ADDENDUM 8

WORKING DISABLED MEDICAID BUY-IN PROCEDURES

The Working Disabled Medicaid Buy-in program has experienced significant growth since it began in April 1999.  The administration of this program involves two divisions within the Department of Health:

• The Division of Public Assistance is responsible for the eligibility determination and ongoing case maintenance, and

• The Division of Health Care Services is responsible for the calculation and collection of premiums.

To ensure the integrity and efficiency of the program it is essential the two divisions work closely together.  This addendum outlines procedures for:

• Case numbering

• Case registration, household size, school status, and income documentation

• Checking for 1619B status

• Process for paying premiums

• Processing cases when the recipient is 45 Days past due paying premiums

• Processing cases for recipients who are repeatedly late with payments

• Communicating with DHCSDivision of Health Care Services

I.  CASE NUMBERING

The DHCSDivision of Health Care Services uses the Working Disabled case number to document all unpaid premium balances.  It is important that DPADivision of Public Assistance staff use the following case numbering procedures:

• Before registering a Working Disabled case number, conduct a full search of all Medicaid case numbers on the CLPMClient Profile/Maintenancescreen.

• Register a Working Disabled case on a stand-alone Medicaid number.  A regular APAAdult Public Assistance /Medicaid case number should never be converted to a Working Disabled case number and vice versa.

• In couple cases where both spouses are disabled, each spouse will have their own Working Disabled Medicaid case.  The couples combined unearned income is compared to the APAAdult Public Assistance need standard for an eligible couple in the second unearned income test.

Example 1:  Mr. Smith is an APAAdult Public Assistance /ME recipient.  On May 2, Mr. Smith started a new job that placed him over income for APAAdult Public Assistance cash and APAAdult Public Assistance -Related Medicaid.

Process:

1. End the APAAdult Public Assistance /ME case number effective May 31.

2. Register a Medicaid-only case number beginning June 1.

3. Authorize Working Disabled Medicaid on the new case number beginning June 1.

4. Notify DHCSDivision of Health Care Services via email at dmatpl@alaska.gov of the open Working Disabled Medicaid case name and number.

5. DHCSDivision of Health Care Services will review the CASSCase Summary , MERIMedical Resource Information, and WODMWorking Disabled Medicaid Authorization screens to calculate the premium amount and send notice M901 - Working Disabled Medicaid-Premiums Due.

Example 2:  On August 10, Mr. Smith is laid of from his job and his income is once again within the APAAdult Public Assistance need standard.

Process:

1. End the Working Disabled case number August 31.

2. Register the former APAAdult Public Assistance /ME case number with a benefit start date of September 1, and authorize September Medicaid benefits.  The recipient will need to reapply for APAAdult Public Assistance cash.

3. Notify DHCSDivision of Health Care Services at dmatpl@alaska.gov of the closed Working Disabled Medicaid case name and number.

4. DHCSDivision of Health Care Services will calculate the premium amount and send notice M901 - Working Disabled Medicaid-Premiums Due.

Example 3:  On December 2, Mr. Smith finds a new job and once again goes over income for APAAdult Public Assistance /Medicaid.

Process:

1. End the APAAdult Public Assistance /ME case number December 31.

2. Register the former Working Disabled case number with a benefit start date of January 1, and authorize Working Disabled Medicaid.

3. Notify DHCSDivision of Health Care Services at dma_tpl@alaska.gov of the open case name and number.

4. DHCSDivision of Health Care Services will calculate the premium amount and send notice M901 - Working Disabled Medicaid-Premiums Due.

II. CASE REGISTRATION / HOUSEHOLD SIZE / SCHOOL STATUS / INCOME DOCUMENTATION

To ensure the correct calculation of premiums, it is important to accurately document household size, the school status of all 18 and 19 year-old dependents, and the income of every household member in the Working Disabled Medicaid Buy-In case.

Process:

• Register the spouse and all dependent household members to the Working Disabled Medicaid case number.

• Complete a separate case note regarding the school status of all 18 and 19 year old status.  Title the case note School Status.

It is also important to write clear case notes in the CANOCase Notes regarding the household’s income.

Process:

• On the CANOCase Notes , breakdown the income of all household members.

• Check the case to ensure that the income information is the same as what is documented on the CANOCase Notes , CASSCase Summary , and WODMWorking Disabled Medicaid Authorization screens.

III. 1619B ELIGIBILITY

It is important to review the 1619B list on Luminist titled HESDX30 under reports every month. An individual who is 1619B is eligible for regular Medicaid coverage.

Do not code an individual who is 1619B eligible as a Working Disabled Medicaid Buy-In case.

IV. PREMIUM PAYMENTS

When completing an intake interview for the Working Disabled Medicaid Buy-In or when converting an APAAdult Public Assistance Medicaid case, caseworkers must:

• Check to see if there is a past Working Disabled case with past due premiums.  If there are any outstanding premiums, Medicaid under this category cannot be established until all past premiums are paid.

• Discuss the importance of paying all premiums timely with the client to ensure continuing eligibility.

Premiums should only be sent to the DHCSDivision of Health Care Services office.  A DPADivision of Public Assistance district office should not collect the premiums, but should tell recipients to always mail their premium payments directly to the DHCSDivision of Health Care Services office in Anchorage.

V. CASE PROCESSING WHEN PREMIUM PAYMENTS ARE 45 DAYS PAST DUE

When a premium payment is 45 days past due, DHCSDivision of Health Care Services sends the recipient notice M904, Working Disabled - Premiums Overdue, and takes adverse action.  The M904 is very specific and states that the case will close unless the payment is received by a specified date.  A second adverse action notice is not necessary as the M904 is sufficient.

Process:

• When the M904 is sent, DHCSDivision of Health Care Services e-mails the caseworker and explains that the recipient is 45 days past due and that the M904 was sent.

• The caseworker accesses the WODMWorking Disabled Medicaid Authorization (Working Disabled Medicaid Authorization) screen for the next month to de-authorize the Medicaid benefits and document the action on CANOCase Notes .

• If the recipient pays the premium by the specified date or by the end of the month, DHCSDivision of Health Care Services e-mails the caseworker.  The caseworker accesses the WODMWorking Disabled Medicaid Authorization to re-authorize the Medicaid benefits.

• If the premium payment is not paid, the caseworker closes the case and documents the action on CANOCase Notes .

Example 1:  Mr. Brown is 45 days overdue on his Buy-In premium.  On May 3, DHCSDivision of Health Care Services sends Mr. Brown the M904 notice requesting he pay his delinquent premiums by May 16, and emails the caseworker who:

1. Accesses the June WODMWorking Disabled Medicaid Authorization screen and de-authorizes benefits, and

2. Documents the action taken on CANOCase Notes .

On May 15, Mr. Brown delivers a check covering all delinquent premiums to the DHCSDivision of Health Care Services office.   DHCS sends an e-mail to the caseworker stating that premiums are now paid.  The caseworker:

1. Accesses June WODMWorking Disabled Medicaid Authorization screen and re-authorizes benefits.

2. Checks to make sure the auto-roll date is set.

3. Documents the action taken on CANOCase Notes .

Example 2:  Mr. Brown is 45 days overdue on his Buy-in premium.  On May 3, DHCSDivision of Health Care Services sends Mr. Brown the M904 notice requesting he pay his premiums by May 16, and emails the caseworker.  The caseworker:

1. Accesses the WODMWorking Disabled Medicaid Authorization screen for benefit month of June and de-authorizes benefits.

2. Documents the action taken on CANOCase Notes .

3. Mr. Brown does not send in his premium payment by the due date or by the end of the May.  The caseworker closes the case and documents the action on CANOCase Notes .

VI. PROCESSING CASES WHEN PREMIUMS ARE REPEATEDLY PAST DUE

The integrity of the Working Disabled Medicaid Buy-In program is dependent on the collection of premiums and keeping recipients accountable for their premium payments.  Occasionally a recipient is repeatedly late and begins to accrue large overdue premium balances.  In order to encourage the timely payment of premiums the procedures listed below will be enforced.

First and Second 45-Day Notices:  When a premium payment is made at the beginning of the month following the 45-day notice:

1. The payment is accepted.

2. Medicaid is reopened.

3. DHCSDivision of Health Care Services sends a reminder to the recipient explaining the importance of paying premiums timely.  After the second 45-day notice, a stronger reminder is sent stating that Medicaid coverage will end for failure to pay premiums on time.

Third 45-Day Notice:  If the premium payment is not made by the end of the month:

1. The case remains closed.

2. The recipient needs to reapply with a new GEN 50C application.

VII. REPORTING CHANGES TO DHCSDivision of Health Care Services

It is the responsibility of the DPADivision of Public Assistance caseworker to contact DHCSDivision of Health Care Services at dmatpl@alaska.gov to report the following changes and information:

• All address and phone changes as reported by the client

• All income changes after updating the WODMWorking Disabled Medicaid Authorization screen

• Closures for any reason, including auto-closures for failure to review

• Any new Working Disabled Buy-In case name and number