AAHAM WESTERN REGION EDUCATIONAL PROGRAM September 19 2019 Stephenson Acquisto amp Colman 303 North Glenoaks Blvd Suite 700 Burbank CA 91502 Office 818 559 4477 Fax 818 559 5484 ID: 795774
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Expansion of Medi Cal Benefits to Undocumented Patients
AAHAM WESTERN REGION EDUCATIONAL PROGRAMSeptember 19, 2019 Stephenson, Acquisto & Colman303 North Glenoaks Blvd. Suite 700 Burbank, CA 91502Office: (818) 559 - 4477Fax: (818) 559 - 5484SACFirm.com
Slide2Healthcare as a National Agenda Item“…we already pay for the healthcare of undocumented immigrants. It's called the emergency room. People show up in the emergency room and they get care, as they should. Julian Castro
Slide3Slide4Cost for Expansion of Undocumented Eligibility$98 million first yearImpacts 138,000 young adults
Slide5Undocumented-MediCal Eligibility Expansion-Senate Bill 104
New Law Expands Medi Cal coverage to now includeResidents through-age 25Regardless of immigration statusPreviously- 2016 under 19 and income level qualified. Income requirements must still be met
Slide6CCS CautionIf 22 and younger- CCS eligibleCCS eligible conditions are a carve out from Medi Cal Managed Care.Must submit to CCS or lose $$$In Orange County and other counties, CCS eligibility and adjudication handled by county now and not state.
Slide7CCS Eligibility Birth to 21 years of ageResidenceIncome Medical eligibility
Slide8AnalysisLegally Present v. UndocumentedBenefits available for both to certain degreesAlternative eligibility
Slide9Legally Present Options:Medi-Cal Income requirementsCalifornia state residencyCovered California-purchase plan with subsidiesMedi-Cal- legal presence and income validation.
Slide10What does it mean to be “Legally Present”Lawful Permanent ResidencePermanent Residence under Color of Law ( PRUCOL)
Slide11ResidencyUnder California law, a person who stays in the state for other than a temporary or transitory purpose is a resident, vacations or brief transactions, such as signing a contract or giving a speech, constitute temporary or transitory purposes that do not confer residency
Slide12Not Legally PresentImpact on Covered CaliforniaMixed status familiesDACA
Slide13Covered CaliforniaMust be lawfully present in CaliforniaIf not- Medi-Cal -25 and under and income verificationPregnancyERCommercial plan outside Covered California
Slide14Families with Mixed StatusCovered California requires all family members to be listed on the plan. Legally presentIncome qualificationIf mixed status- no Covered California subsidy
Slide15DACADeferred Action for Childhood Arrivals-DACANot considered legally present.Cannot purchase plan with Covered California subsidyMedi Cal if 25 or under or pregnant-Income qualification
Slide16Additional Opportunities for EligibilityPrucol-FullQualified Alien-FullHPE –Hosital Presumptive Eligibility Program Full temporary
Slide17PRUCOLPermanently Residing Under Color of LawWill be considered as permanent residents if they meet specific criteria.Criteria listed in “Citizenship, Alienage, and Immigration Status” form.
Slide18Exhibit 1Criteria listed in “Citizenship, Alienage, and Immigration Status” form.
Slide19Qualified AlienQualified Non Citizen entering US prior to August 1996Qualified immigrant completed 5 year waiting periodExempt from 5 year waiting period- refugees, trafficking victims, veteran families, Asylees(political asylum).
Slide20Exemption From 5 Year Waiting PeriodBattered spousesChildren of battered spousesHuman trafficking victimsRefugeesSpouses and children of US military personnelGreen card holdersImmigrants entering US from Cuba or Haiti
Slide21Hospital Presumptive Eligibility ProgramOn January 1, 2014, the Hospital Presumptive Eligibility Program (HPE) was implemented. The HPE Program provides qualified individuals immediate access to temporary, no-cost Medi-Cal while applying for permanent Medi-Cal coverage or other health coverage.
Slide22Hospital Presumptive Eligibility ProgramTo qualify for HPE, individuals must meet the rules below.Have income below the monthly limit for household size.Be a California resident.Not already have Medi-Cal.If not pregnant, have not received PE Enrollment benefits from any Medi-Cal PE Program up to the maximum limitation allowed within the past 12 months of applying. If pregnant, have not had a PE Enrollment during the current pregnancy of applying.
Slide23Hospital Presumptive Eligibility ProgramAnd, be eligible in one of the following HPE groups below:Children under 19 years oldParents and Caretaker RelativesPregnant Women (benefits are limited to ambulatory prenatal services.)Former Foster Youth between ages 18 to 26 years old, who were in foster care in any state on their 18th birthday or older. (No income limit)Adults between ages 19-64, not pregnant, not in Medicare, and not eligible for any group stated above.
Slide24Hospital Presumptive Eligibility ProgramTo apply for HPE benefits, an individual must visit a hospital that is a qualified HPE Provider. The HPE Provider submits the individual’s information via the HPE Medi-Cal Application online portal and eligibility is determined in real-time.
Slide25Hospital Presumptive Eligibility ProgramThe HPE enrollment period begins on the date the individual is determined eligible for HPE, which is the day the HPE Medi-Cal Application is submitted via the online portal. To obtain coverage prior to the HPE start date, individuals must apply for full scope Medi-Cal and mark the box that indicates the individual has medical expenses in the last three months and needs help to pay.
Slide26Undocumented-over 25Limited services available Emergency ServicesPregnancy servicesDialysisNursing Home Status
Slide27Whole Child ModelSenate Bill (SB) 586 authorizes the Department of Health Care Services (DHCS) to establish the Whole Child Model (WCM) program in designated County Organized Health System (COHS) or Regional Health Authority counties to incorporate California Children’s Services (CCS) program covered services for Medi-Cal eligible CCS children and youth into a Medi-Cal managed care plan (MCP) contract. DHCS has developed a “Whole Child Model” to be implemented in 21 specified counties, no sooner than July 2018. The results are improved care coordination for primary, specialty, and behavioral health services for CCS and non-CCS conditions. The benefits are consistent with CCS program standards and provided by CCS paneled providers, specialty care centers, and pediatric acute care hospitals. WCM approach meets the six goals for CCS Redesign:
Slide28Slide29THANK YOU!