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ChangestoMedicaidSpend-down:
Acloserlookatacomplextransi:on
6/22/16
astatewidecoali:onofover475organiza:onsandthousandsofindividualadvocates
AdvocatesforOhio’sFutureis…
6/22/16
OhioshouldbeagreatplaceforALLOhioanstoliveandwork.
Participate in the economy
Be healthy and safe Afford the basics
6/22/16
Advocatewithus!
• You’llreceiveafollow-upemailfromthiswebinar
• Lookfor“ActNow”emailalerts,webinarinvita:ons,andnewresources
• Unsubscribeany:me
6/22/16
BethKowalczykChiefPolicyOfficer
OhioAssocia:onofAreaAgenciesonAging
JeanneCarrollAssistantDirector
OhioJobsandFamilyServicesDirectors’Associa:on
WebinarPresenters
6/22/16
SteveWagnerExecu8veDirector
UniversalHealthCareAc:onNetwork
TeresaLamplAssociateDirector
TheOhioCouncilofBehavioralHealthandFamilyServicesProviders
WebinarPresenters
ZachReatDirectorofWorkSupportIni8a8vesOhioAssocia:onofFoodbanks
6/22/16
Overview and Timelines for Medicaid Disability Determination Redesign Jeanne Carroll
Ohio Job and Family Services Directors Association
6/22/16
Overview
q Section 209 of the Social Security Act requires states to provide Medicaid to anyone who receives Supplemental Security Income (SSI)
q Section 209b allows states to choose to be more restrictive in their income and resource methodologies. Ohio chose to be more restrictive.
q States choosing to be more restrictive are required to allow individuals to “spenddown” to the more restrictive income limit
6/22/16
Ohio is moving from the 209b option to the 1634 option
q This option allows states to accept the Social Security Administration’s decision for SSI
q SSI beneficiaries will be automatically enrolled in Medicaid via a nightly data exchange
q Individuals with income less than 75% FPL will no longer need to spenddown to 64% FPL and will obtain full Medicaid coverage
6/22/16
Timelines q Medicaid ABD 1634 changes will go-live on August 1, 2016
q This policy change will happen at the same time as the change from the old CRIS-e eligibility computer system to the new Ohio Benefits system
q At 5:00 pm on Thursday, July 28, 2016, the CRIS-e system will close in order to prepare for the conversion of all ABD cases (including Long Term Care and Waiver cases) to the new system. The eGateway system will also be down. The self-service portal will remain open for applicants to submit new applications. At this point no new applications will be accepted by CRIS-e and all of the current and pending ABD applications will be transferred to Ohio Benefits
q Ohio Benefits will open on Monday 8/1/16 at 6:00 am and from that time forward ALL Medicaid cases will be processed in the Ohio Benefits system
6/22/16
How will spenddown cases be converted?
q Any individual who met spenddown in at least one month between August 1, 2015 and July 31, 2016 will have full Medicaid coverage after the August 1, 2016 conversion and will be converted to the Ohio Benefits system
q Those individuals will remain eligible for full Medicaid until their next renewal or until there is a major change to their case
q The Ohio Department of Medicaid has requested a waiver of all ABD renewals until January 1, 2017. This means that if a person has a scheduled renewal between August 1, 2016 and January 1, 2017, their renewal will be delayed. At the time of their renewal, converted spenddown cases will have their eligibility for Medicaid determined based on the new 1634 eligibility requirements.
6/22/16
Spenddown Populations
q Based on information from CRIS-e, approximately 34,043 individuals met their spenddown at least once in the past year and will be converted to full Medicaid until their next renewal
q 11,804 SSI recipients not previously enrolled in Medicaid will now be automatically enrolled
q 3,943 single adults who do not otherwise qualify for Medicaid ABD or Medicare but have monthly income below $1,367 (the expansion group limit) will be eligible under the expansion group
q 5,527 individuals with Severe and Persistent Mental Illness will now qualify for the SRS program
6/22/16
Spenddown Cont…
u Based on the new 1634 eligibility requirements, there are a number of people who no longer qualify for Medicaid.
u Some may qualify for:
• Medicare Premium Assistance,
• Medicare only,
• the federal Marketplace Exchange
• some will need to seek private health insurance
6/22/16
Long-Term Care q Income eligibility criteria for individuals needing Medicaid
Long Term Care Services will not change as a result of the redesign. Individuals with income up to $2,199 will qualify as they do today
q Individuals with income over the limit will need to establish a Qualified Income Trust (QIT) to qualify for Medicaid
q This includes all individuals who need long term care residing in a nursing facility or intermediate care facility for individuals with intellectual disabilities (ICF-IDD), or receive home and community based services (HCBS) on waiver programs like PASSPORT, Assisted Living, Ohio Home Care, Individual Options, and MYCare Ohio
6/22/16
OhioAssociationofAreaAgenciesonAging
Disability Determination Redesign:
QITs and Medicare
Beth Kowalczyk
June 22, 2016
Beth Kowalczyk kowalczyk@ohioaging.org
(614) 481-3511
Ohio Association of Area Agencies on Aging
www.ohioaging.org Facebook: o4aadvocacy Twitter: @o4aadvocacy
6/22/16
OhioAssociationofAreaAgenciesonAging
Qualified Income Trusts • Includes MyCare Ohio, PASSPORT, Assisted Living, Ohio Home Care and
DD waivers, NFs, ICFs. • Individuals receiving long-term care services (nursing facilities or home and
community-based services) with an income over 225% FPL ($2199/month). • Will remain eligible for Medicaid by depositing excess income into a
Qualified Income Trust (QIT). • Eligibility starts when income is deposited into trust.
6/22/16
OhioAssociationofAreaAgenciesonAging
Qualified Income Trusts • A special legal arrangement to disregard an individual’s income over certain
thresholds. • An individual, their legal guardian, or their power of attorney may open a
Qualified Income Trust. • Trust is irrevocable. Once established, it cannot be changed or canceled. • Make monthly deposits of income into trust. • Pay bank fees, medical expenses, patient liability and monthly personal or
maintenance needs allowance. • State is beneficiary.
6/22/16
OhioAssociationofAreaAgenciesonAging
• Notices went out in May. • State has template. • Automated Health Systems has contract with state to help with QIT
(documents, banking) – lawyer on staff. Call 1-844-265-4722 or email OhioQIT@automated-health.com .
• Medicaid website: http://medicaid.ohio.gov/INITIATIVES/DisabilityDeterminationRedesign.aspx
Qualified Income Trusts
6/22/16
OhioAssociationofAreaAgenciesonAging
Qualified Income Trusts • Additional resources for help -
Ø ProSeniors legal hotline for seniors age 60 and older - www.proseniors.org or (800) 488-6070
Ø Disability Rights Ohio Voice: 1-800-282-9181 (toll-free in Ohio only) TTY: 1-800-858-3542 (toll-free in Ohio only) http://www.disabilityrightsohio.org/need-our-help
Ø Legal Aid - Legal Aid 1-866-LAWOHIO (1.866.529.6446) www.ohiolegalservices.org/public/legal_problem
6/22/16
OhioAssociationofAreaAgenciesonAging
Medicare and Medicaid • Not receiving or eligible for long term services and supports via nursing facility
or waiver. • If income greater than 75% FPL, not eligible for Medicaid. • Not eligible for Group 8 (Medicaid expansion) coverage. • May be eligible for Medicare assistance programs:
http://medicaid.ohio.gov/Portals/0/Resources/Publications/Materials/mpap-fact-sheet-2014-12-online.pdf
6/22/16
Specialized Recovery Services Program
TeresaLampl,LISW-SAssociateDirector
6/22/16
Specialized Recovery Services (SRS) Program Recognizingasubstan:alnumberofindividualswithmentalillnessuseMedicaidspenddowntoaccessMedicaidcoverage,OhioMedicaiddevelopedtheSRSProgramtopreserveaccesstocomprehensivebehavioralhealthservicesprovidedunderOhio’sMedicaidprogram.THESRSPROGRAMCREATESANEWMEDICAIDELIGIBILITYCATEGORY• 1915(i)StatePlanAmendment• SpecificeligibilitycriteriaMUSTbemettoACCESSMedicaidcoverage• Requires“conflictfreecasemanagement”• Requirestheindividualshometobeevaluatedandcannotbe“ins:tu:onal”like6/22/16
Specialized Recovery Services (SRS) Program Oncedeterminedeligible…1.TheindividualhasaccesstotheFULLMedicaidbenefit
• EnrollmentinMedicaidmanagedcareor• EnrollmentinMyCareOhio(Medicare-Medicaid)
AND2.TheindividualwillhaveaccesstothreenewMedicaidcoveredservices:
• RecoveryManagement• IndividualPlacementandSupport-SupportedEmployment(IPS-SE)• PeerSupport
6/22/16
Specialized Recovery Services (SRS) Eligibility ELIGIBILITYFORSRSPROGRAM(MEDICAIDELIGIBILITY)• Monthlyincomebetween$743and$2,199• Age21orolder• DisabilityDetermina:onbytheSocialSecurityAdministra:on/Medicare
• DiagnosisofaqualifyingMENTALILLNESS• Func:onalimpairmentsrequiringassistancewithdailylivingac:vi:es• Historyofmentalhealthserviceu:liza:on
6/22/16
Specialized Recovery Services (SRS) Eligibility ELIGIBILITYFORSRSPROGRAM(MEDICAIDELIGIBILITY)• Agreetoacceptanew“RecoveryManagementService”
• Thisincludesaccep:nganew“RecoveryManager”(casemanager),par:cipa:oninanassessment,anddevelopmentofa“personcenteredcareplan”forpurposesofSRSenrollment.
• Liveina“homeandcommunity”segng• Individualcannotliveinanursinghome,ICF-IDD,orsegngthatis“ins:tu:onallike”.
• Addi:onalevalua:onrequiredinindividual’shomeis“owned”byaserviceprovider.
• Individualcannotbereceivingotherhomeandcommunitybasedwaivers
6/22/16
New SRS Program Services
• RecoveryManagement• Coordina:onofallspecializedrecoveryserviceprogramservicesandassistanceingainingaccesstoneededmedicalservicesaswellassocial,educa:on,andotherresourcesregardlessoffundingsource.
• Facetofaceevalua:onofindividualsneedstodetermineSRSProgrameligibilityandserviceneeds.
• Personcenteredcareplanning,monitoring,andupda:ngtoassureiden:fiedneedsaremet.
• Facilita:onofcommunitytransi:onsfromins:tu:onalsegngs.
6/22/16
New SRS Program Services • IndividualPlacement&Support–SupportedEmployment(IPS-SE):
• Evidence-basedprac:cethathelpspeoplewithsevereandpersistentmentalillnessand/orco-occurringsubstanceusedisordersiden:fy,acquire,andmaintainintegratedcompe::veemploymentintheircommuni:es.
• EmploymentisintegraltorecoveryNOTanendgoaloftreatment• 19BHproviderscurrentlyOhioMHASCer:fiedforIPS-SE• hjp://mha.ohio.gov/Portals/0/assets/Supports/Employment/Qualified-IPS-Providers.pdf
• PeerRecoverySupport• PeerServicesareprovidedbyindividualsinrecoveryfrommentalillnessand/oraddic:onwhousetheirlivedexperienceasatooltoassistothersbysharingtheirpersonaljourneysandknowledge.
• OhioMHASisdevelopingaNEWPeerCer:fica:onProcess• Cer:fica:onwillberequiredtodeliverPeerRecoverySupportServices
6/22/16
SRS Program Implementation ConsumerNoTficaTon• 5,660individualsiden:fiedasPOTENTIALeligibleforSRSProgram.• LejersenttotheseindividualsinformingthemaRecoveryManagerwillbecontac:ngthemtodiscussaccessingthese“newservices”.
• RecoveryManagersfromstatedesignatedvendorswillbeginoutreachtoconsumerssoon.
• Communitybehavioralhealthproviderorganiza:onsaresendingOhioMedicaidlistsofclientscurrentlyservedthathaveaMedicaidspenddownandqualifyingdiagnosistosupportprogramreferral.
• Consumersareencouragedtotalktotheircommunitybehavioralhealthprovideriftheyhaveques:ons.
6/22/16
SRS Program Information SRSProgramWebpage:hjp://bh.medicaid.ohio.gov/Individuals#4299-specialized-recovery-servicesFAQ:hjp://medicaid.ohio.gov/Portals/0/Ini:a:ves/DDR/FAQ-SRS.pdfIntroductoryVideo:hjps://www.youtube.com/watch?v=fZW4p1fOmWMRecoveryManagementHandbook:hjp://bh.medicaid.ohio.gov/Portals/0/SRS-Handbook-2016.pdf?ver=2016-06-10-164826-630
6/22/16
Thank You! TeresaLampl,LISW-S
e-mail:lampl@theohiocouncil.orgPhone:614-228-0747
6/22/16
www.ohiofoodbanks.org
www.ohiobenefits.org
Changes to Medicaid: Elimination of Spend Down for People in the Community
Zach Reat 6/22/2016
6/22/16
Medicaid Transition: Non-Long-term Care • People receiving aged, blind and disabled (ABD) services with income below 64%
Federal Poverty Level (FPL) and people with income above 64% FPL who met their spend-down between August, 1 2015 and July 30,2016 will continue to receive Medicaid.
6/22/16
Medicaid Transition • People receiving SSI, but not Medicaid, will be automatically added to the
Medicaid program. • People with income above 75% FPL and below 138% FPL will be automatically
enrolled in Group 8 Medicaid coverage.
6/22/16
Medicaid Transition • People with income above 138% and no Medicare will have to find other
coverage will lose coverage effective August 1, 2016. • People who lose access to Minimum Essential Coverage are eligible for a Special
Enrollment Period to shop for insurance on the Health Insurance Marketplace; depending on income may be eligible for subsidies
6/22/16
Options for the 18,000+ losing coverage
• Employer-Sponsored Insurance • Exchange with or without financial assistance • Other private insurance • Going without coverage Special Enrollment Period and Spend-Down According to guidance from CMS dated November 7, 2014: “Medicaid for aged, blind, and disabled individuals eligible for mandatory coverage under CFR 435.121 with or without having to meet spend-down is considered government-sponsored MEC under section 5000A(f)(1)(A)(ii) and the implementing IRS regulations.
6/22/16
Help is Available
Self-Serve • Healthcare.gov • Marketplace Call Center – 1-800-318-2596 In-Person Help • Localhelp.healthcare.gov • Get Covered Connector • Ohio Association of Foodbanks Consumer Assistance
Hotline: 1-800-648-1176
6/22/16
How to identify people losing coverage
• PARTNERSHIP • CDJFS Offices • Area Agencies on Aging • Aging and Disability Resource Network • Local Payee services • Local SSA offices
• Medicaid agreed to provide geographic breakdown of population (pending).
• Information about Navigators on Medicaid termination notices (pending).
6/22/16
Questions?
Zach Reat
zach@ohiofoodbanks.org (614) 634-6458
www.medicaid.ohio.gov
www.healthtransformation.ohio.gov www.healthcare.gov
6/22/16
References • Centers for Medicare & Medicaid Services. SHO# 14-002 Re: Minimum Essential Coverage.
November 7, 2014. Accessed from https://www.medicaid.gov/federal-policy-guidance/downloads/sho-14-002.pdf
• Office of Health Transformation. Disability Determination Redesign Overview. 4/8/2016. Accessed from http://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=nwrdhnOoQqo%3d&tabid=117
• Ohio Department of Medicaid. Medicaid Eligibility Manual. Various Dates. Accessed from http://medicaid.ohio.gov/Portals/0/Resources/Publications/Guidance/Policy/Medicaid-EligibilityManual.pdf. (ABD begins on page 303).
• Ohio Department of Medicaid. Disability Determination Redesign Presentation. 4/19/2016.
6/22/16
BethKowalczykChiefPolicyOfficer
OhioAssocia:onofAreaAgenciesonAging
JeanneCarroll
AssistantDirectorOhioJobsandFamilyServices
Directors’Associa:on
WebinarPresenters
TeresaLamplAssociateDirectorTheOhioCouncilof
BehavioralHealthandFamilyServices
Providers
SteveWagnerExecu8veDirector
UniversalHealthCareAc:onNetwork
ZachReatDirectorofWorkSupport
Ini8a8vesOhioAssocia:onofFoodbanks
6/22/16
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