to non-payment of their premium, they have until the 20th day of the next month to make their payment to get coverage reinstated.

If the 20th falls on a weekend or holiday, they have until the following business day to make the payment.

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Important Dates – Reinstatement (Coverage)

The current and next month’s premiums must be paid to have coverage reinstated.

Example: Coverage cancelled April 30 for non-payment– May and June premiums must be paid by May

22, (the 20th is a Saturday) to have May coverage reinstated.

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Case Maintenance - Changes

Household Composition

Income

Renewals

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Changes – Household Composition

Things to consider:– Does the new HH member want MCRE

coverage?– Will the All or Nothing Rule affect the HH?– Will there be a difference in the premium, or

will adding the new person make them over income?

– Will they be over assets?

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Changes – Household Composition

Steps for Adding a New HH Member1.Determine if the person must be counted in the

MCRE household size.2.Determine if they are requesting coverage.3.Request all information and verification for the HH

member. 4.Determine the new member’s eligibility if applying or

required through All-or-Nothing rule.5.Redetermine HH income and assets.6.Update appropriate MMIS screens, including income

and case notes.

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Changes – Household Composition

Adding a HH member during a penalty period– Household members who are not enrolled

when a penalty period began, are NOT subject to the four month penalty period.

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Changes – Household Composition

If adding a Household Member with Retroactive coverage, they must:– Apply with 30 days of MA/GAMC termination.– Return all requested MCRE verifications by

the end of the month following the month in which verifications were requested.

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Changes – Household Composition

Keep in mind:– They can be added immediately to avoid a

lapse in coverage.– There will be no retro premium, nor are there

any additional premiums due for future months already billed.

– Do not enter a “Y” in the RC field on RCIN.– The retro span will be C33 on RELG (Retro

MCRE – Retro Premium is nonpay).

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Changes - Income

Recalculate household income as soon as the change is reported.

Verification is NOT required until renewal. Premium changes:

– If decreases, takes effect the next month.– If increases, takes effect the next billing

month.– MMIS will send a new bill if the case is in P41

status or the premium decreases.

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Changes – Income Recalculate total annual gross household income. Re-evaluate Major Program & Group Status. Update MMIS screens:

– REMP for employment changes.– RIMG, RELG for Major Program/Status changes.– RINC for new income amount.– FCSN for case note.

For new employment, need ESI verification. If income is over $50,000, close with 10-day notice. If greater than 275% (200%), cancel non-pregnant adults

end of the month following month of month of determination.

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Changes – Income (MCHA)

If household income increase >275%, review the MCHA Exemption for all children.

Compare 10% of the household’s income to the household’s annual MCHA premium (HCPM 22.15)

If income < premium, children remain eligible If income > premium, children are ineligible

– close the end of the following month– do not cancel pregnant women & auto newborns

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Renewals

Renew eligibility every 12 months. Mailed 45 days before the renewal month. For mixed households, align the

healthcare renewal months. – interrupt MA budget period and update MAXIS

STAT/BUDG– do not change cash and food support reviews– the MA renewal can be used for the MCRE

renewal if the form is less than 11 months old.

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Changes – Renewals

Failure to complete a renewal results MMIS auto-close. – MMIS codes C45 (Failure to Reapply) and

C22 (Nonpayment) will show on auto-close letter. RELG will show C22 code.

– C45 code will display on RELG for pregnant women and infants.

Incomplete Renewals should be coded as C48 on RELG.

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Changes – Renewals

Resolving incomplete renewals depend on:– Time of month.– Verifications .– Status of case and payments.

Step-by-step procedures are located in the MMIS Users Manual

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Who Answers MCRE Questions?

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

MCRE Operations case, MCRE Operations answers the questions.

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Resources

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

• 651-431-3930• 1-800-366-7894

– HealthQuest