THP-Plus and THP-FC 2015 Institute | December 17, 2015 Medi-Cal Coverage for Former Foster Youth Welcome & Introductions Marcy Valenzuela, Former Foster Youth Steven Fong, Department of Social Services Susan Zimny, Department of Social Services Karen Chang, Department of Health Care Services Dee Paull, Department of Health Care Services Jessica Haspel, Children Now 2 Whos here? THP Service Providers Social Workers Probation Officers Advocates Lawyers County Staff 3 What do you need to learn today to help support Former Foster Youth? 4 What we will cover Enrollment and Benefits The Affordable Care Act (ACA) Extended Medi-Cal for Former Foster Youth Special Topics Resources for Former Foster Youth 5 The Affordable Care Act & Former Foster Youth Allows young adults to remain on their parents insurance up to age 26 Provides equity for Former Foster Youth through Medicaid up to age 26 Fills a critical need for a very vulnerable population FFY tend to have higher health care needs due to childhood abuse, neglect, and trauma Youth who age out of foster care often lack adequate supports to navigate the transition to adulthood 6 Former Foster Youth Eligibility Today in CA In foster care at age 18 or older - In California, OR - In another state Living in California now Up to age of 26 No income or assets test. Former foster youth qualify regardless of placement type while in foster care. 7 Former Foster Youth Eligibility continued Eligible for the Former Foster Youth Medi-Cal Program even if they: Have children Are married Currently have other health insurance Have income above 138% of the FPL Former foster youth qualify regardless of immigration status. No open enrollment period FFY can apply at anytime. 8 Why enroll as a former foster youth? Continuous coverage up to age 26 (simplified annual renewal each year & not discontinued due to loss of contact) No income & assets requirements More choices: FFY can choose fee-for-service Medi-Cal or Medi-Cal managed care No cost health coverage. Allows FFY to save money for school, rent, and other necessities. 9 What coverage is available? No Cost, Full Scope Medi-Cal EPSDT up to age 21 Comprehensive screening, diagnosis and treatment Including vision, hearing, and dental Adult Medi-Cal 21 and after Includes medical care, visions exams, substance abuse treatment, dental, and mental health services. 10 Quiz Michael has been in foster care since he was 14. He is now 19 and receiving extended foster care benefits through AB 12. Is Michael eligible for Medi-Cal? 11 Answer Michael is eligible for Medi-Cal as a current foster youth. When he leaves foster care, he will be eligible for Medi-Cal as a former foster youth. Although his aid code will change, he should not have any break in coverage. 12 Former Foster Youth Enrollment: Overview Youth exiting foster care today do NOT need to fill out an application. automatically transitioned into the FFY program upon or in preparation for foster care exit with no interruption in coverage. Youth who left care before 1/1/14 or who were in foster care in another state, may need to sign up. For these youth, the sign up process is streamlined. MC 250A FFY streamlined application Self-attestation = immediate enrollment Enrolled while county verifies former foster care status Youth NOT required to provide foster care documentation County verification of FFY status Counties required to verify status in CA by looking in the Child Welfare System/Case Management System (CWS/CMS) If from another state, county must contact other state to verify Youth exiting foster care today do NOT need to fill out an application. automatically transitioned into the FFY program upon or in preparation for foster care exit with no interruption in coverage. Youth who left care before 1/1/14 or who were in foster care in another state, may need to sign up. For these youth, the sign up process is streamlined. MC 250A FFY streamlined application Self-attestation = immediate enrollment Enrolled while county verifies former foster care status Youth NOT required to provide foster care documentation County verification of FFY status Counties required to verify status in CA by looking in the Child Welfare System/Case Management System (CWS/CMS) If from another state, county must contact other state to verify 13 Enrollment: How to Sign Up Apply directly through the county using one-page MC 250A form BEST WAY Full Medi-Cal application NOT required. No income info needed. Many counties have designated a specific person, office, or phone number for FFY to contact to enroll. To find out more info:14 Automatic Transition: Social Workers/ Probation Officers are vital to Medi-Cal for FFY Before Case Closure: Check with the Medi-Cal eligibility worker to ensure the foster youth's Medi-Cal coverage is active while still in foster care. Provide foster youth with information about their ongoing eligibility for Medi-Cal until age 26 and the importance of notifying Medi-Cal if they move. Confirm the foster youth has a Medi-Cal card (also called a Benefits Identification Card or BIC) and contact information for their Medi-Cal eligibility worker. 15 Before Case Closure (Cont.): Work with Medi-Cal eligibility worker to ensure the foster youth is automatically moved into the Medi-Cal program for former foster youth and assigned the "4M" aid code in preparation for or immediately upon exit from foster care. After Case Closure: Contact Medi-Cal eligibility worker to confirm enrollment in "4M" was successfully completed. Provide the youth with confirmation that they have been enrolled in the Medi-Cal program for former foster youth until age Enrollment: Applying Online through Covered California FFY who applied online or through Covered California prior to October 2015 received inappropriate eligibility determinations due to a lack of FFY programming logic in CalHEERS. Counties began correcting these cases during summer 2015 CalHEERS/Covered CA programming fixes pending are being implemented in 2 phases: 1.October 2015: implement programming to prevent incorrect eligibility determinations & grant immediate eligibility 2.February 2016: dynamic programming allows FFY to skip questions (e.g. tax and income questions) Will still require more info than the MC 250A applying through the county 17 Enrollment: Hospital Presumptive Eligibility for FFY Hospital Presumptive Eligibility (HPE) MEDS Worker Alert Medi-Cal Eligibility Division Information Letters (MEDIL) Separate application that asks about FFY status Aid code 4E assigned Alert for the county when an FFY applies for HPE County can move the FFY from 4E to 4M Instructions have been issued for counties on moving FFY from 4E to 4M 18 All County Welfare Directors Letter FFY Provides instructions on FFY Processing and Notices of Action (NOAs). Requires written notice of action relating to FFY eligibility for Medi-Cal when there is a change in Medi-Cal coverage. Verbal notification of eligibility or ineligibility is not sufficient. Requires county to keep FFY in coverage while assessing eligibility for other programs if unable to verify FFY status. 19 Retention: Continuous coverage up to age 26 Simplified annual redetermination: No forms or packets to return Ex parte review by the county County to notify FFY on another year of coverage No discontinuance due to a loss of contact: Move from Managed Care to Fee for Services if the FFY is enrolled in Managed Care Before coverage can be terminated: Identify whether individual is eligible for another Insurance Affordability Program Provide Notice of Action with Appeal Rights 20 Quiz Hector was in foster care in Utah from age 12 18. Now he is 24 and lives in California. Is he eligible for Medi-Cal? 21 Answer Yes. California provides Medi-Cal coverage for young adults who were in foster care in another state at age 18 or older. 22 Special Topic: Out-of-State Issues Are CA FFY eligible for free Medicaid until 26 if they move to & become a resident of another state? MAYBE, but It depends on the rules of the new state. States must cover eligible FFY from their own state up to age 26. They have the option to cover out-of-state FFY. Only 13 states (including CA) have taken this option. If the other state has not taken up the out-of-state FFY option, the youth may still qualify for Medicaid on another basis. Current momentum related to the out-of-state option Advocacy to get more states to take up this option Fed legislation introduced to require states to cover FFY from any state Are CA FFY eligible for free Medicaid until 26 if they move to & become a resident of another state? MAYBE, but It depends on the rules of the new state. States must cover eligible FFY from their own state up to age 26. They have the option to cover out-of-state FFY. Only 13 states (including CA) have taken this option. If the other state has not taken up the out-of-state FFY option, the youth may still qualify for Medicaid on another basis. Current momentum related to the out-of-state option Advocacy to get more states to take up this option Fed legislation introduced to require states to cover FFY from any state 23 Special Topic: Attending school out-of-state Option #1: Maintain CA residency & keep Medi-Cal Must let county know that he/she plans to return to CA Medi-Cal will only cover emergency services in another state. Can still get preventative care in CA Option #2: Discontinue Medi-Cal & apply for Medicaid in new state Must be a resident of new state to apply for Medicaid there Eligibility for Medicaid in new state depends on rules of new state If eligible for Medicaid in new state can get preventative care covered in new state See All County Welfare Directors Letter No for more information Option #1: Maintain CA residency & keep Medi-Cal Must let county know that he/she plans to return to CA Medi-Cal will only cover emergency services in another state. Can still get preventative care in CA Option #2: Discontinue Medi-Cal & apply for Medicaid in new state Must be a resident of new state to apply for Medicaid there Eligibility for Medicaid in new state depends on rules of new state If eligible for Medicaid in new state can get preventative care covered in new state See All County Welfare Directors Letter No for more information 24 Special Topic: Coverage while temporarily out-of-state Medi-Cal only covers emergency services in another state. FFY should tell the out-of-state provider that he/she has Medi-Cal The out-of-state provider should contact the Medi-Cal Out-Of-State provider unit at (916) to get authorization for treatment The Health Consumer Alliance can provide legal assistance to youth who receive a bill for emergency services received while out of state. http ://www.childrennow.org/files/5914/2792/0299/MCFFY- County_Health_Advocates.pdfhttp ://www.childrennow.org/files/5914/2792/0299/MCFFY- County_Health_Advocates.pdf Medi-Cal only covers emergency services in another state. FFY should tell the out-of-state provider that he/she has Medi-Cal The out-of-state provider should contact the Medi-Cal Out-Of-State provider unit at (916) to get authorization for treatment The Health Consumer Alliance can provide legal assistance to youth who receive a bill for emergency services received while out of state. http ://www.childrennow.org/files/5914/2792/0299/MCFFY- County_Health_Advocates.pdfhttp ://www.childrennow.org/files/5914/2792/0299/MCFFY- County_Health_Advocates.pdf 25 Special Topic: FFY on CalWORKS or SSI CalWORKS and SSI get Medi-Cal automatically DHCS, counties, CWDA & other stakeholders are exploring ways to ensure FFY on cash assistance programs such as SSI or CalWORKS receive the benefits of being in the FFY program. Continuous coverage up to age 26 with no discontinuance due to a loss of contact Voluntary managed care/fee-for-service option CalWORKS and SSI get Medi-Cal automatically DHCS, counties, CWDA & other stakeholders are exploring ways to ensure FFY on cash assistance programs such as SSI or CalWORKS receive the benefits of being in the FFY program. Continuous coverage up to age 26 with no discontinuance due to a loss of contact Voluntary managed care/fee-for-service option 26 Global Data Sharing Agreement Collaborative effort between CDSS, DHCS and counties and tribes that opt-in Executed on April 9, 2015 Collaborative effort between CDSS, DHCS and counties and tribes that opt-in Executed on April 9, Global Data Sharing Agreement Under the data sharing agreement both the CDSS and the DHCS have agreed to share both confidential and non-confidential data and match their records for all children in the child welfare system 28 Global Data Sharing Agreement - Purpose To explore, identify, and support effective strategies in overseeing and monitoring health and human service interventions for children and youth in the child welfare system A tool that can be used by the state and counties to inform appropriate policies and practices Easy county access to health and human services data To explore, identify, and support effective strategies in overseeing and monitoring health and human service interventions for children and youth in the child welfare system A tool that can be used by the state and counties to inform appropriate policies and practices Easy county access to health and human services data 29 Global Data Sharing Agreement - Purpose Available data includes: Medical information including: Mental health services, Pharmaceutical services (medication) Medi-Cal Eligibility & Payment Data Children and non-minor dependents receiving child welfare services. Available data includes: Medical information including: Mental health services, Pharmaceutical services (medication) Medi-Cal Eligibility & Payment Data Children and non-minor dependents receiving child welfare services. 30 Global Data Sharing Agreement Questions?CDSS CWDAB at: Questions?CDSS CWDAB at: 31 CalFresh and other FFY Resources What is CalFresh and the benefit for FFY The CalFresh Program, federally known as the Supplemental Nutrition Assistance Program (SNAP), can add to your food budget to put healthy and nutritious food on the table. The program issues monthly electronic benefits that can be used to buy most foods at many markets and food stores. The CalFresh Program helps to improve the health and well-being of qualified households and individuals by providing them a means to meet their nutritional needs. Resource Links: ACINs I and I ACL What is CalFresh and the benefit for FFY The CalFresh Program, federally known as the Supplemental Nutrition Assistance Program (SNAP), can add to your food budget to put healthy and nutritious food on the table. The program issues monthly electronic benefits that can be used to buy most foods at many markets and food stores. The CalFresh Program helps to improve the health and well-being of qualified households and individuals by providing them a means to meet their nutritional needs. Resource Links: ACINs I and I ACL 33 DHCS Web-Site Resources for FFY Outreach materials Youth friendly design Linkage to other support programs Resources for Social Workers, Probation Officers, and Service Providers Tips and instructional letters for workers Data Information on workgroups and stakeholder meetings at34 For additional resources Help Spread the Word! - Coveredtil26 Coveredtil26 is a statewide outreach campaign to inform former foster youth about Medi-Cal coverage until age 26. Resources: Visita youth-friendly website with FAQs, resources, and tips on how to sign up.www.coveredtil26.org Download free Coveredtil26 outreach materials & share. FFY who have additional questions or need more help canChildren Now is spearheading Coveredtil26. Funded by a grant from The California Wellness Foundation. 35 For additional resources Application for Medi-Cal for Former Foster Care Youth (MC 250A form): All County Information Notice (ACIN) No. I Extension of Medi-Cal Benefits for Youth Exiting Foster Care All County Welfare Directors Letter (ACWDL) Medi-Cal General Notice Of Actions For Former Foster YouthACWDL No : Former Foster Youth Who Applied for Health Coverage Through California Healthcare Eligibility, Enrollment and Retention System and Aid Code 4MACWDL No : Enrollment in the Former Foster Care Childrens (FFCC) ProgramACWDL No : Residency for Out-of-State StudentsApplication for Medi-Cal for Former Foster Care Youth (MC 250A form): All County Information Notice (ACIN) No. I Extension of Medi-Cal Benefits for Youth Exiting Foster Care All County Welfare Directors Letter (ACWDL) Medi-Cal General Notice Of Actions For Former Foster YouthACWDL No : Former Foster Youth Who Applied for Health Coverage Through California Healthcare Eligibility, Enrollment and Retention System and Aid Code 4MACWDL No : Enrollment in the Former Foster Care Childrens (FFCC) ProgramACWDL No : Residency for Out-of-State Students36 Medi-Cal Eligibility Division Information Letter (MEDIL) No County Process to Change Hospital Presumptive Eligibility Former Foster Youth Aid Code 4E to Former Foster Youth Aid Code 4MACIN No. I-35-13: Best Practices for Increasing Eligible Youth Participation in the CalFresh ProgramACIN No. I-22-12: CalFresh for Foster YouthAll County Letter (ACL) No : Food Stamp Application Process for Youth Who are Aging Out of Foster Care37 Children Now: Jessica Haspel, Department of Health Care Services: Dee Paull, Department of Social Services: Steven Fong, 38