January 9, 2014
Washington State
Hospital Association

Mary Wood
Office of Medicaid and Medicare Eligibility Policy and
Outreach, Washington State Health Care Authority
Janet Walthew
Director, Patient Financial Services & Patient Access
Northwest Hospital & Medical Center
Barbara Gorham
Policy Director, Access
Washington State Hospital Association
Washington State
Hospital Association

• Basic Health Plan
• Washington State Health Insurance Pool
• Managed Care Auto-Enrollment
• Renewals
• Retroactive Coverage
• Alien Emergency Medical
• Medicaid for Aged, Blind, and Disabled
• Spend-down Coverage
• Questions
Washington State
Hospital Association

Basic Health Program (BHP) – ended 12/31/13
– BHP recipients received 4 letters on the conversion process
– Recipients had 3 ways to apply
• Online at www.wahealthplanfinder.org
• Paper application
• Call HBE Customer Support Center at
1-855-923-4633
– It is not too late…families can still apply after 1/1/14 for coverage
Washington State
Hospital Association

WSHIP recipients can keep WSHIP coverage or buy new coverage through www.wahealthplanfinder.org
– If they wanted to keep WSHIP they were automatically renewed.
Recipients had the opportunity to switch to a different WSHIP plan during fall open enrollment.
– Federal rules define state high risk pool coverage as “minimum essential coverage” for 2014. That means recipients who decide to keep WSHIP coverage in 2014, will not have to pay a penalty.
– Non-Medicare WSHIP coverage is scheduled to end 12/31/17.
Washington State
Hospital Association

• In 2014, Medicaid recipients will continue to be autoenrolled to a managed care plan.
• In 2015, HCA hopes to implement system changes that would allow individuals to shop and select their
Medicaid managed care plan online through the
Healthplanfinder. (HPF)
Washington State
Hospital Association

Until online shopping is available, recipients can make a change in their plan selection by:
• Go online at http://www.hca.wa.gov/Documents/managed_care
/ChangePlanEnrollment.pdf
• Return a HCA 13-862 Enrollment form
• Call MACSC at 1-800-562-3022
Washington State
Hospital Association

• HCA is concerned about the rate of successful renewal completions for family, children and pregnancy cases through the HPF.
• Several factors are believed to be involved in the lower rate of completions:
– A new system
– System issues and availability (especially in the first two months)
– System error which require a manual effort to fix
Washington State
Hospital Association

As you work with individuals and families:
– Inform them that there is a new online system and provide the address www.wahealthplanfinder.org
– Encourage them to try to complete their renewal online for a real-time determination
– Individuals not comfortable with the online application can complete an Application for Health Care Coverage (HCA 18-
001) http://www.hca.wa.gov/medicaid/forms/Documents/18-
001P.pdf
Washington State
Hospital Association

All Medicaid coverage groups (including new adult) have
3 months retro coverage from the month of application.
– Answer yes to the question “Do you or anyone you are applying for need help in paying for unpaid medical bills?”
– A report will be pulled and retro medical approved by HCA enrollment staff
– No real-time determination available for retro coverage
Washington State
Hospital Association

• If client is over 65 or on Medicare; apply through www.washingtonconnection.org or send a HCA 18-001 directly to DSHS. There is no change in AEM applications for this group.
• For client who fall under MAGI (family, children, and new adult group); apply online or with paper application through Healthplanfinder.
Washington State
Hospital Association

Check one of the boxes in the non-citizen emergency medical section of the application, if an individual:
– Has been treated for an emergency medical condition this month or during the previous three months
– Needs dialysis or cancer treatment
– Needs anti-rejection medication as a result of an organ transplant
– Needs nursing home, assisted living, or in-home care
Washington State
Hospital Association

AEM remains a two-step process:
1. Individual must be determined financially eligible for and related to a Medicaid program. This is decided through
HPF for MAGI cases and by DSHS eligibility staff for all other cases.
2. Individuals must have an emergent medical condition.
This is decided by a HCA clinical staff review of medical evidence. No change in medical evidence requirements .
Washington State
Hospital Association

• With implementation of new adult group on 1/1/14, many more adults who have emergent medical treatment in a hospital will be eligible for AEM.
Washington State
Hospital Association

• Sometimes referred to as Classic Medicaid
• Includes medical for:
– SSI cash recipients
– Individuals over 65
– Medicare recipients
– Medicare Savings Programs
– Long-Term Care and Waiver Services (COPES)
• These medical coverage groups will be processed by
DSHS - no change
Washington State
Hospital Association

• If receiving Medicare, they are considered Classic and will have medical eligibility determined by DSHS – no change
• If determined disabled by Social Security but not yet on Medicare, they can be in new adult group.
Benefits to individual include:
– More comprehensive benefit package
– No spenddown
– No asset test
Washington State
Hospital Association

Why would someone choose the spenddown program rather than purchase a Qualified Health Plan (QHP)?
– Applying for coverage outside the open enrollment period and do not meet one of the exceptions.
– No retroactive coverage look-back period for QHP coverage.
Earliest begin date for QHP coverage is month after application month.
Washington State
Hospital Association

• A report will be generated and worked by enrollment staff at HCA when the following occurs:
– Woman marks she is pregnant and has income over 193%
FPL
– Application is for a child and family income over 312 % FPL
• Letter will be generated to household giving spenddown option
Washington State
Hospital Association

Washington State
Hospital Association

Washington State Healthcare Authority
Mary.Wood@hca.wa.gov
Northwest Hospital & Medical Center
Janet.Walthew@nwhsea.org
Washington State Hospital Association
BarbaraG@wsha.org
Washington State
Hospital Association