Childrens Medicaid

1
Childrens Medicaid
2
Senate Bill 43

• Simplify the Medicaid eligibility process for
  children under age 19
• Effective 1/1/2002

3
Senate Bill 43

• Remove perceived barriers to accessing Medicaid
• Create a seamless process for families to apply
  for Medicaid or CHIP
• Educate newly certified families about proper use
  of health coverage
• Encourage the use of preventive care

4
Simplification

• Joint application form for Childrens Medicaid
  and CHIP
• Same procedures as CHIP, to the extent allowed by
  federal law
• Eliminate the face to face interview requirement
• 6 months continuous eligibility

5
Seamless Process

• Create a seamless process for families applying
  for Medicaid or CHIP
• Joint application, same process
• Easy renewal process, like CHIP
• Provide coverage for gaps when transitioning from
  Medicaid to CHIP

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Renewal

• Renew by the middle of the 5th month of the 6
  month eligibility period to allow sufficient time
  for children deemed to CHIP to complete the
  enrollment process
• Timely renewal by family
• Timely processing by DHS/TexCare

7
Health Care Orientation (HCO)

• Caretaker or payee must have HCO after initial
  eligibility determination
• Proper use of Medicaid
• Form 1188, Common Questions Asked About the
  Introduction to Health Care Orientation, to
  inform household

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HCO Compliance

• THSteps and Maximus staff responsible for
  outreaching and delivering HCO
• Receive before first renewal
• If not in compliance, must have face to face
  interview in DHS office for advisor to deliver
  before Medicaid is renewed

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Texas Health Steps

• Comply with THSteps regimen of care
• Children age 2 through 18
• Encourage the use of preventive care
• Form 1187, Welcome to Texas Health Steps
  Medicaid, at certification to explain
  consequences of failing to comply with
  requirements

10
THSteps Compliance

• Advisors must
• Have a THSteps desk reference
• Provide Check-ups and a Whole Lot More brochure
  and THSteps wallet card
• Require face to face interview if child is not in
  compliance by second renewal after initial
  informing

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Applications

• Families can apply for childrens Medicaid using
  
• Form 1010, Application for Assistance
• Form 1014, TexCare Application
• TexCare Application revised to include fields for
  the head of households date of birth, SSN and
  expanded asset questions.

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Verification Requirements

• Self-declaration is acceptable for
• Age
• Household composition
• Relationship
• US Citizenship
• Residence

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Verification Requirements

• Verification is required for
• Alien Status
• Non-exempt income
• Dependent care costs
• Child support and alimony payments
• Payments to dependents outside the home
• Conflicting information

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Verification Requirements

• Verification of income may be
• One paycheck stub issued in the 60 days before
  the file date
• Most recent tax return
• Most recent document verifying income such as the
  most recent RSDI award letter, child support
  check, proof of self-employment, or a letter from
  an employer

15
HB 2292 Changes

• HB 2292 allows use of third party sources for
  verification
• Run a combined Data Broker report on all
  childrens Medicaid applications and renewals,
  including TANF applications, reviews, and
  referrals from CHIP
• Do not request a report on child-only cases,
  unless advisor believes there is unreported
  income or assets.

16
SB 1522 Changes

• Face to face interviews
• Conduct a face to face interview if DHS receives
  conflicting information on household composition,
  income or resources that affects eligibility and
  the information cannot be verified by other
  means.
• Develop risk-based criteria to target cases at
  renewal

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Renewal Changes

• Revised renewal form
• No EZ renewal option - the family must complete
  the entire form and provide new verification
• Same information as initial application
• DOB and SSN requested for head of household and
  spouse
• Expanded assets questions

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Renewal Verification

• If the family does not provide verification,
  research associated cases for verification before
  requesting it from the family
• Use verification of alien status, assets, income
  and deductions provided by the family in the 90
  days prior to file date for reported changes or
  case actions that are more recent than the last
  Medicaid action

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Continuous Eligibility

• A child under 19 is continuously eligible for 6
  months or through the month of their 19th
  birthday, whichever is earlier.
• SB 1522 delayed implementation of 12 months
  continuous eligibility until September 1, 2005.

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Continuous Eligibility

• Take no action on reported changes in income or
  resources until the next renewal
• Take necessary actions on associated Food Stamp,
  TANF and adult Medicaid cases
• Take action when the family reports a
• Change in address
• Child leaving the home
• Child joining the family, if they want Medicaid
  for the child

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• Legislative Changes

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Medically Needy

• TP 55 now covers
• Adults with TANF-level income
• TP 30 adults with TANF-level income
• Women certified for Breast and Cervical Cancer
  Medicaid coverage
• Spend down for children and pregnant women with
  income above TP 40/43/44/48).

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Medically Needy

• Adults with income at or above TANF level lost
  coverage effective 9/1/03
• Allow medically coverage for applications
  received before 9/1/03
• No prior coverage authorized unless DHS error or
  appeal decision
• Clearinghouse will process and allow 1 month
  extension

24
Pregnant Women

• Income limit for women age 19 and over lowered to
  158
• Continuous eligibility applies if the pregnant
  woman was income or age eligible in a prior month

25
Pay for Performance

• TANF caretaker loses Medicaid for non-cooperation
  with CHOICES
• One month penalty
• Must cooperate to restore eligibility
• Does not affect childs eligibility for Medicaid
  Pay for Performance

26
CHIP Changes

• 6 months eligibility period
• 90 day waiting period good cause applies,
  including deeming from DHS as active/recent
  Medicaid recipient
• No deductions allowed in income test
• Assets test for households with income above 150
  FPL