Transcript Targeted Low-Income Children’s Program (TLICP)

Program Overview
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V2 12-18-12
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Assembly Bills 1494 and 1468 provide for the transition
of children from Healthy Families Program (HFP) to the
California Medi-Cal program. Medi-Cal will cover these
children under a new optional coverage group known as
the Targeted Low-Income Children’s Program (TLICP).
This presentation will cover the following:
Targeted Low Income Children’s Program
SPE Process
Access for Infants and Mothers
Aid Codes and Premiums
CEC
Data Reporting and Performance Standards
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No sooner than January 1, 2013, the Department of
Health Care Services (DHCS) will implement the TLICP,
which covers children who would have previously been
enrolled in Healthy Families.
Once the TLICP is implemented, the Managed Risk
Medical Insurance Board (MRMIB) will no longer enroll
children into the HFP.
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Increases Federal Poverty Level (FPL) limits under Medi-Cal for
children ages zero to 19 years of age
Generally follows other existing FPL Program eligibility rules
Implements a premium requirement for children with income
over 150% FPL ($13 per child to a maximum of $39 per family)
Age of Child*
Current Medi-Cal FPL
Limits
TLC FPL for Children
Medi-Cal FPL
Subject to Premium
0-1
At or below 200%
Above 200% up to 250%
N/A
1-6
At or below 133%
Above 133% up to 250%
Above 150%
6-19
At or below 100%
Above 100% up to 250%
Above 150%
* Up to the month of the
1st,
6th,
or
19th
birthday
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SPE will continue to do the following:
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Receive applications (paper and online via Health-e-App)
Conduct file clearance for these applications
Review the applications it receives for completeness
Screen for accelerated enrollment (8E)
Forward applications to counties
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The AIM program provides coverage for pregnant mothers with
income above 200% up to 300% FPL.
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Counties will play a role for the first time with AIM-linked infants
AIM-linked infants (up to 2 years of age) are affected as follows:
o Family income up to 250% FPL will now be eligible to TLICP
o Family income above 250% up to 300% FPL will be referred
back to HFP using existing Bridging processes
o Identified on MEDS with prior aid code of “0C”
Note: Counties will need to develop a process to identify AIM-linked
infants that need to be referred back to Healthy Families if their
income is, or increases above, 250% FPL.
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Age Group
Percent Level
Aid Code
0-1
At or below 200%
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0-1
Above 200% - Up to 250%
H1
1-6
At or below 133%
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1-6
At or below 133%, Over Assets
8P
NEW
1-6
Above 133%- Up to 150%
H2
NEW
1-6
Above 150%- Up to 250%
H3
6-19
At or below 100%
7A
6-19
At or below 100%, Over Assets
8R
NEW
6-19
Above 100%- Up to 150%
H4
NEW
6-19
Above 150%- Up to 250%
H5
NEW
PREMIUM
PREMIUM
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Children with family income above 150% up to
250% will have monthly premiums
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County determines eligibility for TLICP with premium
o
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H3 and H5 aid codes convey need for premium
The Medi-Cal Premium Payment Section:
Handles premium notification and collection
o Informs county of non-payment of premiums
o
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Premiums are $13 per child, with a family maximum of $39
o It is a flat amount per child, not a sliding scale
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County
All eligibility and
case
maintenance for
children with
income up to
250% (H1-H5)
Premium
Payment
Section Premium
collection and
notification for
children with
income above
150%- up to
250% (H3 & H5)
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Children in H1-H5 are eligible to CEC
Follow existing Medi-Cal CEC rules
When County is notified of non-payment of premium:
o County must follow SB 87 rules to evaluate child for eligibility to
other Medi-Cal programs and
o Either place child into another program (if eligible) or discontinue
with timely notice due to non-payment (if no other eligibility found)
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CEC will not cover non-payment of premiums
o This means that if a child in H3 or H5 becomes ineligible for another
reason that is CEC eligible, they can receive coverage through CEC;
o However, if they do not pay premiums, they will be discontinued
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Retroactive TLICP is available following the existing
retroactive Medi-Cal rules
However, retroactive eligibility to the TLICP is not available
for any months prior to TLICP implementation
o Counties must evaluate for other Medi-Cal programs that were in
existence in the requested month(s)
Example:
Family applies in February 2013 and requests 3-month retroactive
Medi-Cal. TLICP can only be granted for January 2013. Eligibility
for November and December 2012 must be evaluated for other
Medi-Cal programs – not for TLICP.
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Application received from SPE is for a child…
Processing Timeframe
Granted Accelerated Enrollment
Follow 45/90 day performance standard
timeframes. Day 1 begins the date
county receives the application from SPE.
Not granted Accelerated Enrollment due to
existence of active Medi-Cal
Follow 45/90 day performance standard
timeframes. Day 1 begins the date
county receives the application from SPE.
Not granted Accelerated Enrollment and does 90% of applications received complete
not have active Medi-Cal
and without client error must be
processed within 10 working days. Day 1
is day county receives app from SPE.
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All 58 counties must report semi-annually on Performance
Standards to DHCS in 2013
Counties report on those cases subject to 10-day rule:
o Applications that were received from SPE, and
o Were not granted accelerated enrollment, and
o Did not have active Medi-Cal, and
o Were complete and without client error
Goal: 90% processed within 10 days
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Both 10 and 45 day applications count from the date the
county receive applications from SPE
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Different from Performance Standards reporting
Due monthly beginning in March 2013 and continue
through February 2014
o Example: March 2013 report is for January 2013 data
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Include data on processing of applications submitted
directly to the county and from the SPE that were not
granted Accelerated Enrollment (AE)
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Report ing Requirements include:
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Number of children approved in each of the following aid codes:
o
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H1
H2
H3
H4
H5
For applications received directly to the county and from the SPE
that were not granted accelerated enrollment:
o Total number of applications approved for aid codes H1-H5
o Average number of days it took to make the final eligibility determination
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Total number of applications denied (of applications received
from the SPE that were not granted accelerated enrollment)
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The TLICP is incorporated in the Medi-Cal program hierarchy
Beginning January 1, 2013, the TLICP must be evaluated
when applicable at any Medi-Cal eligibility determination.
o Eligibility determinations include but are not limited to applications,
annual redeterminations, mid year status reports, or reported
changes.
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Children who now have a share of cost can qualify for the
TLICP with no share of cost or with a premium.
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ACWDL 12-33 (November 16, 2012)
Targeted Low-Income Children’s Program
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ACWDL 12-29 (November 13, 2012)
Data Reporting and Performance Standards for the Healthy
Families Program (HFP) to Medi-Cal Transition
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Healthy Families Program Transition To Medi-Cal
DHCS Transition Page
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