Application Processing Changes for ACA Implementation

Fall 2013

Presented by the Self-Sufficiency Training Unit

Oregon is ready to implement changes in the way we offer medical coverage to our customers

This webinar will explain the immediate changes we will be supporting, including:

Guidelines for daily work Interacting with our customersCollaboration with OHA and Cover Oregon

Medical cases will be carried by the OHA Statewide Processing Center (5503), APD and AAA

DHS will continue to determine REFM medical eligibility

Cover Oregon will help customers compare and enroll into insurance that fits their budget

Medical applications with a DOR prior to October 1 will be processed in the branch using current eligibility rules

◦ This includes cases that may be in pend status

Once eligibility is established, and a separate P2 medical case is open, transfer the medical case to 5503

Effective with a DOR of October 1, 2013 and later, DHS will do medical differently

Eligibility for OCCS medical programs: BCCTP, CEC, CEM, CHIP, EXT, HKC, MAA, MAF, OPC, OP6, OPU and SAC will be determined by staff at 5503

Renewals occurring October 2013 – March 2014 will be deferred out 6 months (excludes some populations)

Original Renewal Month

Deferred Renewal Month

October 2013 April 2014

November 2013 May 2014

December 2013 June 2014

January 2014 July 2014

February 2014 August 2014

March 2014 September 20146

SSP, OHA and APD will work together to complete all case transfers

◦ All OCCS medical cases in SSP branches will be transferred to 5503

◦ QMB/OCCS combination medical cases will be transferred to 5503 (example: a pregnant woman who also qualifies for QMB) No further action is required by the branch

◦ Any APD medical cases currently in an SSP office will need to be transferred to the local APD or AAA office A transfer notice needs to be sent

All OCCS medical cases in APD branches will be transferred to 5503

This includes QMB/OCCS medical combination cases (example: a pregnant woman receiving QMB)

No transfer notice will be required

The Medical Chapter of the FSM will be removed on September 30, 2013 in preparation for the new MAGI medical eligibility processes that will begin October 1, 2013

The Medical Chapter will remain available on the FSM Archive site

If a request for medical is received in an SSP office on, or after October 1, the branch will:

◦ Complete the Date of Request for OCCS Medical Request form

◦ Fax to: (503) 373-7493

◦ Or email to: : 5503 Case Transfers

Medical DOR form for OHA-5503

If a request for medical is received in an SSP office, the branch can:

◦ Provide the applicant with a date stamped 7210 application

◦ The application can be completed and mailed by the customer to 5503 or the branch can email or FAX the application to

5503 Fax: (503) 373-7493 Email: 5503 Case Transfers

Direct the applicant to www.coveroregon.com

Clients transitioning off of TANF due to an increase in income will remain eligible for EXT

Indicate changes on the Date of Request for OCCS Medical Program Benefits form

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10/01/13 revision will exclude medical

questions

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Paper Application Online

Compatible with all browsers

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• SNAP Based Medical

• Pended Presumptive Referrals

• Parents with Medically Eligible Children

• Standard Reservation List

SNAP-Based Medical and Eligibility for Parents of Medically Eligible Children will be on a “fast-track” enrollment for the new January 2014 programs

Your clients may receive a letter of consent Date stamp – fax or email to 5503

OHP Standard Reservation List requesters will be mailed a letter in mid-October regarding new health care options for January 1, 2014

When creating separate CM cases:

◦Open two sessions of DHR

◦Determine the type of combo case

◦Verify there are no duplicate cases

◦Follow the steps to separate and transfer

the newly created case

From Webm,Find◦ Select the CM case, F22 for CASEM

Place a “Y” in the Srce field Choose individuals to transfer F14

DO NOT SAVE YET!

DO NOT SAVE YET!

Verify all information is correct on both cases

First! ◦ Press F9 twice on your original combo case

Second! ◦ Press F9 twice on your newly created medical

stand alone case

DO NOT SAVE YET!

DO NOT SAVE YET!

Verify all information is correct on both cases

First! ◦ Press F9 twice on your original combo case

Second! ◦ Press F9 twice on your newly created medical

stand alone case

DO NOT SAVE YET!

DO NOT SAVE YET!

Verify all information is correct on both cases

First! ◦ Press F9 twice on your original combo case

Second! ◦ Press F9 twice on your newly created medical

stand alone case

DO NOT SAVE YET!

DO NOT SAVE YET!

If you receive this error on the original combo case“Exempt reason code P requires DUE N/R or CH/NO under 2 years”Add the DUE date back onto the TANF only case.

Verify all information is correct on both cases

First! ◦ Press F9 twice on your original combo case

Second! ◦ Press F9 twice on your newly created medical

stand alone case

Notice that recipient is only receiving QMB. If recipient was receiving QMB and OCCS medical, transfer whole case to 5503.

DO NOT SAVE YET!

DO NOT SAVE YET!

Verify all information is correct on both cases

First! ◦ Press F9 twice on your original combo case

Second! ◦ Press F9 twice on your newly created medical

stand alone case

For policy questions: Medical.SSP-POLICY@dhsoha.state.or.us

To refer applicants: Cover Oregon: 1-855-CoverOR (268-3767)www.coveroregon.com

OHA Statewide Processing Center Phone: 1-800-699-9075Fax: (503) 373-7493 Email: 5503sspcasetransfers@dhs.oregon.gov

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ERDC: Childcare.Policy@state.or.us

JPI, TA-DVS and TANFTANF.Policy@state.or.us

Questions regarding impact on DHS Field Operations: Chere LeFore Phone: (503) 945-6473Email: Chere.LEFORE@dhsoha.state.or.us

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