CAAS Training
Enrolling Families and
Children in Medicaid
and Child Health Plan Plus
CAAS Training
Department of Health Care
Policy and Financing
The Department of Health Care Policy and
Financing is the state department that
administers Child Health Plan Plus (CHP+)
and other medical programs for low income
families, persons who are blind or persons
with disabilities and the elderly.
CAAS Training
What we will cover
Medical Assistance (MA) Sites
Presumptive Eligibility (PE) Sites
Certified Application Assistance sites (CAAS)
• Responsibilities
• Expectations
• Application and certification
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Responsibilities for all sites
• Must meet all Federal and State criteria
• Adhere to all Department of Health Care Policy
and Financing (Department) rules, regulations,
and agency letters. To view these documents,
visit: Colorado.gov/cs/Satellite/HCPF/HCPF/1226307681414
• Assist families with the completion of the Public
Health Insurance for Families Application and other
Medical programs
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Responsibilities for all sites
• Participate in required trainings
• Display current site location and contact
information on the Department Web site
• Inform the Department of any changes
made to the primary site contact in a timely
manner
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Responsibilities for all sites
• Abide by all applicable HIPAA Privacy and
Security requirements regarding health
information
– As defined in 42 U.S.C. 1320d – 1320d-8, and implementing
regulations at 45 C.F.R. Parts 160, 162 and 164
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Responsibilities for all sites
• Offer voter registration at the time of initial
application
– Pursuant to the National Voter Registration Act of
1993, 42 U.S.C.S 1973gg-5(a)(2)(H)
– Track the number of voter registrations offered
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National Voter Registration Act
• Congress enacted the National Voter Registration
Act (NVRA) in 1993
• Requires voter registration opportunities to be
offered at each agency that:
– Provides public assistance (including food
stamps, Medicare and Medicaid, WIC, and
Colorado Works/unemployment assistance)
– Provides state-funded programs primarily for
persons with disabilities
– Recruits for the armed forces
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Complying with NVRA
• Voter registration must be offered:
– Upon initial request for services
– At service renewal
– Upon address change
• Applicants must be:
– Provided a voter registration form including a
declination section
– Offered assistance in completing the forms
• Each agency is required to transmit forms
to the appropriate county clerk
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Agency-Based Voter
Application
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Implementing NVRA
• The Department will inform all PE and
CAAS sites with requirements and
implementation dates.
• Each site will be responsible for
implementing a NVRA process to be in
compliance with NVRA.
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Voting Registration Supplies
Blank agency voter registration forms, agency
voter registration reporting forms and special
envelopes may be ordered directly from the
Secretary of State’s office or through your local
county clerk.
CAAS Training
Additional NVRA Information
Elections Questions and Answers:
www.elections.colorado.gov
Voter Information: www.govotecolorado.com
County Elections Offices:
www.elections.colorado.gov
NVRA E-mail Address:
elections@sos.state.co.us
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Medical Assistance Sites
(MA)
CAAS Training
Medical Assistance (MA) Site
Designated site that:
• Accepts and processes applications for Medical
Assistance Programs
• Uses the Colorado Benefits Management System
(CBMS) to determine eligibility for Child Health
Plan Plus (CHP+) and Medicaid programs
• Transfers the cases to the appropriate County
Department of Human/Social Services for
ongoing case maintenance
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MA Site expectations
• Self-funded (non-monetary contract)
• Have capacity and capability to process all
Medical Assistance applications submitted
to include: i.e., staff, workspace, equipment
• Provide and maintain adequate hardware
and software to access the CBMS
application through the Department’s
secured Web Portal
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MA Site expectations
• Process and authorize the eligibility
determination within the processing
timelines; 45 days for family and children’s
applications and non-disability applications,
and 90 days for disability applications
• Resolve any applicant/client issues in a
timely manner
• Respond to requests from the Department
in a timely manner
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MA Site expectations
• Accept and process all walk-in and mail-in
applications in a timely manner
• Explain the benefits of the programs that are
administered by the Department
• Conduct internal quality improvement reviews on
a monthly basis
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MA Site expectations
• Respond to any audit or Medicaid
Eligibility Quality Control (MEQC)
requests for case files and client
information
• Maintain copies of the active case files
and non-active case files for three
years after the discontinuation or
denial of eligibility
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How to apply to be an MA site
Submit a Letter of Interest (LOI) to the Department
The LOI should address the following:
1. Why is your organization interested in becoming an MA Site?
2. What population will benefit from your organization becoming an
MA Site?
3. What are the benefits to your organization in becoming an MA
Site?
4. What are the anticipated staffing levels and location(s) if your
organization becomes an MA Site?
5. How is your organization going to fund your ability to function as
an MA site?
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Address
• Health Care Policy and Financing (HCPF),
at 1570 Grant Street, Denver, CO 80203,
Attention: Monica Owens, MA Site
Contract Manager, or via email to
Monica.Owens@state.co.us
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Presumptive Eligibility (PE)
Sites
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Presumptive Eligibility (PE) Site
• Temporary health care coverage for
children 18 and under and pregnant women
while their eligibility is being determined
• PE Coverage is no less than 45 days
• PE Site list available:
CHPplus.org/materials/PESiteList.pdf
CAAS Training
What does a PE site offer?
• Immediate access to health care
– Medicaid PE for children: includes
all Medicaid-covered services
– Medicaid PE for pregnant women:
includes only outpatient services
– CHP+ PE: includes all CHP+
covered services - except dental
benefits
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PE Site qualifications
Sites must meet specific federal and state criteria:
• Federal Criteria
A “qualified provider” may grant Presumptive
Eligibility to pregnant women if all of the
following criteria is met:
– Be eligible to receive payments through the
State;
– Provide outpatient hospital services, rural
health services, or clinic services; and
– Be determined by the state agency to be
capable of making PE determinations.
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PE Site qualifications
A “qualified entity” may grant
presumptive eligibility to children if any
one of the following criteria is met:
– Be eligible to receive payments through
the State;
– Provide health care items or services;
and
– Be determined by the State agency to be
capable of making PE determinations.
CAAS Training
PE Site expectations
• State Criteria
– Have appropriate internet access that is capable
of supporting the Colorado Benefit
Management System (CBMS);
– Be a Medicaid and/or CHP+ provider OR be
affiliated with a Medicaid/CHP+ provider;
– Routinely be able to provide pregnancy testing
or assure referral to prenatal care and/or
children’s routine medical care;
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PE Site responsibilities
– Make necessary referrals to practitioners for
continued care for normal and high-risk
patients;
– Have client contact personnel available to
determine eligibility;
– Accept the Colorado Public Health Insurance for
Families Application and forward to the
appropriate county;
– Maintain at least a 90% accuracy rate of
eligibility determinations;
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PE Site responsibilities
– Participate in initial and ongoing PE trainings;
– Agree to fulfill all the responsibilities of a
qualified provider as stipulated by the
Department; and
– Be capable of assisting non-English speaking
clients.
– CAAS trained and approved
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How to apply to be a PE site
• Download the application from the
Department website, colorado.gov/hcpf
• Contact Corinne Lamberson
PE.Eligibility@hcpf.state.co.us
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Certified Application
Assistance Sites (CAAS)
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Certified Application
Assistance Sites
Agencies that assist families in completing the
“Colorado Public Health Insurance for
Families Application”
Certified to verify citizenship and
identification documentation
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CAAS responsibilities
A certified agency must:
• Train all staff on the process for
completing an application and how to
verify citizenship and identity documents.
CAAS Training
CAAS responsibilities
A certified agency must also:
• Complete an “Certification Site
Application” aka Certified Application
Assistance Site Application, visit:
Colorado.gov/cs/Satellite/HCPF/HCPF/1226307681
414
• Submit completed applications and all
documentation to local county within five
business days.
CAAS Training
What are Medicaid and CHP+?
• Medicaid – Low-cost health insurance for
Colorado children, pregnant women,
parents with dependent children, the
elderly, and people with disabilities
• CHP+ – Low-cost health insurance for
Colorado children and pregnant women
who exceed the income guidelines for
Medicaid eligibility
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Who is eligible for Medicaid?
• Children who are 18 years old and under
• Parents caring for dependent children who
are enrolled in Medicaid or CHP+
• Pregnant women
• Within income guidelines
• Colorado residents
• US citizens or legal permanent residents for
at least 5 years
– Some exceptions to 5 year ban
• Okay to have another form of insurance
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Who is eligible for CHP+ ?
•
•
•
•
•
•
Children who are 18 years old and under
Not eligible for Medicaid
Within income guidelines
Colorado residents
Not covered by other health insurance
US citizens or legal permanent residents for
at least 5 years
• Unable to access employee health insurance
through the State of Colorado
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2010-2011 Income Guidelines for
CHP+ and Medicaid
Slide updated: 07/13/2010
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Financial Responsibility
Self
Spouse
Parent
Sibling
Child
Others
Self
Spouse
Child
Sibling
Parent
Child
CAAS Training
What expenses should be
listed on the application?
•
•
•
•
Child care and elder care expenses
Medical/prescription expenses
Health insurance premiums
Outgoing and incoming child support
and alimony
– Expenses must be from the same month as the income
being reported
– Some or all of these expenses will be deducted from the
family’s income to determine eligibility
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What is acceptable proof
of income?
• Paycheck stubs
– At least one paycheck stub with pay date in
previous or current month
OR
• Signed written document from employer
– Exact gross income from previous month OR
– Exact hourly wage, hours worked, how often
paid, and date of last paycheck
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What about self-employed
applicants?
• Profit and loss statement for previous or
current month must be included
OR
• Complete self-employment section - the
ledger - on the application
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Joint Application
• Determines eligibility for
Medicaid and CHP+
– Applications are checked for
Medicaid eligibility first, then
CHP+
• Available in English and Spanish
• Available at CHPplus.org or
Colorado.gov/hcpf or
Department of Human/Social
Services Offices or by calling toll
free: 1-800-359-1991
CAAS Training
Points of Clarification
Question 1:
• Use legal names
• Include mailing address if
different from physical address
• Must include at least 1 phone
number
Question 3:
• List all members of the
household even if the person is
not a family member
• Make a copy of this page if
more than 8 people
live
in the household
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Points of Clarification
Question 4:
• This information is for
any child in the family
Question 5:
• If anyone in the
household is pregnant, be
sure to complete this entire
section
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Points of Clarification
• Complete one page for
each child applying; if
needed, make a copy of this
page for each additional child
• Add child’s full name
including middle initial
•Include only natural or
adoptive parents living in the
home (don’t include stepparents in this section)
•Alaskan Native or Native
American applicants: check
box in order to receive
fee exemptions
CAAS Training
Points of Clarification
Question 2:
• If applicable, write alien
registration number on the
line and make a copy of
both sides of resident card
to include with the
application
Question 4:
• Medicaid will allow up to 3
months of backdated
coverage; CHP+ does not
back date and enrollment
begins the day an application
is date-stamped and received
by a CHP+ partner
organization
CAAS Training
Points of Clarification
Question 5:
•Applicants who have
access to Colorado State
Government health
benefits do not qualify for
CHP+ but may qualify for
Medicaid
Question 6:
•Pre-existing conditions
do not impact eligibility
•If yes, child may qualify
for other programs
CAAS Training
Points of Clarification
• ONLY Pregnant women
and adults 19 years and
older in the household
applying for health
insurance will complete this
form
• Permanent legal residents
must include a copy of
both sides of the resident
card with the application
CAAS Training
Points of Clarification
Questions 1 and 2:
• Only refer to those
applying for benefits
• If anyone applying is/ was
covered by other health
insurance, complete ALL
fields in the appropriate
section
• Include a copy of both
sides of the health insurance
card for question 1 if
available
CAAS Training
Points of Clarification
•List all working members of
the household and their
income details
Question 1:
•Self-employed workers must
complete this section OR
submit a profit and loss
statement showing income
and expenses for either the
current or previous month
Question 2:
List all other income for all
household members
here
CAAS Training
Points of Clarification
•List all allowable
expenses/income
deductions for each
member of the
household
Blue box:
•Applicant must
include HMO
choice or the State
Managed Care
Network depending
on the county of
residence (refer to
application insert)
CAAS Training
Medicaid Disregards
• The disregards run automatically in CBMS
• Earned Income Disregard
– $90/month/person whose earned income is used to determine
program eligibility
• Child/Spousal Support Disregard
– $50/month/household
• Dependent Care Disregard
– $200/person < age 2; or
– $175/person ≥ age 2
CAAS Training
Selecting an HMO for CHP+
• An HMO is a group of doctors, nurses, hospitals, and
other providers who care for members
• An HMO manages the health insurance benefits that
CHP+ offers
• Applicants must select an HMO or the State Managed
Care Network, depending on the county of residence
• For a complete list of HMOs available in your county,
see:
– CHP+ deskguide for professionals
– Health Plan Comparison Chart Insert (in application)
– CHPplus.org
CAAS Training
Pre-HMO
enrollment period
• All CHP+ members have a pre-HMO
enrollment period
– Provides medical coverage from received date of
application up to HMO/Dental effective date.
– Provides medical care immediately so members don’t
have to wait
• The pre-HMO coverage is through the
State Managed Care Network
– Members will receive a temporary identification card
during this time
– Dental services are not covered during this time
CAAS Training
Points of Clarification
•All adults 19 or
older applying for
health coverage
must sign here
•Parents or
guardians applying
for health coverage
for their children
must sign name,
print name, and
write the date here
CAAS Training
Verification requirements
Medicaid and CHP+ applicants may be
asked to provide original or certified
copies of documents proving the identity
and citizenship of all who are applying
– Clients must provide the original copies
to the Certified Application Assistance
Site or the county to be verified
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Verification requirements
• An insert explaining the
documents required is included in
each application
– List of documents and organizations where
original documents can be verified:
Colorado.gov/cs/Satellite?c=Page&cid=12
26307681414&pagename=HCPF%2FHCPF
Layout
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Verifying Documents for
Medicaid and CHP+
• For US Citizens or legal permanent
residents
• Applicants must present an original or
certified copy, never a photocopy
• Exemptions include: PE clients, Needy
Newborns, SSI and SSDI eligible clients,
current Medicare recipients, and Foster
Care children
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Citizenship and Identity
Documentation
• A passport (current or expired) can be
used to establish both citizenship and
identity
CAAS Training
Citizenship Documentation
Examples of acceptable citizenship
documents:
•
•
•
•
•
•
U.S. birth certificate
Certificate of birth abroad
U.S. Nation ID card
Native American Tribal document
Final adoption decree
Official military record of service showing a
U.S. place of birth
• Religious/School records
CAAS Training
Identity Documentation
Examples of acceptable identity
documents:
• Driver’s license or state ID card with photo
• ID card issued by a federal, state, or local government
agency
• U.S. military card or draft record or U.S. Coast Guard
Merchant Mariner Card
• School ID card with photo
• Verified school, nursery or daycare records (for
children under age 16)
• Clinic, doctor or hospital records (for children
under age 16)
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Written Affidavits
• Can only be used when other
documentation is not available
• Can only be used to prove either
citizenship or identity, not both
• Affidavits do not need to be notarized
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Submitting Certified
Documents - Option 1
•
A photocopy of the original or certified
document, with the following information
either stamped or written on each copied
document:
–
–
–
–
–
–
Agency name
Name and signature of staff who viewed documents
Agency’s full address
Agency’s phone number
Date documents are verified
Write words “verified original” above stamp or
agency information on each document
CAAS Training
Submitting Certified
Documents – Option 2
• A photocopy of the original or certified
documents attached to the “Citizenship and
Identity Documentation Received” form
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What happens if falsified
documents are submitted?
• Sites are verifying that documents
submitted are original or a certified
copy
– If doubts or reservations about a submitted
document, do not certify the document; refer
the client to local county office
– Sites should not knowingly accept documents
such as a fax or photo copied birth certificate;
all documents must have a visible stamp or the
required certification information on it
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Submitting Applications
• Applicant must sign and date the
last page of the application
• Send applications to the county
Department of Human/Social
Services in which the applicant
resides, or:
CHP+
PO Box 929
Denver, CO 80201
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How does an applicant
follow up?
• All communication is sent directly to the
applicant, not the Certified Application
Assistance Site
• Eligibility should be determined within 45
days
• If an applicant has not been notified,
contact the agency to which the application
was submitted
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Appeal Process
• Clients can appeal an eligibility decision
– They will be notified by mail of their
appeal rights and instructions on how to
proceed if their application is denied
– They have 30 days from the date on the
denial letter to appeal the decision
• Appeals must be submitted in writing
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Resources
• CHPplus.org
• Colorado.gov/hcpf
• CHP+ Customer Service: 1-800-359-1991
• Medicaid Customer Service
Denver Metro:
303-866-3513
Toll free:
1-800-221-3943