Transcript Document
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 107244) 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 [email protected]
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:
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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:
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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.