wake county human services - nc get covered · 2019. 7. 29. · client’s case is assigned to an...
TRANSCRIPT
Wake County Human Services
Economic Self Sufficiency Services-Medicaid ProgramsSam Murillo
Family and Children’s Medicaid Intake-Program Manager
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ESS Organizational Structure
Division/Asst Division Director
Leads ESS Division Programs
Supervisor
Leads Case Manager Unit
Program Manager
Leads Program
Case Manager
Directly services clients
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Intake Teams
• Intake Teams process applications for families seeking to receive assistance for the first time.
Medicaid Program StructureReview Teams
• Review Teams re-determine ongoing eligibility for families and individuals who are recipients of benefits.
1 Application comes into WCHS
2 HS Case Manager Processes Application
3 If approved, client’s case is assigned to an ongoing HS Case Manager
1 HS Case Manager conducts review
2 If approved, case continues in appropriate program
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Family & Children’s Medicaid
•Programs and Income Guidelines
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• Medical coverage for parent(s) or other caretaker/relative with child(ren) under age 18 in the household and for children under age 21. A pregnant woman may also qualify.
• You cannot have more than $3,000 in assets such as savings in the bank.
Medicaid for Families with Dependent Children (MAF)
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• Medical coverage for children under age 19.
• There is no limit on Medical coverage for children under age 19. The income limits are determined by the family size and the age of the child(ren) for whom you are applying.
• There is no limit on resources.• 107% to 210% of the Federal
Poverty Level depending on child’s age
Medicaid for Infants and Children (MIC)
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• May pay for certain medical expenses such as:
• Hospital bills• Prescriptions• Vision care• Dental care (For Children)• Mental health care• Most medically necessary services
for children under age 21• Doctor bills
MAF and MIC Covered Services
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• Medical coverage for pregnant women whose income is below established program income limits
• Only covers services related to pregnancy
• There is no limit on resources• 196% of the Federal Poverty
Level
Medicaid for Pregnant Women (MPW)
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• Only covers services related to pregnancy:
• Prenatal care, delivery and 60 days postpartum care
• Services to treat medical conditions which may complicate the pregnancy
• Childbirth and parenting classes• Family planning services• Maternity care coordination
services
MPW Covered Services
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• Program designed to reduce unintended pregnancies and improve the well being of children and families in North Carolina.
• Services are provided to eligible men and women whose income is below 195% of the federal poverty level and are determined ineligible for all other Medicaid programs.
• There is no limit on age or resources.
Family Planning Program (FPP)
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• Limited coverage under this program. Only covers:• Family planning initial and yearly exams• Follow-up family planning visits• Birth control and family planning counseling• Pregnancy tests• Some types of birth control methods like the pill,
the shot, IUDS, as well as vasectomies and tubal ligations
• Family planning lab tests• HIV testing• Limited screening and treatment for some STDs• Pap smears• Help on when to have a baby• Referrals
Family Planning Program Covered Services
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• A free or reduced price comprehensive health care program for children 6-18 yrs. If the family makes too much money to qualify for Medicaid, the child(ren) may qualify for NCHC
• There is no limit on resources• 133% to 211% of the Federal
Poverty Level
North Carolina Health Choice for Children (NCHC)
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• Covers hospitalization and outpatient care including the following but not limited to:
• Physician and clinic services• Laboratory and radiology services• Surgical services• Prescription drugs• Dental services• Vision• Hearing• Home health care
NCHC Covered Services
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• Coverage Groups= Aged 65+, or blind or disabled individuals of any age
• Provides medical coverage to individuals living at home or in facilities such as nursing homes or assisted living facilities
• Income limit varies based on family size and whether the person lives at home or in a facility
• Can have no more than $2,000 in assets for an individual, or $3,000 in assets for a married couple
Adult Medicaid Program
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• Extended care in a hospital or medical facility such as skilled nursing
• Medicaid covered individual pays income to facility, then Medicaid pays
• Some income may be reserved for a spouse living at home
• Reserve limit = $2,000• Some assets may be protected for
a spouse living at home
Long Term Care Medicaid
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• Cash benefit for eligible individuals in assisted living or licensed care home
• Covered individual pays income to facility, then Special Assistance pays
• Funded by State/County funds (50/50%)
• Maximum monthly income to qualify:o $1,247.50 Basic Levelo $1,580.50 Special Care Unit
Special Assistance
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• Approximately 24,045 individuals in Wake County receive coverage (FY ‘17-’18)
• Processed 11,297 applications in Wake County during calendar year 2017 (avg. per month 941 applications)
• In North Carolina, aged and disabled individuals make up 28% of the Medicaid enrolled population, but account for 64% of Medicaid expenditures
Adult Medicaid Program Data
Wake County Family Medicaid Program DataFFM Applications: Comparison of FY 17 and FY 18 Daily Pending Applications
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370 406587 621 707
1149 1185 1288 1338 1411 1456 1496
2127 21872330 2376
2705 2772 2760 27773059 3163 3112
32533011 2949
27982561 2509
208 245408 476 526
790 886 912 993 1035 11331404 1401 1411 1508
16901867 1917 1947
21502306 2310 2392
2551 2607 2588
3623
33953290
0
500
1000
1500
2000
2500
3000
3500
4000
11/1 11/2 11/6 11/7 11/8 11/9 11/1311/1411/1511/1611/2011/2111/2711/2811/2911/30 12/4 12/5 12/6 12/7 12/1112/1212/1312/1412/1812/1912/31 1/2 1/3
Affordable Care Act (FFM) Applications: Comparison of FY17 and FY18 Enrollment Period for Daily Pending Applications
FY 17 FY18
Source: NC Fast O&M Report NFOMD002A - MAGI Pending Apps by County By Source as of 1/4/2018
Wake County Family Medicaid Program Data
FFM Applications Submitted: Comparison of FY 17 and FY 18
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Month/Year MAGI Application Submitted Method of Application
Row Labels In Person Online Paper Phone Grand Total2017 2,007 10,783 3,813 12 16,615 Jul 292 1,042 470 1,804 Aug 431 1,099 641 2,171 Sep 330 972 651 1,953 Oct 433 1,021 761 8 2,223 Nov 324 3,068 656 2 4,050 Dec 197 3,581 634 2 4,414
2018 2,215 13,369 6,588 122 22,294 Jan 235 1,245 665 3 2,148 Feb 196 475 686 14 1,371 Mar 205 1,641 653 6 2,505 Apr 179 941 567 4 1,691 May 217 883 638 10 1,748 Jun 194 812 525 13 1,544 Jul 180 945 507 18 1,650 Aug 219 1,017 626 11 1,873 Sep 178 788 506 8 1,480 Oct 214 761 648 22 1,645 Nov 139 2,184 419 10 2,752 Dec 59 1,677 148 3 1,887
Grand Total 4,222 24,152 10,401 134 38,909
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Outreach staff could help inform consumers about importance of:• Explanation as to why County is making contact• Clear employer information• Good estimate of income• Add all of the household members (you can add your spouse and
children even if you are not applying for them through the Marketplace)
• Informed consumers = Happy Apps and wait times!
FCMA+PARTNERS =
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Questions??
