21
• Presentation Title • Month #, 2017 • Margaret Schultze, VDSS Commissioner The FFM Remix Virginia Department of Social Services May 2019
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
The FFM RemixVirginia Department of Social Services
May 2019
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
2
OBJECTIVES• Principles
• No Wrong Door
• What is the FFM?
• How Does It Appear?• My Workspace
• Referrals
• Determinations
• Combinations
• How to Handle Information?• FFM-D System Actions
• Additional Guidance
• Resources • QRGS & Trainings
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
PRINCIPLES
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
4NO WRONG DOOR
Individuals may apply for MA through their local department of social services (LDSS), the Health Insurance Marketplace (HIM), at the CommonHelp website, or the Cover Virginia Call Center. Applications maybe routed to either the LDSS or Cover Virginia for processing.
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
5
Effective 11/1/2018, applications made through the HIM that require MAGI
eligibility determinations will have the eligibility determination made by the
HIM.
WHAT IS THE FFM?
• The Federally Facilitated Marketplace (FFM) is an insurance exchange overseen by the federal government that allows citizens to shop and qualify for health insurance. Virginia uses the Federally Facilitated Marketplace (FFM) while some other states have their own Health Insurance Marketplace (HIM).
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
How Does It Appear
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
7MY WORKSPACE
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
8Whose Applying?
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
9REFERRALS
• Are applications for individuals from the HIM that are potentially eligible for Medicaid
• Virginia has Received referrals since the inception of Affordable Care Act in Oct. 2013
• Referrals are still sent to Virginia for individuals whose eligibility cannot be determined at the HIM
• Some reasons individuals may be referred
• Details may be missing from the application
• Their eligibility is not in a MAGI group determined by the HIM
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
10
• Are done on applications submitted by individuals at the HIM
–Eligibility evaluations are made for MAGI individuals
•Do not determine Plan First
–No checks are made to determine if the individuals may already have coverage with Virginia
–Individuals are notified of their eligibility for Medicaid and informed they will receive their card
–Application information and eligibility results are transmitted to Virginia for enrollment through VaCMS to MMIS
–VaCMS sends an additional notice to the customer with their enrollee ID
Determinations
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
11HIM Notice of Eligibility
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
12
COMBINATIONS• Are applications that contain individuals that have been referred and determined.
• The determined individual should follow the outlined information for determined individuals
–Do not delay their enrollment while trying to evaluate an individual who was referred.
• It is possible to receive information from the HH while evaluating the referred individual that changes the eligibility of the determined individual
How to manage
THE INFORMATION
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
14FFM-D SYSTEM ACTIONS• When the automated transfer fails
• Utilize the “Restart Determination” buttons
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
15
•Why should you utilize the “Restart Determination” buttons?
–Continues the automated population of the FFM-D results
–Workers don’t have to manually complete the cases
–Eligibility results will align with FFM determination
–Case will show as authorized by system not worker
–Generates tasks & reminders associated FFM-D processing
FFM-D SYSTEM ACTIONS
Cont’d
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
16FFM Determination - Eligibility Summary
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
17Additional Guidance
Changes and Renewals:*Associate to existing case and convert to the appropriate designation• Add a Persons note the designation
of whether the application was a “R” or “D” in the Application Inbox
Make RAU Referrals M1700.300 NON-FRAUD RECOVERY
No verification checklists should be sent to
determined individual to establish their
eligibility as their eligibility has been
determined by the FFM.
‘Other’ should be selected as the
verification source and documented that
the verification was completed at the
Marketplace.
Duplicate cases created by FFM-D push may be closed.
Utilize Tasks & Reminders!!!
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
19
QRGS & TRAININGS
QRGS:
• Case Association• FFM Application
• Overview• Field Mapping• Reference Codes
• Quick Guide to Processing FFM-D Cases
Trainings:
MEDEX1001-Adult MAGI Training Document
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Questions?
• Presentation Title
• Month #, 2017
• Margaret Schultze, VDSS Commissioner
Contact:
Chartoya Newton, Medical Assistance ConsultantDivision of Benefit Programs
