Transcript Baltimore HealthCare Access Medical Assistance for Families

Medical Assistance for
Families Program, MCHP and PAC
Darlene Toms, Supervisor-Grant Manager
FCHD-MA Eligibility Unit
New Health Care for More Families!
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Working Families and Small Business Health
Coverage Act – Senate Bill 6
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Expanded Medical Assistance eligibility to parents and
caregiver relatives with dependent children
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Medical Assistance for Families (MAF) Program will
cover parents and caregiver relatives with incomes up
to 116% of the FPL (this limit was 30% FPL)
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For a family of 4, the income limit is $2131 monthly
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Assets are not counted
Who’s Covered?
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Parents and relative caregivers of children
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Must be taking care of children in their household
under age 21
Relative caregiver by relative, marriage, or adoption
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Adults aged 19 and up
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Adults on Medicare or other Employee Based
Program
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Will be considered a secondary health insurance and
can be applied for premiums, co-payments, and
deductibles (will not cover prescriptions for recipients
of Medicare Part D)
What Application Should Be Used?
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A new, shorter MA only application will be
available – the application will be combined
with MCHP
A person should use the MCHP/MA
application if they are:
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A
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parent(s) or child(ren) applying for Medicaid
relative caregiver
child applying for Medicaid only
pregnant woman applying for Medicaid only
Who Should Not Use the
New Application?
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An Aged, Blind, or Disabled (ABD)
individual(s) applying for Medicaid (use
the 9702 application)
A person who wants to apply for Medicaid
as well as additional programs such as
TCA, Food Stamps, etc. (use the 9701
application)
A person applying for PAC (use the PAC
application)
How Do I Apply For MAF/MCHP?
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Visit us at 350 Montevue Lane – Entrance B
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Monday, Wednesday, Friday – 8:00 am-4:30 pm
Tuesday – 9:00 am – 12:00 pm or Thursday – 2:00 pm –
4:30 pm
Call 1-800-456-8900 or the MA Eligibility Unit at FCHD at
301-600-3124 to have an application mailed & fax back to
us at 301-600-3111.
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On-Line through the FCHD website, State website or SAIL
(Service Access Information Link) website at:
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www.co.frederick.md.us/index.asp?nid=2406
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www.dhmh.state.md.us/ma4families
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www.marylandSAIL.org
How Do I Apply For PAC?
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Call 1-800-226-2142 for an application
On-line through the State website at:
www.dhmh.state.md.us/mma/pac/index.htm
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Call or visit the Frederick Community
Action Agency
100 S. Market Street – 301-600-1506
How Long Does it Take?
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Eligibility Processing Time
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FCHD has 10 working days from the date
of application
LDSS has 30 calendar days from the
date of application
Face-to-Face interview is no longer
mandatory
What Information Is Needed To Apply?
o Information about family members (such as names
and birth dates),
o Proof of Citizenship and Identity for all family
members applying,
• For a list of ways to prove citizenship and identity, see:
http://www.dhmh.state.md.us/html/hotissues_citizen.htm
o Social Security numbers of all family members
applying for health care,
o Sources and amounts of family income –
Declaratory (do not need proof) but may be asked
to provide if there is a discrepancy
• Information on assets is not needed for MCHP or the
MAF Program
Additional Information Needed to Apply?
o Information on any other health insurance
coverage that you or your family might have
• A person can have health insurance and still apply,
however, if their income is at 185% or above the
children will not be eligible for the MCHP.
o Child care/day care expenses - declaratory
o If found over income for MAF the case is
forwarded to LDSS for Spenddown and this
information will then be required
• Verification of assets
• Verification of any medical bills for spend down
What Is Covered?
PAC vs Medical Assistance for Families
PAC benefits include (yellow & white card):
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Free outpatient visits to a mental health provider
Lower-priced or no-cost prescription drugs
Once they become active in an MCO they will get an MCO
card, then they are able to access their PCP for routine care
They can receive all of the services that are covered by the
Maryland Family Planning Program except sterilization
(tubal-ligation)
Some MCO’s offer more services than others, such as
dental services and eye exams
***PAC does not pay for hospital stays, emergency room
visits, or specialty care.
What Is Covered?
PAC vs Medical Assistance for Families
Medical Assistance for Families offers PAC
benefits and:
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Specialty care
X-ray and lab services
Hospital services
Emergency Services
Physical Therapy
OB/GYN care for women
Outpatient treatment for drug and alcohol abuse
Targeted case management for HIV-infected individuals
Home health services
Hospice services
Transportation services
Eye exams (Eye Glasses for beneficiaries under 21)
Dental services for beneficiaries under 21
What If Someone Already Has PAC?
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Previous PAC recipients with children will be
redetermined to see if they qualify under MAF
Clients will remain on the same MCO and have
the same doctor. Families can be united in one
MCO.
If a client does not have a dependent child on
MCHP/Medicaid, they will stay on PAC
If a client has a dependent child, but not enrolled
in MCHP/Medicaid, they will need to apply for the
child
What Is A Family Unit?
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A natural or adoptive parent must be included in the Family
Unit with his/her own child unless:
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The parent is a minor living with his/her own parent or parents.
The parent is the spouse of a caregiver stepparent and the
stepparent is excluded.
The parent is a SSI recipient
Child(ren) may be excluded from the family unit as long as at
least one child remains in the unit with the parent.
A caregiver relative may be included with other family
members.
In a three generation family, the grandparent(s) or minor
parent should be included in the family unit and both must
sign.
Married persons under 21 who are living with their parents or
caregiver relative are a separate family unit.
What If We Make Too Much Money
For The Free Program?
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If the total household income exceeds
200% of the FPL the child(ren) can still be
eligible in the MCHP Premium Program
When applying for MCHP they must indicate
on the application that they are willing to
pay a premium each month
The child(ren) can not have any other
health insurance
The child(ren) will have the same medical
benefits as the child(ren) in the free
program
Family Income Guidelines
Family Size
1
2
3
4
5
For each additional family
member add 
Maximum Family Income Limit, Effective March 1, 2009
Children
Pregnant Women
(Family Size includes Unborn
$ 21,660
Child)
$ 29,140
$ 36,425
$ 36,620
$ 45,775
$ 44,100
$ 55,125
$ 51,580
$ 64,475
$ 7,480
$ 9,350
MCHP
Premium
Family Size
1
2
3
4
5
For each additional family
member add 
You Pay 
Maximum Family Income Limit, Effective March 1, 2009
Children above 200% through
Children above 250% through
250% FPL
300% FPL
$ 27,075
$ 36,425
$ 45,775
$ 55,125
$ 64,475
$ 32,490
$ 43,710
$ 54,930
$ 66,150
$ 77,370
$9,350
$ 11,220
$48
$60
Questions?
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Call the Medical Assistance Hotline: (800) 4568900 or TDD for the Disabled: (800) 735-2258 or
visit the website at:
www.dhmh.state.md.us/ma4families
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Call FCHD – MA Eligibility Unit at 301-600-3124
or ACCU – 301-600-3348 (with questions about
providers and benefits)
o Visit our website at
www.co.frederick.md.us/index.asp?nid=2406
Informational Handouts
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Selected Health Coverage Initiatives At
a Glance
Monthly Income and Asset Guidelines
for Maryland Medical Care Programs