The 2014/2015 Renewal Process

Kristen Dowty, Medical Administration Manager, DSS Josephine Sempere, Training and Education Manager, AHCT

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Renewals

Renewal – an opportunity for a member who is already enrolled in a CT marketplace health plan to enroll in the same or another health plan (based on an applicant’s eligibility) Why do we need a renewal process? In compliance with the ACA, Access Health CT has implemented a streamlined renewal process to promote retention of active members. We want to keep our current members for multiple years.

10/17 – 10/23

10/27 – 10/30

11/15 – 2/15

1334 Notice M/CH 30 Day

1/1 Auto Renew

Effective Date

2014/2015 Renewals Process

December November October February January March

11/1*

12/1

*Actual Date to be Reconfirmed *60 days prior to coverage end date **30 days prior to coverage end date ***15 days prior to coverage end date

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12/5

12/1**

Reconsideration Period

Bulk Services

12/15***

Access Health CT Enrollments Total enrollment as of 10/1/14: Qualified Health Plan: 74,221 Medicaid: 205,905 TOTAL 281,026

QHPMedicaid

Renewals For 1/1/2015

Qualified Health Plan: 74,221 MAGI Medicaid: 27,000

http://learn.accesshealthct.com/renewal/

Meet “Tina” The Access Health CT Virtual Assistant

Tina will be appearing on the Access Health Consumer Portal before 2015 Open Enrollment . She will provide shopping, eligibility and enrollment guidance to our website visitors. Her role is to provide information and to answer questions about the ACA (Affordable Care Act) and the application process.

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2014 Qualified Health Plan (QHP) Offerings

QHP Issuers Individual Standard Plans

Individual Non-Standard Plans

SHOP Standard Plans

SHOP Non-Standard Plans

Anthem 1 Gold 1 Silver* 1 Bronze

1 Gold 1 Silver* 2 Bronze 1 Catastrophic

1 Gold 1 Silver 1 Bronze

1 Gold 1 Bronze

ConnectiCare Benefits, Inc. 1 Platinum 1 Gold 1 Silver* 1 Bronze

2 Bronze 1 Catastrophic

0 0

HealthyCT Co-op 1 Gold 1 Silver* 1 Bronze

1 Bronze 1 Catastrophic

1 Gold 1 Silver 1 Bronze

1 Bronze

UnitedHealthcare 1 Gold 1 Silver* 1 Bronze

0 1 Gold 1 Silver 1 Bronze

0

*All Individual Silver Plans include three cost sharing reduction plans All Standard Individual Plans include AI/AN zero cost sharing plans and AI/AN limited cost sharing plans

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Standard Plan Designs 2015

Bronze Bronze H.S.A Silver Gold Platinum

Deductible

In-Network Individual $5,000 $4,600 $2,600 $1,000 $0

Family $10,000 $9,200 $5,200 $2,000 $0

Out of Network Individual $10,000 $9,200 $6,000 $3,000 $2,000

Family $20,000 $18,400 $12,000 $6,000 $4,000

Prescription Deductible

In-Network Individual n/a n/a $25 $0 n/a

Family n/a n/a $50 $0 n/a

Out of Network Individual n/a n/a $350 $350 n/a

Family n/a n/a $700 $700 n/a

Out of Pocket Max

In-Network Individual $6,600 $6,450 $6,600 $3,000 $2,000

Family $13,200 $12,900 $13,200 $6,000 $4,000

Out of Network Individual $13,200 $12,900 $12,500 $6,000 $4,000

Family $26,400 $25,800 $25,000 $12,000 $8,000

QHP/APTC Renewal Process: The Active Role

Individuals are given the following 3 options to renew coverage during the Open Enrollment Period: 1.Renewing online on the Access Health CT Consumer Portal 2. Returning the signed Signature Form included in the Open Enrollment Renewal notice 3. Contacting the Access Health CT Call Center by phone or in-person at one of our two Enrollment Centers

Renewals- Medicaid Medicaid and CHIP Renewal - Year One (Pre-MAGI to MAGI)

There are no changes required to the AHCT system to accommodate Pre- MAGI to MAGI Medicaid and CHIP renewals.

Individuals currently enrolled in pre-MAGI Medicaid or CHIP are instructed to complete their Medicaid or CHIP renewal through the AHCT system. Pre-MAGI Medicaid or CHIP enrollees who enter AHCT for renewals will complete the full AHCT application and undergo full eligibility determination using MAGI-based rules.

The system will verify if the individual is currently receiving Medicaid or CHIP and is within the renewal period of 60 days. If so, an eligibility determination will be made and notices sent to the individuals. Individuals cannot renew coverage outside of this 60 day window.

Renewals- Medicaid Year Two Medicaid/CHIP Renewal Timeline

Key Points • Medicaid renewals will occur throughout the year on a monthly basis • Medicaid enrollees will be able to renew online as soon as the first renewal notice is received and the coverage start

date will be coordinated appropriately • The batch process is run 15 days prior to the coverage end date for Medicaid/CHIP enrollees who have not manually

renewed coverage. The system will auto-renew eligible enrollees OR terminate the coverage, effective the end of the month, if it cannot be renewed

• There will be no gap in coverage for auto-renewals • Medicaid enrollees should receive a full 12 months of coverage (except for those aging out such as HUSKY A and B

children or Former Foster Care Children turning 26 during that coverage year)

Renewals- Medicaid Medicaid and CHIP Renewal Year Two (2015) and Beyond (MAGI to MAGI)

Prior to the Medicaid and/or CHIP coverage end date, a renewal notice will be sent to all active enrollees, informing them about their projected eligibility determination results and instructions on how to renew Medicaid/CHIP coverage. Individuals who are eligible for auto-renewal will be informed in the notice as well. No action required unless otherwise noted.

Individuals are given the following options to renew coverage during the renewal period if their circumstances have changed:

• Renewing online on the Access Health CT Consumer Portal

• Returning the signed AH3-R form (pre-populated renewal form) to AHCT*

• Contacting the AHCT call center by phone or in person

60 days

Renewals- Medicaid Medicaid and CHIP Renewal

Prior to the coverage end date, the Medicaid and CHIP Renewal Reminder Notice will be sent again to all eligible active enrollees

Prior to the coverage end date, for all individuals who are currently enrolled in Medicaid/CHIP and who have not reported a change in circumstances, the system will auto-renew coverage beginning the 1st of the following month. If coverage cannot be auto-renewed, the system will terminate the coverage, at the end of the month.

30 days

15 days

Renewals- Medicaid Medicaid and CHIP Renewal

The AHCT system will send a notice to notify the enrollee of the final eligibility determination

For individuals who can be auto renewed, the system will send an additional verification notice if self-attested income and lawful presence cannot be verified with the external data sources.

In addition, an enrollment PDF will be sent to EMS/ConneXion to renew the coverage. If coverage cannot be auto renewed or the client reported a change that resulted in eligibility, the system will send a change PDF to close the programs.

Renewals- Medicaid Households are able to auto-renew if:

• The system can retrieve sufficient information from application and data sources AND

• All necessary application information is verified by electronic data sources AND

• The household’s program eligibility has not changed (e.g. HUSKY A to HUSKY )OR

• Individuals in the household have switched between Medicaid/CHIP coverage groups except for CHIP Bands 2 & 3. (e.g. HUSKY A to HUSKY D or HUSKY A to HUSKY B band 1)

Renewals- Medicaid Households are unable to auto-renew if:

• Information is inaccurate or insufficient to determine eligibility and renew coverage. The individual must contact Access Health CT and report changes (Online, Paper or Phone) OR

• Any necessary application information is not verified by electronic data sources OR

• Changes reported during the Renewal period result in a loss of Medicaid/CHIP eligibility for at least one household member OR

• Changes reported during the Renewal period result in a gain of CHIP Band 2 or 3 eligibility from Medicaid or CHIP Band 1

• Individual is in the Medicaid Pregnant Women or MAGI for the post-partum period

For the above scenarios, a notice with a pre-populated renewal form will be sent out to the individual. The pre-populated form will not contain PII and sensitive information, such as tax return information retrieved from IRS. The notice also includes detailed instructions on how to renew Medicaid and CHIP coverage. The individual is instructed that he/she must take an action within 45 days of the notice to complete the renewal process.

Renewals- Medicaid The system will not try to renew individuals in the following scenarios:

• Individuals are not within the 60 day renewal window when this process is running.

• Individuals who have had their eligibility overridden on an application are excluded from the renewal process. A pre-populated form is not provided, but the individual will receive a notice to call the AHCT Contact Center.

Renewals- Medicaid Current Coverage Projected

Determination Auto

Renew Comments

Medicaid QHP No MA ineligible Medicaid QHP w/ APTC No MA ineligible

Medicaid P/C Medicaid P/C Yes Same sub-program Medicaid LIA Medicaid P/C Yes Different MA sub-program Medicaid CHIP Band 1 Yes

Medicaid CHIP Band 2, Band 3 No CHIP band 2 and Band 3 have a premium

CHIP QHP No CHIP ineligible CHIP QHP w/ APTC No CHIP ineligible CHIP Medicaid Yes CHIP Band 1, Band 2, Band 3 CHIP Band 1 Yes CHIP Band 1 CHIP Band 2 No CHIP band 2 has a premium CHIP Band 3 CHIP Band 2 Yes Reduction in premium CHIP Band 1, Band 2, CHIP Band 3 No CHIP band 3 has a premium CHIP Band 3 CHIP Band 3 Yes CHIP Band 2 CHIP Band 2 Yes

This table demonstrates when auto-renewal will occur for current Medicaid enrollees

Auto Renewals- Medicaid/CHIP

Medicaid/CHIP enrollees eligible for auto-renewal will be able to view their renewed coverage on the Account Home page

Renewals- Medicaid Reconsideration Period

Individuals who lost coverage due to inaction during the renewal period will have the opportunity to regain the Medicaid/CHIP coverage within three months from the loss of coverage (i.e., Reconsideration period)

Individuals who regain coverage during the Reconsideration period will receive Medicaid/CHIP coverage retroactive to the day coverage was lost. There will be no gap in coverage.

The system will determine the correct effective coverage date automatically (day after coverage was lost if applicant is within redetermination period) using their previous eligibility period in the system

Individuals who wait until after the reconsideration period to enroll in Medicaid/CHIP will receive coverage starting on the 1st of the month a new application is submitted. There can be a gap in coverage

Renewals- Coverage End Dates

If an individual’s coverage is renewed, the individual will receive a full 12 months of coverage from his/her coverage start date and the coverage end date will be set appropriately.

• If an individual’s renewed coverage begins on 7/1/15, his/her coverage end date will be set to 6/30/16

Individuals receiving Former Foster Care Medicaid will have an end date set to the

month they turn 26 if his/her birthday is within 12 months. • If an individual’s renewed coverage begins on 7/1/15 and his/her 26th birthday

is 11/15/2015, the coverage end date will be set to 11/30/15

Individuals renewing for Medicaid Children or CHIP, and who are turning 19, are notified directly by the HUSKY Program when they are aging out.

Individuals within the same household who have different coverage start dates will have their coverage end dates aligned. This will result in the whole household being up for renewal at the same time the next year.

• E.g. two individuals in the household, one with a start date of 7/1/14 and the other with a start date of 9/1/14, the coverage end date for both individuals will be set to 6/30/15

Step 2: • The applicant is given the opportunity to review their

existing coverage before renewing the application. The applicant clicks Next to continue

Step 1: • When a Medicaid consumer logs into his or her account

within 60 days of their coverage end date the option to Renew/Report a Change in Income or Household will display on the Home Screen

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Step 4: • After reviewing previous application data the user is

presented with the option to report a change. If the consumer does not have any changes the individual clicks Proceed to Renew. If the consumer would like to report a change before renewing the individual should click Report a Change and Renew

Step 3:

• The applicant is given the opportunity to review their existing

coverage section by section before renewing the application. The applicant clicks Next to continue

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Step 6: • The consumer receive information on their current

enrollment and should click Next

Step 5: • If the consumer has no changes to the application the

individual will be directed to the Application signature section where the individual should e-sign and click Next

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Step 8: • The consumer will be able to view their eligibility

determination screen and can click Next to complete the renewal

Step 7: • If a consumer’s renewal period is outside of open

enrollment, the consumer will receive the Enrollment Qualification Information Screen and should click Next

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Step 10: • The consumer will be asked to confirm their additional

Medicaid Questions. If there are no changes click Next

Step 9: • The consumer will be asked to confirm that they would like

to proceed with their enrollment. Consumer should click Continue

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Step 12: • The consumer is able to upload any documents. The

consumer can the click Next

Step 11: • The consumer will review the terms and conditions and

should click Next

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Step 14: • The consumer confirms their renewal and clicks Confirm

Step 13: • The consumer can continue to confirm their plan and should

click Next

Steps

Medicaid Consumer Renews Coverage on Consumer Portal

Effective Date: June 1, 2015 Effective Date: May 31, 2016

Questions?