Medicaid and Child Health Plan Plus (CHP+)

1
Medicaid and Child Health Plan Plus (CHP)

• An overview for beginners who need to know the
  basics

2
What You Need to Know

• Medicaid and
• Child Health Plan Plus (CHP)
• What are these 2 programs?
• Who is eligible for each?
• What are the different categories I might hear
  people refer to?

3
Public Health Insurance

• Medicaid and CHP
• Government Funded
• Partial federal/state
• Safety-net for most vulnerable groups
• Largest source of funding for health-related
  services
• Not to be confused with Medicare

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A Little History Lesson
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Who do they serve?
6
About Medicaid

• Families and Children

• Disabled Children and Adults

• Elderly

• Different Populations Different Needs
• Various Programs within Medicaid
• For children, parents, and pregnant women
• For disabled, elderly, or those in need of
  long-term care

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Colorado Medicaid

• Includes benefits such as
• Physician visits
• Prescription drugs
• Labs and X-rays
• Emergency Services
• Inpatient Hospital Services
• Outpatient Hospital Services
• and many more

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How is eligibility for Medicaid determined?

• Family Size and Makeup
• Citizenship
• Income
• Earned Income (through working)
• Unearned Income (such as Supplemental Security
  Income)
• of Federal Poverty level
• Different levels for different groups
• Other considerations
• Resources
• Disability
• Level of Care

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Family Medicaid

• Insures children, adults with dependent children,
  and pregnant women

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Family Medicaid Income Levels

• Parents whose income is at or below 60 of the
  Federal Poverty Level
• Children age 6-19 whose family income is at or
  below 100 of the Federal Poverty Level
• Children under the age of 6 and pregnant women
  whose family income is at or below 133 of the
  Federal Poverty Level

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Medicaid Income Levels
of Federal Poverty Level
12
Medicaid Income Levels
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What is EPSDT?

• Early Periodic Screening Diagnosis and Treatment
  (EPSDT)
• PREVENTIVE health care program focusing on early
  identification and treatment of medical, dental,
  vision, hearing and developmental problems for
  clients ages 20 and under
• Primary Care Physician (PCP) or Managed Care
  Organizations (MCO) performs Periodic Screening
  exams
• Federally mandated, and administered in
  partnership with each state

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Benefits of EPSDT

• Emphasizes preventive care and complete early
  treatments
• Provides comprehensive health care benefit
  package for Medicaid enrolled children, ages
  birth through 20 years
• Assures availability and accessibility of
  required health care services and items
• HMO or provider staff and EPSDT Outreach
  Coordinators assist Medicaid clients and their
  parents or guardians effectively use these
  resources

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ESPDT Coordinators

• FREE Resource for Families
• Notifies every enrolled family of the scope of
  EPSDT benefits and outreach coordination support
  services
• Guides families to appropriately use their
  Medicaid benefits with emphasis on education,
  prevention, diagnosis and timely treatment

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ESPDT Coordinators

• Assists providers in reducing the incidence of
  multiple appointments missed by Medicaid enrolled
  children and youth
• Identifies and refers families to other community
  resources such as
• Housing
• Part C
• Food banks
• Women, Infants and Children food program (WIC)
• Waiver sites
• Prenatal Plus
• Head Start

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Emergency Medicaid

• For Non-citizens who would otherwise qualify for
  Medicaid
• Non-qualified aliens (those without appropriate
  legal documentation)
• Legal aliens who have been in country lt5 years
• Life or limb emergency only
• Labor and Delivery is considered a medical
  emergency
• Prenatal care is NOT included in Emergency
  Medicaid

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State-Only Prenatal

• Provided for legal aliens who have not been in
  the country 5 years
• Not eligible for regular Medicaid during 5 year
  bar
• State-Only Prenatal provides prenatal care for
  this population
• No federal funds provided for prenatal care for
  this population
• State funding fills the coverage gap

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State-Only Prenatal

• Would qualify for Medicaid except for their alien
  status
• Womans portion of household income is at or
  below 133 of the Federal Poverty Level
• Pregnancy has been verified by doctors statement
  or staff observation
• Eligibility ends 60 days after pregnancy ends

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Medicaid Benefits for Pregnant Women
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Needy Newborn

• A baby born to a mother for whom Medicaid paid
  for the labor and delivery
• Any form of Medicaid, such as Emergency, Family
  Medicaid, etc.
• Babies born to mothers on State Only Prenatal
  also qualify
• Automatically eligible for Medicaid for 1 full
  year
• As long as the baby stays with the mom in the
  home
• Anyone can report the birth to the county
  Department Human/Social Services to add the baby
  into CBMS

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Questions about Medicaid?
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What is Child Health Plan Plus (CHP)?

• Even working families and those above the
  poverty level have a hard time
  affording health insurance
• CHP offers coverage
  for children and pregnant
  women who make a little
  too much for Medicaid

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About CHP

• Children

• Pregnant Women

• Two Programs within CHP
• CHP (for children only)
• CHP Prenatal Care Program

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Colorado CHP

• Include benefits such as
• Physician visits
• Prescription drugs
• Immunizations (shots)
• Hospital services
• Prenatal care
• Dental Care (for kids only)
• and many more

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How is eligibility for CHP determined?

• Family Size and Makeup
• Citizenship
• Income
• Earned Income (through working)
• Unearned Income (such as child support)
• Allowable Income Deductions
• of Federal Poverty level
• Different levels for different groups
• Other requirements
• Is not eligible for Medicaid
• Does not have other health insurance
• Does not have access to State Employee benefits

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Comparison of Income Levels
of Federal Poverty Level
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CHP Income Levels
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Some differences between the CHP Programs
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CHP Newborn Guarantee

• CHP Newborn
• A baby born to a mother enrolled in the CHP
  Prenatal Care Program at the time of birth
• Mother must be 19 or older to be in Prenatal
  Program
• Baby born to a mother in regular CHP (for kids)
  is not guaranteed enrollment
• Automatically eligible for CHP for 12 months
• Even if income increases or decreases
• Anyone can report the birth to add the baby into
  CBMS
• Must notify CHP of baby's birth in order to
  enroll

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Questions about CHP?
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What is PE?

• Presumptive Eligibility (PE) is immediate medical
  coverage for certain individuals who appear
  eligible for either Medicaid or CHP
• Only available for
• Children under 19
• Pregnant women
• Presumptive Eligibility can only be granted at a
  site authorized to determine PE

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What does PE cover?

• Provides no less than 45 days of temporary
  coverage while client waits for eligibility
  determination
• Immediate access to health care includes
• Medicaid PE for children all Medicaid-covered
  services
• Medicaid PE for pregnant women only outpatient
  services
• CHP PE (children and pregnant women) all CHP
  services except dental benefits

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Questions about Presumptive Eligibility?
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Where to Find More Information

• Medicaid and EPSDT
• Colorado.gov/hcpf
• Customer service
• Denver metro [phone]
• Toll free [phone]
• CHP
• CHPplus.org
• Customer Service [phone]