October 2015
Build
HCPF Projects
On a scale of 1-10, how would you
rate your current knowledge of the
October HCPF CBMS Build projects?
For all October 2015 build
projects, please visit
TrainColorado.com for more
information.
Courses > CBMS Build Training > October
2015> CBMS/PEAK October 2015 Build
Project Guide – HCPF
Project 8655
CBMS Continuous Eligibility Updates
Project 8655
 Expands Continuous Eligibility to all
children receiving Medicaid.
What is Continuous Eligibility?
 Implemented 03/2014
 Allows eligible children up to 12
months continuous coverage,
regardless of changes in family’s
circumstances, with some
exceptions.
What is Continuous Eligibility?
 Previously only applied to
MAGI Child and CHP+
 Will now expand to all Medicaid
programs children may be eligible
for
 Children are considered children
until their 19th birthday
CE Eligible Programs








Magi Children
CHP+
HCBS waivers
NF/300% institutionalized
SSI Mandatory
Pickle
DAC
CBWD
Continuous Eligibility Process
 When a child becomes ineligible for one
of these programs
 CBMS will first check eligibility for equal or higher
benefit category programs
 If not eligible, the client will be placed on Continuous
Eligibility until their RRR date (or the month they
turn 19)
Benefit Categories
01
• NF/300% hospital
• HCBS programs, PACE
02
• SSI Mandatory, FFC, Pickle, DAC, QDW, OAP Med, Trans
Med, Refugee, BCCP
• MAGI Programs, Legal Immigrant Newborn, Needy Newborn
03
• WAwD
• CBwD
04, 05
• QMB (04)
• SLIMB, QI-1, QDWI (05)
06, 07
• OAP HCP-A, OAP HCP-B (06)
• LIS (07)
• CHP+ Children, CHP+ Newborn, CHP+ Prenatal
08
Clients may
move upwards
in Benefit
Category
CHP+ must
remain CHP+
Exceptions
 CHP+ can not move up to MAGI Children
 HCBS and SSI will move to MAGI children
(CE)
 HCBS will lose HCBS services
CE will be discontinued if
 The child is deceased
 The child becomes an inmate of a public
institution
 The child is no longer part of the
Medical Assistance household
 The child is no longer a Colorado
resident
 The child cannot be located
 The family requests that the child be
withdrawn from continuous eligibility
 The family fails to provide documents
requested to verify the child’s eligibility
 Non Payment
More notes
 CE also applies to children no longer
eligible for foster care
 Children transitioning off TRAILS
Medicaid will be eligible for CE under
MAGI children
 CBMS will automatically AI and activate
these cases
Dis-enrollment
 Clients can opt-out of CE through PEAK
or their eligibility worker
 Workers should also get a declaration of
income in this scenario
 Family is likely trying to get to the
marketplace or qualify for another MA
program
Dis-enrollment
 Opt-out button added to Case Individual
 Opt-outs are not APTC eligible
 Multiple program opt-outs now exist
14 day no fault period
 Protects against worker error, incorrect
data, etc.
 After initial authorization, changes made
within 14 days will not trigger CE
 14 days applies to intake, RRR and
addition of a household member
Miscellaneous
 Children transitioning off SSI Mandatory
may not have an RRR date
 An RRR will be set 2 months from
authorization in these cases
Search Tools
 G flag indicates a child is on Continuous
Eligibility
 Clock showing CE expiration will be
shown in wrap-up and inquire
Continuous Eligibility Scenarios
Mom and Daughter
apply for MA on
01/15/2015 with no
income
MAGI Child
MAGI Parent/Caretaker
Continuous Eligibility Scenarios
On 10/02/2015 Mom
reports $10,000/mo.
income!
MAGI Child
Will receive CE
through
12/31/2015
MAGI Parent/Caretaker
discontinued 10/31/2015
Continuous Eligibility Scenarios
Son is re-determined
eligible for HCBS-CWA on
09/15/2015
Fail excess income
Approved HCBS-CWA
Continuous Eligibility Scenarios
On 01/06/2016, worker
is notified Level of Care
ends 01/31/2016, and
enters this into CBMS
Fail excess income
On 02/01/2016 Son is
switched to MAGI
Child (CE) through
RRR
Continuous Eligibility Scenarios
CHP+
On 03/14/2015
Family applies for
MA.
Mom works Dad
stays home.
Fail excess income
Fail, excess
income
CHP+
Continuous Eligibility Scenarios
CHP+ (CE)
On 06/01/2015
Mom convinces her
boss to hire Dad.
This puts them over
the CHP+ HH limit
Fail excess income
Fail, excess
income
CHP+ (CE)
Continuous Eligibility Scenarios
CHP+ (CE)
On 07/15/2015 Mom
and Dad are both
fired and will have no
income beginning
08/01/2015
MAGI Parent/Caretaker
MAGI
Parent/Caretaker
CHP+ (CE)
Continuous Eligibility Scenarios
On 10/10/2015 a
family applies for
MA with no
income. Case is
authorized
10/11/2015.
MAGI
Parent/Caretaker
MAGI Parent/Caretaker
MAGI child
Continuous Eligibility Scenarios
On 10/21/2015
Eligibility worker
discovers (or receives
verification) that Mom
had provided
verification of
monthly income
($12,000)!
Continuous Eligibility Scenarios
Data entry is
corrected/update
d 10/22/2015.
(within 14 days
of initial
authorization)
Discontinued
11/30/2015
10 day notice
Continuous Eligibility Scenarios
What if the
worker didn’t
correct/update
the record until
10/28? (after 14
day cutoff?)
Parents will be
discontinued 11/30
But kids will receive
MAGI child (CE) until
RRR
Questions?
Project 9004
CBMS MA Transitional Med Updates
Current Functionality
 Trans Med rules in CBMS need to be
updated
After Build Functionality
 Update Transitional Medicaid rules in
CBMS
 CBMS will accurately determine
eligibility for Trans Med for individuals
Trans Med (Adults)
 Who qualifies?
 MAGI Parent/Caretaker in 3 out of the last 6 months
 19 years of age and older
 Individual has earned income that exceeds MAGI
Adult FPL
 Dependent child in MBU or another child (5th degree
relationship)
 Meet citizenship/non-citizen requirements for MA
Trans Med (Dependent Child)
 Child can qualify if they have:
 An adult in their MBU eligible for Trans Med
 A responsible relative (in the home) eligible
 A parent in the home eligible
Newly added Individual
 New adult added to the HH (within 5th
degree of kinship)
 Spouse of the individual on Trans Med
Scenario #1
MAGI Parent/Caretaker
Approved for
Transitional Medicaid
effective
MAGI2/1/2016
Child
Mom reports new job
$2,000.00/monthly
MAGI Child
(Continuous Eligibility)
Scenario #2
Mom reports new job
$1,000.00/monthly
Mom reports increase
to $2,000.00/monthly
MAGI Parent/Caretaker
10/2015 – 1/2016
Approved for MAGI
Adult effective 2/1/2016
MAGI Child (CE Begins)
MAGI Child
MAGI Child
Denied Transitional
Medicaid
Income Calculation for Trans Med
 Use earned income when determining
potential Trans Med eligibility
 Earned and Self-Employment income
Scenario #3
Mom has unearned
income $200/monthly
and earned income
$400/monthly. Total $600
MAGI Parent/Caretaker
MAGI Adult (Not eligible
for Trans Med)
MAGI Child
Mom reports a new job now
making $800/monthly. Total
$1000/monthly
MAGI Child
Knowledge Check
True or False:
When determining the income calculation
for Transitional Medicaid CBMS will use
unearned income and earned income
amounts.
Trans Med Begin Date




Eligibility cannot exceed 12 months
Begins first month of eligibility
Ends in the 12th month
RRR due month will realign to 11 months
from the TMA eligibility begin date
Scenario #4
Mom has unearned
income $200/monthly
and earned income
$400/monthly. Total $600
MAGI Parent/Caretaker
Transitional Medicaid
(2/1/2016)
MAGI Child
Mom reports a new job
making $1,800/monthly.
Total of $2,000/monthly
**RRR due month will be 1/2017 (11 months
from eligibility start month).
MAGI Child
(CE begins)
Fluctuating Income (Trans Med)
 Increase or decrease no MA
category change (except if
eligible for higher benefit
category)
Scenario #5
MAGI Parent/Caretaker
Mom has unearned income $200/monthly
and earned income $400/monthly. Total
$600
Transitional Medicaid
(2/1/2016)
Transitional Medicaid
MAGI Child
Mom reports a new job making
$1,800/monthly. Total of $2,000/monthly
Mom reports her income
decreased to $800/monthly for
a total income of
$1,000/monthly
MAGI Child
begins)
MAGI (CE
Child
(CE cont.)
**Even though the client’s decrease in income
puts her in the MAGI Adult range, mom would
remain eligible for Trans Med for the 12
months.
Trans Med Closure Exceptions
 Adult no longer in the MBU who is
employed (unless it ended with good
cause)

Unacceptable good cause reasons: Fired, Quit, Other,
and Not Good Cause
 No longer a dependent child in the MBU
 Client ops out of Trans Med
 Can change to a new MA category
12 Month Trans Med Ends
 End of the 12 month Trans Med period
 MA eligibility will be run
 If not eligible for other MA categories
then MA will be discontinued
Child’s Continuous Eligibility
Ends
 Child is eligible for Transitional
Medicaid once continuous
eligibility ends if their parent or
caretaker is on Transitional
Medicaid
Scenario #6
MAGI Parent/Caretaker
Transitional Medicaid
(2/2016 – 1/2017)
Mom starts job
$2,000/monthly and
over income for MAGI
Adult and
Parent/Caretaker
MAGI Child
MAGI Child
CE ends 9/30/2016
** Mom- remains eligible for Transitional Medicaid through 1/2017.
Child- is eligible for transitional Medicaid starting 10/2016 - 1/2017 along with
mom.
RRR and Ongoing Cases
 Individual can be eligible for
Trans Med anytime if they meet
the criteria below:
 19 years of age and older
 MAGI Parent/Caretaker in 3 out of the last 6
months
 Individual has earned income that exceeds
MAGI Adult FPL
 Dependent child in MBU or another child (5th
degree relationship)
 Meet citizenship/non-citizen requirements for
MA
PEAK RMC/RRR Changes
 Client will have the opportunity to opt
out of Transitional Medicaid or
continuous eligibility in PEAK
CBMS Page Changes
 New field on Case Individual MA Trans Med
Opt In Yes/No and Continuous Eligibility Opt
In
 MA Trans Med Opt In or Continuous Eligibility
opt In = No (individual not considered)
 MA Trans Med Opt In or Continuous Eligibility
opt In = Yes (individual is considered)
What Happens Next?
 Eligibility will automatically run on all
active MA cases with an eligible Trans Med
individual
 Individuals no longer eligible based on new
rules will be discontinued with 10-day
noticing
 Individuals can be eligible for Trans Med
many times in a lifetime
Questions?
Project 8242
CBMS MA CHP+ Updates
Project 8242
 Ensures CHP+ enrollment fees are not
charged more than once every 12 months
 Ensures children born to CHP+ mothers
are CHP+ newborns rather than MAGI
newborns
Project 8242
 Previously individuals changing
categories mid-certification were being
re-charged enrollment fees
 Enrollment fees will now only be charged
at intake and RRR
 Additionally CBMS will check to make
sure a fee has not been charged within
the previous 12 months
Project 8242
 Some changes reported do set new RRR
dates
 When this occurs the enrollment fee will
also be delayed to align with the new
RRR
Project 8242 Scenario
MA application of 01/08/2015
235% FPL
Kids pass
for CHP+
Fail for
income
Fail for
income
Project 8242 Scenario
Changes reported 07/08/2015
Dad lost his job
Mom is Pregnant
Due 02/02/2016
Under 112%
Project 8242 Scenario
Changes reported 07/08/2015
Dad lost his job
Mom is Pregnant
Due 02/02/2016
Mom is
MAGI
Pregnant
Under 112%
Kids
remain on
CHP+
Dad is MAGI adult
Project 8242 Scenario
RRR date 12/15/2015!
Dad went back to work
Mom is still Pregnant
Due 02/02/2016
235%
Project 8242 Scenario
RRR date 12/15/2015!
235%
Dad went back to work
Mom is still Pregnant
Due 02/02/2016
Still MAGI
Pregnant
CHP+
Fails for excess
income
Project 8242 Scenario
02/2/2016
Baby is born! (It’s a boy)
Dad got a raise
245%
Project 8242 Scenario
02/02/2016
245%
Baby is born! (It’s a boy)
Dad got a raise
CHP+
Needy
Newborn
Still MAGI
Pregnant
Fails for excess
income
Project 8242 Scenario
04/15/2016 RRR!
245%
CHP+
Needy
Newborn
Discontinued,
MAGI pregnant
ends 04/30/2016
Fails for excess
income
Project 8242 Scenario
01/15/2017 RRR!
245%
Project 8242 Scenario
01/15/2017 RRR!
245%
CHP+
CHP+
Fails excess
income
Fails for excess
income
Project 8242
 CHP+ newborns will now be correctly
identified and coded as CHP+ rather than
MAGI child (regardless of income)
A Tale of Two Moms
A tale of two Moms
CHP+ Mom
CHP+ Prenatal
MAGI Mom
MAGI Pregnant
A Tale of Two Moms
On 11/02/2015 changes are reported!
CHP+ Mom
Gave Birth
and lost
income
CHP+ Prenatal
Gave Birth
MAGI Mom and gained
income
(over 200%)
MAGI Pregnant
A Tale of Two Moms
 What will happen?
A Tale of Two Moms
Guaranteed programs will not change
CHP+ Mom
CHP+ Baby will be
CHP+ Newborn
(despite income)
CHP+ Prenatal
through post-partum
MAGI Mom
MAGI baby be
Needy Newborn
(despite income)
MAGI Pregnant
through post-partum
8242 RRR language added
 Directs CHP+ Health Plan changes to call
HealthColorado
 In Denver metro area
 303-839-2120
 Outside Denver metro area
 1-88-367-6557
Questions?
Project 8608
MA Civil Union vs Marriage
Project 8608
 Addresses how Civil Unions differ from
Marriages for Medicaid eligibility
Project 8608 Background
 Colorado law allows for Civil Unions
 As of 10/07/2014, the state also
recognizes same sex marriages
Project 8608 Background
 Federal Medicaid provisions do not view
Civil Unions as Marriages
 Civil Unions are not considered married
for Medicaid eligibility
Project 8608





Married is Married
Common Law is Married
Civil Union is not Married
Domestic Partner is not Married
Client statement is acceptable unless
questionable
Project 8608
 Marital Status and Household
Relationships must be complete and
consistent
Data Entry Issues
 Marital Status was not a required field
prior to 06/2015
 Continue to update at RRR
 Data Conflicts will be generated for both
fields if they are blank or inconsistent
Knowledge Check
Same sex couple applies for MA they now
declare they are Common Law. Your
previous record shows Civil Union. What do
you need to do in CBMS?
Update the Marital Status fields for both
individuals AND ensure the Household
relationships reflect the marriage
Questions?
Project 8708
MA Non-Citizen Verification – SAVE Interface
Updates (Steps 2 and 3)
Current Functionality
 Only step 1 of Verify Lawful Presence
available
After Build Functionality
 CBMS changes to Non-Citizen and Verify
Lawful Presence page
 Implement steps 2 & 3 of VLP interface
 VLP more accurate
 New reports
VLP Step 1




Client applies for MA in PEAK (AFB)
Non-Citizen information entered in PEAK
Non-citizen page saved
Step 1 of VLP Interface begins
VLP Step 2
 5 days from application date Step 2
starts
 Three additional requests are made
 Three types of responses can be received
VLP Step 3





New 90 day ROP
Three requests are made
Denver Health users fill out G-845 form
Send completed form to DHS
Two responses can be received (positive,
negative)
CBMS Changes
Step 1
Step 2
Step 3
Questions?
Project 8709
MA Income Updates
Change 1: SSI/SSDI Lump Sums
For Non-MAGI categories of Medical
Assistance (MA), SSDI and SSI lump
sum income must be exempt for 9
months from the date acquired
SSI/SSDI Lump Sums
 Speed Letter requesting verification
 End of 8th month
 If the client still has the lump sum, it
will be counted as a resource
 The eligibility worker will need to
dispose of the original lump sum
resource record in CBMS!
Knowledge Check!
 If the client receives an SSI lump
sum on June 17th, when will the
speed letter be sent?




At the beginning of January
Mid-July
At the end of September
At the end of January
Change 2: Tax Dependents who File
Taxes
Tax dependents who file
taxes are currently being
considered tax filers
when determining MBU
They will now be
considered tax
dependents
Change 3: Earned Income Expenses

Expense types that apply to Non-MAGI, Cash or Food
Assistance will now only appear in Income Expenses for
those cases
Earned Income Expenses
Business Expense
Business Related
Travel
Clothing and
Uniforms
Impairment
Related Work
Expense
Books and
Supplies
Bus Tickets
Mandatory Fees
Interest on Capital
Assets, Durable
Goods and Loans
State Tax
Taxes – Other
Tips Allocated but
Not Received
Transportation
Change 4: Earned Income
Expenses
For MA, Reimbursement of Expenses
will be added to the countable
expenses drop-down menu
This should be used if a client is
reimbursed and that amount is
counted as income
Change 5: Verification of Rental
Income
Client statement will
now be an
acceptable
Verification Source
for rental income for
MAGI categories
Change 6: Rental Income and Real
Property
 Data entry of real property is currently
required for all cases with rental income
 Now, this will only be required for NonMAGI, Cash and Food Assistance cases
 MAGI will not consider real property
Change 7: Tax
Expenses/Deductions
 For MA and the Marketplace, Tax
Expenses/Deductions will now
have a limit based on federal caps
 There are monthly caps and
annual caps
 The Marketplace will consider annual caps
 MA will consider monthly caps
Tax Expenses/Deductions
Expense Type
HSA Deduction
Meals
Student Loan Interest
Contributions to a
Traditional IRA
Capital Losses
Annual
Amount
Monthly
Amount
$358.33
Percentage
50%
$2,500
$6,500
$2,500
$6,500
$3,000
$3,000
Questions?
Project 8710
MA Non-Citizen Updates
Change 1: Class Code A19
 Individuals in the US under Class Code
A19 have a U-Visa. They are victims of
certain crimes
 These individuals should be eligible for
MA if they are pregnant or under 19
Class Code A19
 Eligibility for other programs:
Marketplace
Eligible
Food
Assistance
Ineligible
Cash
Assistance
Eligible
Knowledge Check!
 True or False:
 Class Code A19 will now be eligible for
Food and Cash Assistance.
Change 2: Citizenship in PEAK
 Fields added:

Class Code, Document Type, Card Number, Date Asylum
Granted, and Document Number
 “Other” will be added as an option for Class
Code and Document Type


Not acceptable for Cash, Food, and Medical Assistance
Will allow for Reasonable Opportunity Period (ROP) for
the Marketplace
Citizenship in PEAK
For MA-only applications,
these fields (other than Date
Asylum Granted) will be
mandatory
• These fields will be dynamic based
on the Status and/or Document
selected
Change 3: C4HCO Other
 C4HCO Document Type and C4HCO Class
Code fields will be added to the NonCitizen page in CBMS
 These values will not be valid for ANY program other
than the Marketplace, and eligibility workers will not
have access to modify them
C4HCO Other
Questions?
Project 8597
CBMS, PEAK, PEAKHealth Needy Newborn
Updates
Current Functionality
 Lengthy needy newborn reporting
requirements in PEAK and PEAKHealth
 Lengthy CBMS data entry required for a
needy newborn
After Build Functionality
 Simplified process when clients add needy
newborns to the MA case via PEAK and
PEAKHealth
 Minimal information required
 Minimal data entry for needy newborns in
CBMS
Reminder!
 Eligible Needy Newborn or CHP+
Newborn
 Child born to an eligible mother who is
receiving either MA or CHP+ at the time of birth
 Pregnancy record not required in CBMS
 Must be reported within one year from the DOB
PEAKHealth Updates
 Report pregnancy via PEAKHealth
 Who is pregnant?
 Number of unborn(s)
 Expected due date
PEAK & PEAKHealth Updates
 Required needy newborn information:




Mother’s name
Childs name
DOB
Gender
 Optional:
 Childs SSN (if available)
CBMS Screenshots
CBMS Add a Newborn queue Updates
 Individual
Demographics
 Address
 ID
 Case Individual
 Individual Tax
Information
 Household
Relationships
 Purchase and





Prepare
Individual Attributes
Individual Residency
Pregnancy
Absent Parent
Summary
Absent Parent
Details
Household Relationships
 Only mother and needy newborn
information is populated
 Relationships must be added for all other
HH members
Pregnancy Page
Questions?
On a scale of 1-10, how would you
rate your current knowledge of the
October HCPF CBMS Build projects?
For all October 2015 build
projects, please visit
TrainColorado.com for more
information.
Courses > CBMS Build Training > October
2015> CBMS/PEAK October 2015 Build
Project Guide – HCPF