CMS Update and Dialogue

Cheryl Camillo

Supporting Families After Welfare Reform

Breakthrough Series

Collaborative Learning Session #2

New Orleans, LA

November 13-15, 2002

Transitional Medicaid (TMA) Update

• Section 1925 extended through December 31, 2002 (for the first quarter of Federal Fiscal Year 2003) by Public Law 107-229, a continuing resolution.

• If not extended again, will sunset after December 31. If so, TMA under Section 1902(e)(1) of the Social Security Act will go into effect. So:– Families that become eligible for TMA before January 1, 2003

receive TMA under Section 1925

– Families that become eligible for TMA after January 1, 2003 receive TMA under Section 1902(e)(1).

TMA Update

• There are key differences between TMA under Section 1925 and TMA under Section 1902(e)(1). Under Section 1902(e)(1):

– Families must lose Section 1931 Medicaid because of increased hours or earnings from employment of any family member;

– Families receive 4 months of TMA; and

– A family member must be employed for the family to receive TMA.

QI (Qualifying Individuals) Update

QI-1s• Public Law 107-229 (as amended by P.L.s 107-240 an 107-

244) extended this benefit at current funding levels through January 21, 2003.

• State can make January Part B premium payment and should not take any action to notify or terminate QI–1s at this time.

QI (Qualifying Individuals) Update

QI - 2s• Sunsets after December 31, 2002.

• States should provide advance notice of termination action informing recipients that termination was caused by Federal law.

• Notice should advise recipients to contact the state if their income has changed, as they may be eligible for other programs.

• States need not provide a hearing opportunity.

QI (Qualifying Individuals) Update

QIs

• Explanatory State Medicaid Director letter issued on November 6, 2002. A copy can be found in each notebook and on CMS’ Web site at: http://www.cms.hhs.gov/states/letters/smd11602.pdf

HIFA(Health Insurance Flexibility and Accountability Demonstration Initiative)

• Encourages new, comprehensive state approaches that will increase number of individuals with health insurance coverage using current-level Medicaid and SCHIP resources.

• Emphasizes maximizing private health insurance coverage and targeting populations with income below 200% FPL.

• Application guidance and template can be found at: http://www.cms.hhs.gov/hifa/hifagde.asp

• 7 waivers have been approved (Arizona, California, Colorado, Illinois, Maine, new Mexico, and Oregon).

HIFA

• Arizona – Uses Title XXI funds to expand coverage to: (1) adults over 18 without dependent children and with adjusted net family income at or below 100% FPL and (2) otherwise ineligible parents of Medicaid and SCHIP children with adjusted net family income between 100% and 200% FPL

• Maine – Will cover all individuals with incomes at or below 100% FPL (option to go to 125% FPL) using available DSH funds and a cigarette tax increase for the state share.

HIFA

• Interested states can contact Theresa Sachs at (410) 786-0307 or tsachs@cms.hhs.gov

Prenatal Care for Unborn Children Rule

• Final rule published October 2, 2002 (Fed. Reg. Vol. 67, No. 191, Pg. 61956). A copy can be found in each notebook or at: http://cms.hhs.gov/providerupdate/regs/cms2127f.pdf.

• Allows states to file a state plan amendment (a waiver is not necessary) to use existing SCHIP funding for coverage for children from conception to birth and up to age 19.

• Allows states to provide this benefit regardless of mother’s immigration status.

Limited English Proficiency (LEP) Guidance

• August 30, 2000 HHS LEP guidance republished for comment on February 1, 2002 (Fed. Reg. Vol. 67, No. 22, Pg. 4968). A copy can be found in each notebook or on CMS’ Web site at: http://www.cms.hhs.gov/states/letters.lepguide.pdf

• August 30, 2000 guidance is effective until revised guidance is published.

LEP Guidance

• In deciding what language assistance services to provide, recipients of Federal funding should conduct an analysis of four factors:

– The number or proportion of LEP persons eligible to be served or likely to be encountered,

– The frequency with which LEP individuals come into contact with the program.

– The nature or importance of the program, activity, or service to people’s lives, and

– The resources available to the grantee/recipient and costs.

LEP Guidance

• There is no “one size fits all” solution. OCR will make assessment on case-by-case basis and recipient will have flexibility in determining how to fulfill obligation. OCR will focus on the end result.

• Key to providing meaningful access is to ensure that the recipient and LEP person can communicate effectively.

LEP Guidance

• Recipients have two main ways of providing language services:– Oral,

– Written.

• Quality and accuracy of the language service is critical in order to avoid serious consequences to the LEP person and to the recipient.

LEP Guidance

• Recipients of Federal funding should develop implementation plan. The following five steps may be helpful:

– Identify LEP individuals who need language assistance,

– Include information about language assistance measures,

– Include staff training,

– Include measures to provide notice to LEP persons,

– Include process for monitoring and updating the plan.

Electronic Applications

• States may use electronic applications.

• Per Federal regulation 42 CFR 435.907(b), the application must be “signed under a penalty of perjury.”

• States may obtain signatures as follows:– Electronically (e.g., using the digital certificate or digitized

signature technologies),

– Sending postcards to applicants asking them to attest to accuracy of online application, or

– Applicant can print application or short statement, sign it, and send it to office via mail, fax, or hand delivery.

Rolling Renewals

• Use existing providers and community-based organizations to renew eligibility on-site.

• Successful renewals will receive an additional 12 months of coverage.

• Massachusetts performed pilot.

Notices

• Federal regulations at 42 CFR, Part 431, Subpart E and Part 435, Subpart J require that each applicant who is denied, awarded, or terminated from Medicaid receive timely written notice of the agency’s decision.

• Notices should explain the agency’s decision and the applicant’s/recipient’s rights and responsibilities, including the right to request a hearing.