Medicaid 101 & Iowa Health and Wellness Plan. Lindsay Buechel Communications Manager Bryan Dempsey Provider Services Outreach Supervisor

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1 Medicaid 101 & Iowa Health and Wellness Plan Lindsay Buechel Communications Manager Bryan Dempsey Provider Services Outreach Supervisor

2 Medicaid Updates 1. New Applications 2. Renewals and Open Enrollment 3. Iowa Health and Wellness Plan 4. Healthy Behaviors Program 2

3 Medicaid Eligibility Reminders Coverage begins first day of the month the application is submitted Retroactive Coverage Up to three months of retroactive coverage available, if member is eligible Sun Mon Tues Wed Thu Fri Sat 1 *** ** No enrollment period, can apply all year Example: Applied on 15th (**) Coverage begins on 1st (***) 3

4 Medicaid Application Options Federal Health Insurance Marketplace DHS website dhsservices.iowa.gov DHS Contact Center DHS Local Offices APPLICATION Submission 4

5 Member Application Process 1. Application Submitted to DHS 2. DHS Reviews Application, Requests Add l Info if Needed 3. DHS Sends Notice of Action with Approval or Denial 4. If Approved, Member Receives Medicaid ID Card 5. Member Receives Medicaid Program Information 6. Member Begins Using Medicaid Benefits 5

6 Medicaid Application Processing New Medicaid application o o Renewals o days for processing Coverage effective first day of the month application is submitted days for processing 6

7 Medicaid Renewals Enrolled for 12 months of coverage o Eligibility reviewed at end of 12 months All members are required to go through the renewal process, coverage not continued automatically Renewal sent via mail packet to most current address available to DHS o Remind members to update address with DHS 7

8 Medicaid Renewals Typically have been issued 30 days prior to the end of the certification period, and processed in the timeframe o Certification period ends Sept. 30, renewal issued August 30, processed by Sept. 20 th for timely notice MAGI renewals will now be issued 60 days prior to the end of the certification period, and processed in the timeframe o Certification period ends Dec. 31, renewal issued October 31, processed by Dec. 20 th for timely notice IowaCare renewals have been sent out 30 days prior to the end of the certification period, following previous rules as cases are converted to MAGI and placed in the new eligibility system 8

9 Iowa Health and Wellness Plan

10 Quick Facts Iowa Wellness Plan: 0-100% FPL Administered by Iowa Medicaid Uses Iowa Medicaid provider network Offers comprehensive set of benefits Uses a primary care case management (PCCM) program, referred to as managed care Primary Care Patient Manager, or primary care provider (PCP) coordinates care and referrals for the member 10

11 Iowa Wellness Plan Managed Care Map: As of September 2014 Lyon Osceola Dickinson Emmet Winnebago Worth Mitchell Howard Winneshiek Allamakee Kossuth Sioux O Brien Clay Palo Alto Hancock Cerro Gordo Floyd Chickasaw Fayette Clayton Plymouth Cherokee Buena Vista Pocahontas Humboldt Wright Franklin Butler Bremer Woodbury Ida Sac Calhoun Webster Hamilton Hardin Grundy Black Hawk Buchanan Delaware Dubuque Monona Crawford Carroll Greene Boone Story Marshall Tama Benton Linn Jones Jackson Clinton Harrison Shelby Audubon Guthrie Dallas Polk Jasper Poweshiek Iowa Johnson Cedar Scott Pottawattamie Cass Adair Madison Warren Marion Mahaska Keokuk Washington Muscatine Mills Montgomery Adams Union Clarke Lucas Monroe Wapello Jefferson Henry Louisa Des Moines Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren Lee Counties in light blue are Iowa Wellness Plan Managed Care Counties in dark blue can have Iowa Wellness Plan Managed Care or HMO Counties in white are non-managed care (Fee-for-service)

12 Marketplace Choice Plan: % FPL Quick Facts Members select a certain commercial health plan available on the Health Insurance Marketplace Medicaid pays the premiums to the commercial health plan on behalf of the member Offers comprehensive set of benefits Commercial health plans available to members are CoOportunity Health and Coventry Health Care of Iowa Uses the commercial plan s statewide provider network 12

13 Overall Iowa Health and Wellness Plan Enrollment: As of September 26, 2014 Lyon Osceola Dickinson Emmet Winnebago Worth Mitchell Howard Winneshiek Allamakee Sioux O Brien Clay Palo Alto Hancock Cerro Gordo Floyd Chickasaw Plymouth Cherokee Buena Vista Pocahontas Humboldt Wright Franklin Butler Bremer Woodbury Ida Sac Calhoun Kossuth , Webster 2, Hamilton ,778 Hardin Grundy Black Hawk Fayette 750 Clayton 388 Buchanan Delaware Dubuque 5, ,847 Monona Crawford Carroll Greene Harrison Shelby Audubon Guthrie Pottawattamie Dallas Boone ,846 1, Story Marshall Tama Benton Linn Jones Polk Jasper Poweshiek ,063 19,926 1, ,038 Iowa Johnson Cedar Cass Adair Madison Warren Marion Mahaska Keokuk Washington 4, , ,386 Mills Montgomery Adams Union Clarke Lucas Monroe Wapello Jefferson Fremont Page Taylor Ringgold Decatur Wayne Appanoose Davis Van Buren 3, , Henry Lee Louisa Muscatine 1,833 Des Moines 2,059 Jackson Clinton 1,956 Scott 724 7,772 Map represents overall program enrollment, which include the Iowa Wellness Plan and the Iowa Marketplace Choice Plan. Total Enrollment as of September 26, 2014: 107,760 1,762

14 Healthy Behaviors Program

15 Healthy Behaviors Program Helps waive any possible contribution (premium) for the next year of enrollment Physical Exam No Premium in 2015 Health Risk Assessment

16 Healthy Behaviors Program Members have 12 months to complete Healthy Behaviors o Enrolled in January 2014, have until January 2015 o Enrolled in April 2014, have until April 2015 Contribution amount if activities not completed: o o Wellness Plan (50-100% FPL): $5 per month Marketplace Choice Plan ( % FPL): $10 per month

17 How To: Wellness Exam 1. Identify the member s primary care provider 2. If unknown, member can: A. Call Iowa Medicaid Member Services at (8-5, M-F) B. Member Services can share provider and phone # 3. Provider can: A. Call ELVS or access portal online 17

18 Wellness Exam: Expanded Codes CPT Codes Accepted New Patient CPT Codes years of age years of age Established Patient CPT Codes years of age years of age Evaluation and Management CPT Codes Accepted V70.0, V70.5 and V V70.0, V70.5 and V V70.0, V70.5 and V V70.0, V70.5 and V V70.0, V70.5 and V70.9 Outpatient Hospital Clinic Visits G0463 V70.0, V70.5 and V

19 Health Risk Assessment Wellness Plan Members 1. Using tool called Assess My Health AssessMyHealth.com 2. Can be completed online or by phone By phone through IME Member Services 3. Member gets 5-digit code from their provider, enters code on assessment

20 Health Risk Assessment Marketplace Choice Plan Members CoOportunity Health members should use their assessment: Coventry members should use their assessment: Can also use Assess My Health if the member prefers

21 Member Campaign All members received a letter and flyer end of May Customized direct mail campaign began in early October Active community outreach, events, educational forums

22 Outreach Support New website launched specific to Iowa Health and Wellness Plan and Healthy Behaviors: Provider Toolkit available: BehaviorsToolkit.pdf Stakeholder Toolkit available: Toolkit_ pdf

23 Information General Medicaid Information: Information on the Iowa Health and Wellness Plan: 23