welcome 2015 open enrollment, ses and cbms training
TRANSCRIPT
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Welcome
2015 Open Enrollment,
SES and CBMS
Training
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For all October 2015 build projects, please visit TrainColorado.com for
more information.Courses > CBMS Build Training >
October 2015> CBMS/PEAK October 2015 Build Project Guide – HCPF
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Glossary
SES – Shared Eligibility System
MA - Medical Assistance APTC - Advanced Premium Tax
Credits CSR - Cost Sharing Reductions C4HCO or C4 - Connect for
Health Colorado
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Open Enrollment 2016 Open Enrollment is an opportunity for those who want to apply for
Federal Financial Assistance to help purchase private health insurance through C4HCO for the 2016 plan year
Open Enrollment begins November 1, 2015
Open Enrollment ends January 31, 2016
It does not impact current Medicaid or CHP+ clients unless they are no longer eligible for Medicaid or CHP+
Client must receive a MA denial during the Open Enrollment Period in order to enroll in a plan
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Applying for Medical Assistance (MA)
No wrong door for applications Phone, Fax, PEAK/SES, Paper, In
person SSAp, Single Purpose Application
(SPA)
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Shared Eligibility System (SES)
Applicants applying for MA only through PEAK or C4
MA only application includes CHP+, APTC and CSR results
Eligibility determined individually
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Questions?
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CBMS C4HCO User Interface/User Experience Updates
Project 8764
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Current Functionality
Many application questions need to be answered for MA applicants
Many questions from applicants about the MA application and the process
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After Build Functionality
PEAK/SES changes CBMS page changes MA eligibility changes
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PEAK Changes
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PEAK Changes
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Mandatory PEAK Questions
Apply for Benefits MA only Applications: What type of coverage is this person currently enrolled in? Who else has access to this coverage Is this person a U.S. citizen? Is ___ currently enrolled in a health plan offered by (employer)? Is anyone in your home covered by Health Insurance that you have
not already reported above? Report My Changes/RRR MA only cases:
Is this person a resident of Colorado? Is this person a U.S. citizen? Who else has access to this coverage?
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RMC/RRR Summary Page
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CBMS Changes
Past expenses added for APTC
Private Disability Taxable amount added to income received details page
Qualifying widow(er) with dependent child added to individual tax information page
Ethnicity page changes
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CBMS Changes
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Questions?
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CBMS Connect for Health Colorado Big Rocks
Project 8759
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Overview of Changes CBMS and PEAK changes for MA
Add expedited income path for MA only applications
Add avatar to the SES
Add summary page to SES
Allow client to review prior to submitting application
SES changes for life change events
Create Service center portal for customer service representatives
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MA Standard Income Path
Standard Income Path Combo applications (MA, CDHS) Possible Non-MAGI Household (over 64 years old,
disabled, needs care) HH members not lawfully present No tax filers Married filing separately tax filing status
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MA Expedited Income Path
Expedited Income Path Client can reports tax household’s annual income
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MA Expedited Income Path cont.
Multiple tax households on same application
FPL thresholds 10% higher than normal FPLs for MA categories
Expedited income not matched with IEVS
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AI/AN Expedited or Standard?
AI/AN income = yes than Standard AI/AN income = no than Expedited
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Apply for Benefits (AFB) Expedited
Income Path applications
If the RTE determination is successful and the eligibility results are
mixed meaning there are APTC and MA individuals then the application will be assigned to the C4
caseload
If no individuals are approved for APTC/CSR then the application will
be assigned to the County of residence
If the RTE determination is un-successful the application will be
assigned to the State of Colorado inbox where C4
workers will be able to process the application
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Report My Changes (RMC) Applications
If a client submits a change using Report My Changes
within 15 months of the APTC only case being closed and that application is routed down the
Expedited Path then the application will be assigned to the State of Colorado inbox.
If a client submits a change using Report My Changes
within 15 months of the APTC only case being closed and that application is routed down the
Standard Path then the application will be assigned to
the County Inbox
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Meet Kyla
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Application Summary Page
Review MA application prior to submitting Correct/edit information prior to submitting
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Eligibility Results Page
Summary page to show client how eligibility was determined Gross income HH composition Denial reason Non countable income Deductions that are counted Expenses that are being counted
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Life Change Events (LCE)
LCE’s will be asked in PEAK after the client reports changes
Summary page to confirm changes, add additional LCE(s)
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Questions?
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CBMS C4HCO Life Change Event Updates
Project 8761
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Current Functionality
Life Change Events (LCE) based off data entry
Eligible APTC/CSR individuals are not being approved
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After build Functionality
CBMS page changes Life Change Event changes
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CBMS Page changes
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System Determined LCEs
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Questions?
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CBMS C4HCO Policy Rules Engine Updates
Project 8765
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Overview of Changes
Policy and rule changes regarding Pregnancy
Shared Eligibility System(SES) changes
Intercounty Transfer changes
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Pregnancy Changes
APTC/CSR individual reporting pregnancy in RMC/RRR
Does the client want to remain on APTC/CSR?
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SES Changes
MA closed in past 15 months
User has to go through RMC/RRR
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Intercounty Transfer Changes
MA case contains Marketplace eligible (Marketplace only or mixed HH) individual = MA assigned to C4HCO
Ability to push MA case to new C4HCO caseload
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Questions?
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C4HCO Noticing Updates
Project 8762
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Current Functionality
MA/APTC summary boxes combined MA/APTC correspondence is
confusing to clients
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After build Functionality
MA and APTC are separated Eligibility Start Date added Translation page provided Denver Health contact info in NOA –
CHP+
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NOA Layout Example
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Questions?
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Case Assignment
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Case Assignment
New office within Denver Health is Colorado Medical Assistance Program (CMAP)
Separate from Denver Health MA Site
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Denver Health Colorado Medical Assistance Program (CMAP)
CMAP will receive Department of Corrections (DOC) applications (only) in the PEAK Inbox, including DOC real time eligibility (RTE) exceptions from PEAK. All other PEAK RTE exceptions will be routed to the PEAK Inbox for the Head of Household’s (HOH) County of Residence
CMAP will take phone applications and, upon authorization, the case will be assigned to the HOH County of Residence
CMAP will keep and maintain all DOC and Buy-In (Adult & Children) cases
CMAP will process CHP+ enrollment fees and Buy-In premiums. CMAP will not keep or maintain CHP+ cases
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Denver Health MA Site
Denver Health MA Site will process any applications they receive and, upon authorization, they will keep and maintain that case regardless if it is all MAGI, Non-MAGI, or a combination of both
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Counties
All PEAK RTE exceptions (not including DOC applications) will now be assigned to the HOH County of Residence
Combo applications and Non-MAGI applications (except those Non-MAGI applications initiated by Denver Health MA Site) will continue to be assigned to the HOH County of Residence
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Connect For Health
Colorado
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Connect for Health Colorado
The C4HCO caseload assignment will remain unchanged
Cases with APTC or MA/APTC will be assigned to the C4HCO caseload
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Who Does what?
Certified Health Insurance Agents & Brokers Help customers with application and enrollment Advice comparing rates, evaluating benefits and
purchasing health plans Receive commissions from insurance companies Services are free to the customer
Health Coverage Guides & Certified Application Educate, engage and enroll customers in health plans
through marketplace In person assistance with the individual application
process and enrollment Act in the best interest of the customers
Customer Service Representatives Help customers with Financial Assistance and
Non-Financial Assistance applications through to enrolling in a health plan
Help address or escalate questions and issues through call-in support, email and online chat
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Questions?
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Additional Resources Staff Development Center Inbox:
Medicaid Inbox: [email protected]
Customer contact Center #(800)-221-3943
Connect For Health Colorado Call Center # 1-855-PLANS-4-YOU (1-855-752-6749)
PEAK Technical issues: [email protected]