Upload File

state-specific processes for expansion medicaid-to …...about medicaid expansion 31 states, plus...

  • Home
  • Documents
  • State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty
21
Julie Carter Federal Policy Associate State-Specific Processes for Expansion Medicaid-to-Medicare Transitions Emily Balkan Senior Policy & Client Services Associate

Upload: others

Post on 31-Jul-2020

4 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

Julie CarterFederal Policy Associate

State-Specific Processes for

Expansion Medicaid-to-Medicare

Transitions

Emily BalkanSenior Policy & Client Services Associate

Page 2: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 2

About Medicare Rights

National helpline: Around 20,000 questions

answered per year. Affordability, denials, and

enrollment confusion are perennial problems

Education: Uses helpline information to develop

educational programming serving millions

annually

Policy: Regulatory and legislative comments,

education of policymakers, voice for consumers in

Washington, DC and New York

Introduction

Page 3: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 3

Some introductory items

Who is in the room?

Raise your hand if you…

Introduction

Page 4: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 4

The project

Still in progress!

Medicare Rights is working in partnership with

and with funding from NCOA

We are conducting a survey of states that are

offering Medicaid to the adult group (expansion

Medicaid) as a result of the Affordable Care Act

Introduction

Page 5: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 5

About Medicaid expansion

31 states, plus DC, have expanded Medicaid

eligibility to adults 19-64 under 138% of the

Federal Poverty line ($16,643 in most states)

A person cannot be dually enrolled in expansion

Medicaid and Medicare

Those who become eligible for Medicare must

transition from one program to another

Introduction

Page 6: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 6

Project goals

Learn how (and if) states help Medicaid

expansion enrollees transition to other Medicaid

programs, Medicare, and MSPs

Look for best practices among the various states

(stumble across some worst practices too)

Project

Page 7: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 7

More goals

Spot themes and trends in states

What are states trying to do?

What have they identified as goals?

Identify common barriers to successful help with

transitions

Project

Page 8: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 8

What have we done?

Conducted initial online research into how and if

states post information on Medicaid, Medicare,

and MSPs

Developed a short questionnaire through an

iterative process with feedback from CMS, NCOA,

and advocates

Launched the survey and interview process

Continue to look for participants. Join us!

Project

Page 9: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 9

Who has responded?

Targeting all 31 expansion states, plus DC

People in 18 states have responded so far

State employees, SHIP employees, and

advocates have all provided their unique

perspectives

Project

Page 10: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 10

Common themes: Identification

Most states do try to notify those who are

approaching Medicare eligibility that they will

have to take some action Example: Washington sends a notice approximately

two months before the 65th birthday month

Identifying people who are becoming eligible

following their 24-month SSDI waiting period is a

challenge for most states

Common themes

Page 11: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 11

Common themes: Computers

Computer systems can help states identify and

contact those who are approaching Medicare

eligibility, but they can also create chaos and add

another frustrating layer if not done right Example: a computer system that must be overridden

by the system developer on a case-by-case basis in

order to get appropriate enrollment

Common themes

Page 12: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 12

Common themes: Staffing

Staffing cuts and lack of training can exacerbate

any other systemic issues and interfere with

beneficiaries being able to get answers to urgent

questions Example: if a computer gives a nonsensical output

such as flagging a 90-year-old woman as pregnant,

leading to her loss of benefits for failing to submit

proper documentation

Common themes

Page 13: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 13

Common themes: Knowledge gaps

Knowledge gaps create access problems Example: beneficiaries who are unaware of the

existence of MSPs who reject Medicare Part B

because of the expense

Little outreach and little or no information about

Medicare or MSPs on their websites Example: If someone doesn’t know there is a deadline

to enroll, or potential penalties or potential help, they

might not think to look up the information

Common themes

Page 14: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 14

Common themes: Communication

Incomplete, incorrect, or confusing notice or

application language and design Example: an MSP application where applicants must

handwrite in that they are requesting an MSP

In some cases, even state workers do not

understand the notices Example: a notice that uses several different terms that

all refer to MSPs, but caseworkers only know one of

the terms

Common themes

Page 15: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 15

Good practices: Notice & eligibility

Send notices to people approaching Medicare

eligibility, including an appeal form Examples: NY, OH, CA

Automatically determine MSP eligibility Example: CA (at least some counties)

Good practices

Page 16: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 16

Good practices: Communication

Good, easy-to-find and self-explanatory

information available on their websites that

explains the timelines for Medicare, interactions

between various insurance options, etc. Example: Washington

https://www.insurance.wa.gov/your-

insurance/medicare/

Good practices

https://www.insurance.wa.gov/your-insurance/medicare/
Page 17: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 17

Good practices: Communication

From Washington’s Medicare site:

Good practices

Page 18: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 18

Areas of concern

Most interview subjects did not feel their states

were doing a good job preparing Medicaid

enrollees to transition to Medicare, or getting

eligible Medicare enrollees into MSPs

Staffing continues to fall in most areas

Notices and applications need significant work

Coordination between federal and state entities is

not always good

Conclusion

Page 19: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 19

Big picture

If states do not view this area as one that is of

primary concern to them, they may not be willing

to take steps to ease transitions, even when

failing to do so may cause harm to beneficiaries,

headaches for the state, and hassles for

caseworkers and advocates

Conclusion

Page 20: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 20

Get involved

Interested in taking part in this research? We welcome your

involvement

Come talk with us!

Complete our survey

https://www.surveymonkey.com/r/5FQ2W2B

Or contact Julie Carter: [email protected]

Conclusion

https://www.surveymonkey.com/r/5FQ2W2B
mailto:[email protected]
Page 21: State-Specific Processes for Expansion Medicaid-to …...About Medicaid expansion 31 states, plus DC, have expanded Medicaid eligibility to adults 19-64 under 138% of the Federal Poverty

© 2017 Medicare Rights CenterPage 21

Stay involved

Visit us at www.medicarerights.org

Advocate at www.medicarerights.org/protect

Call our helpline at 1-800-333-4114

Sign up for Medicare Watch

Like us on Facebook

Follow @medicarerights

Conclusion

http://www.medicarerights.org/
http://www.medicarerights.org/protect
http://action.medicarerights.org/p/salsa/web/common/public/signup?signup_page_KEY=8390&
https://www.facebook.com/medicarerights

Medicaid expansion. expanding coverage under aca Medicaid Expansion: Will cover 250,000 uninsured in SC By 2014 states can extend Medicaid eligibility

State Medicaid Eligibility and Coverage Changes: …...State, Federal Medicaid Policy Reflects System Tensions Between Expanding Coverage and Containing Costs • Medicaid expansion

Evolution of Medicaid Managed Care Systems and Eligibility ... · PDF fileEvolution of Medicaid Managed Care Systems and Eligibility Expansions Leighton Ku, ... through Medicaid expansions,

medicaid expansion in sc

Pathways to Medicare Medicaid Eligibility: A Literature · PDF filePathways to Medicare‐Medicaid Eligibility: A Literature Review ... Pathways to Medicare-Medicaid eligibility: A

August 2012 MEDICAID EXPANSION States’ Implementation of ... · Appendix I States Must Expand Medicaid Eligibility Levels and Streamline the Enrollment Process 11 ! Appendix II

Create a medicaid eligibility SPA in MACPro · Medicaid Eligibility SPAs in MACPro Version 1.0 1 Medicaid & CHIP Business Information Solutions (MACBIS) Introduction This reference

Exchange/Medicaid/CHIP Eligibility Appeals · PDF fileExchange/Medicaid/CHIP Eligibility Appeals . Center for Medicaid and CHIP Services ... –Is receiving APTC –Then requests an

Medicaid Expansion in 2014 ACA creates new option to expand Medicaid eligibility Ensures Medicaid coverage for all adults 19-64 with incomes up to 138%

Florida Medicaid Expansion Chartbook

Medicaid Expansion

Healthcare in Louisiana & Medicaid Expansion

The Implications of Medicaid Expansion in the Remaining ......applications beginning on August 1, 2020. For the purposes of this brief, only states that have expanded Medicaid eligibility

Medicaid Expansion options...200% Income Limits for Medicaid, CHIP and Tax Credit Eligibility Optional Medicaid Expansion 50% 100% 133%. 8 The Utah Department of Health (UDOH) commissioned

Medicaid Eligibility, Enrollment Simplification, and Coordination

Expansion of Medicaid Covered Smoking Cessation … · Expansion of Medicaid Covered Smoking Cessation ... Medicaid coverage for nicotine replacement ... The PRAMS surveillance system

Transformation Lessons and Issues · • Coverage expansion boosting Medicaid eligibility • Most demand growth over the next ... increased referrals to additional preventive testing

Medicaid expansion ballot initiative training

Analyzing the Impact of State Medicaid Expansion Decisions · standards than states moving forward. Currently, all states have Medicaid and CHIP eligibility levels for children that

DDS Maintaining Medicaid Eligibility equals Waiver … · It is called a State Of onnecticut Department Of Social Services ... DDS Maintaining Medicaid Eligibility equals Waiver Eligibility

Medicaid Expansion: Eligibility Determinationjlarc.virginia.gov › pdfs › presentations › HHR_Medicaid_Eligibility_Determination.pdfMedicaid expansion NOTE: Plan First and GAP

Medicaid Eligibility Overview

Medicaid Eligibility - Virginia4 Eligibility Process DMAS, DSS and the Department of Corrections (DOC) have established a process (effective in July 2013) for Medicaid eligibility

› sites › vr-rrtc.org › files › Silverstein ACA_…  · Web viewThis mandatory expansion would have created a uniform minimum Medicaid eligibility threshold across states

Medicaid Expansion and Section 1115 Waiversknowledgecenter.csg.org/kc/system/files/Musumeci Medicaid Expansion...Medicaid Expansion and Section 1115 Waivers ... 6.1% 4.5% 3.4% 6.9%

Medicaid Eligibility Handbook Release 17-03 · Medicaid Eligibility Handbook Release 17-03 WISCONSIN DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services P-10030 (11/2017)

Medicaid Eligibility Manual - University of Michiganmdover/website/Social... · Medicaid Eligibility Manual Transmittal Letter No. 44 April 2, 2008 To: All Medicaid Eligibility Manual

Utah Medicaid Expansion Study

A Guide to Assessing Tobacco Cessation Coverage in Health ......5. [Medicaid Question] Please describe any differences in eligibility requirements or coverage for Medicaid expansion

North Dakota Medicaid Expansion

A Performance Audit of Medicaid Eligibility

HCS vs Medicaid Expansion

Medicaid Eligibility Final Rule Summary

New Mexico Medicaid Benefit Eligibility/Response Companion ... · For accurate and precise New Mexico Medicaid co-pay, eligibility and other New Mexico Medicaid specific information

The ACA's Medicaid Expansion: A Review of Ineligible ...€¦ · Second, eligibility audits that restarted in 2019 by the Centers for Medi-care and Medicaid Services (CMS), after