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Application Processing Changes for ACA Implementation. Fall 2013. Presented by the Self-Sufficiency Training Unit. ACA Implementation. Oregon is ready to implement changes in the way we offer medical coverage to our customers - PowerPoint PPT Presentation
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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: [email protected]
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: [email protected]
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ERDC: [email protected]
JPI, TA-DVS and [email protected]
Questions regarding impact on DHS Field Operations: Chere LeFore Phone: (503) 945-6473Email: [email protected]
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