ABP is part of the expansion of Medicaid:

Includes Members newly eligible for Medicaid (Individuals 19 to 65 who have income below 138% FPL; meet citizenship requirements; are not incarcerated; and are not eligible for Medicaid)

Expansion members will be covered by ABP, unless: They are Medically Fragile, then they

have the choice to be Exempt ABPs and receive full Medicaid.

ABP

ABP Coverage

Medicaid Expansion Population

Exempt ABP (Medically Frail), can choose:

Members can self-identify as Exempt (must be approved by BCBS)Or be identified by Care Coordinators

19-20 Year Olds receive additional EPSDT Coverage

Expansion State Plan = full Medicaid

Exempt Population List:

Individuals who qualify for medical assistance on the basis of being blind or disabled (not contingent upon eligibility for SSI benefits)

Individuals who are terminally ill and are receiving benefits for hospice care

Pregnant women

Individuals who are Medically Frail

Details on Medically Frail:

Disabling mental disorders

Chronic substance use disorder

Serious and complex medical conditions

Physical, intellectual or developmental disability that impairs the member’s ability to perform one or more activities of daily living (ADL)

Disability determination based on Social Security criteria

A full list is included in your handout for future reference.

Compare Benefits of ABP vs Medicaid

19-20 year old ABP members have EPSDT coverage

Some of the ABP coverage exceeds Medicaid coverage and visa versa

Complete details are included in the handout for future reference

Example breakdown is:

Limited Coverage of ABP -compared to Medicaid

Vision

Over the Counter Medicines

Medical Supplies

Better Coverage of ABP –compared to Medicaid

Nutritional Counseling

Disease Management

Autism Spectrum Disorder

Care Coordination of ABP Population: Members that meet the medically frail

criteria may be identified throughout the normal Health Risk Assessment (HRA) and Comprehensive Needs Assessment (CNA) process Medically Frail members should be

placed in a Care Coordination Level 2 or 3 Identified members should be notified

to advise them that they may be eligible for the Expansion State Plan benefits Members should be provided an

explanation of the benefit and cost-sharing differences Movement into the Expansion State Plan

benefit should be facilitated by the Care Coordinator