Washington Apple Health Overview for Non-Citizens Dody McAlpine Francesca Matias Medicaid Eligibility & Community Support
Objectives Provide an overview of the different immigration categories; and Corresponding potential Apple Health eligibility; and How to enroll 2
Immigration Categories There are two categories of lawfully present immigrants: Lawfully Present Qualified Immigrants; and Lawfully Present Non-Qualified Immigrants. 3
Lawfully Present Qualified Immigrants Adults under this status who have met or who are exempt from the 5-year bar are potentially eligible for the same coverage as U.S. citizens. See Citizenship and Alien Status Guide for a complete description on which immigration statuses must meet the 5-year bar and which ones are exempt. 4
Refugees Refugees are classified as Qualified immigrants; Other Qualified immigrants treated as refugees: Asylees Certified victims of severe forms of trafficking Cuban/Haitian Entrants Special Immigrants from Iran and Iraq Refugees are exempt from the 5-year bar: Once a refugee obtains Lawful Permanent Residence status, they remain exempt from the 5-year bar. 5
Eligibility Table for Qualified Immigrants Citizenship/Alien Status Potentially Eligible: Not Eligible: Lawfully Present Qualified Aliens 5-Year Bar Met or Exempt Apple Health for Kids Apple Health for Pregnant Women Apple Health for Parents and Caretakers Apple Health for Adults Classic Medicaid Purchase QHP in HPF HIPTC if a tax filer MCS AEM 5-Year Bar Required and Not Met Apple Health for Kids Apple Health for Pregnant Women MCS AEM Purchase QHP in HPF HIPTC if a tax filer Apple Health for Parents and Caretakers Apple Health for Adults Classic Medicaid 6
Lawfully Present Non-Qualified Immigrants Non-immigrant visa holders which include holders of agricultural work visas (H-2A) are included in this category. Migrant workers may be H-2A visa holders All lawfully present migrant workers are included in this category. See Citizenship and Alien Status Guide for a complete description of non-qualified immigrants. 7
H-2A Visa Holders H-2A visa holders are non-immigrants and classified as Non-Qualified immigrants. They are in the U.S. on an agricultural work visa H-2A visa holders will be issued an employment authorization document (EAD) and will be required to provide a social security number. As Non-Qualified immigrants, H-2A visa holders are potentially eligible for the same Apple Health programs as other Non-Qualified immigrants. 8
Eligibility Table for Non-Qualified Immigrants Citizenship/Alien Status Potentially Eligible: Not Eligible: Lawfully Present Non- Qualified Aliens Apple Health for Kids Apple Health for Pregnant Women MCS AEM Purchase QHP in HPF HIPTC if a tax filer Apple Health for Parents and Caretakers Apple Health for Adults Classic Medicaid 9
Reporting Income Washington Healthplanfinder asks the applicant to provide income from the current month. Many migrant workers and H-2A visa holders have seasonally fluctuating income. If the applicant s income changes from month to month, the applicant can either provide: Averaged monthly income over a period of time; or Actual monthly income 10
Income for Refugee Medical If a refugee is eligible for Apple Health coverage at the time of application, he or she remains eligible through the first 8 months of U.S. residency, or the first 8 months from the date the qualifying refugee immigration status was obtained. Refugees must have income at or below 200% of the FPL in the month of application to be eligible for refugee medical. 11
SSN Requirements There are no SSN requirements for the following programs: Refugee Medical Alien Emergency Medical Apple Health for non-citizen children and non-citizen pregnant women If the individual has an SSN, they should enter it in the HPF regardless of whether or not it is required for the program. H-2A visa holders will be issued an Employment Authorization Card (EAC) and will need to obtain an SSN. 12
Apple Health Enrollment Apply online at www.wahealthplanfinder.org; Helpful information to have when applying: SSNs, if one has been issued Current citizenship and immigration documents 13
Apple Health Enrollment Refugees who just arrived in the U.S. or just obtained refugee status apply through their local VOLAGS; For in-person assistance with enrolling through the Healthplanfinder, contact a navigator at www.wahealthplanfinder.org Select Customer Support, then Find a Navigator Search by organization name, zip code or language 14
Apple Health Resources HCA Training & Education Resources www.hca.wa.gov/hcr/me/pages/training_education.aspx Washington Healthplanfinder: 1-855-923-4633 Washington Health Care Authority: 1-855-623-9357 HCA Community-Based Specialists http://www.hca.wa.gov/hcr/me/documents/community_bas ed_staff_contact.pdf 15
Questions? 16
Apple Health Updates 17
HCA Divisions Office of Audit and Accountability (A&A) Central Services Administration (CSA) Clinical Quality and Care Transformation (CQCT) Communications (COM) Division of Legal Services (DLS) Employee Resources Division (ERD) Enterprise Technology Services (ETS) Financial Services (FS) 18 Medicaid Eligibility and Community Support (MECS) Medicaid Program Operations and Integrity (MPOI) Medicaid Services (MS) Office of the Director (EXO) Policy, Planning and Performance (PPP) ProviderOne Operations and Services (P1OS) Public Employees Benefits (PEB) Portfolio Management and Monitoring (PM&M)
Managed Care Updates Changes coming April 2016 to Apple Health Managed Care, include: Statewide: Earlier Enrollment Single Managed Care plan for Foster Care Behavioral Health Organizations replace Regional Support Networks Clark And Skamania Counties Fully Integrated Managed Care (FIMC) 19
Earlier Enrollment Beginning April 1, newly eligible Medicaid clients will be enrolled in managed care effective the first of the current month, rather than prospectively to the first of the next month. Existing enrollees who change plans, or who lose then regain enrollment, will be enrolled in the new plan for the first of the following month. Example: A new client who became eligible for coverage February 22, will be enrolled into managed care on February 1, instead of March 1. 20
Fully Integrated Managed Care Fully Integrated Managed Care (FIMC) will be implemented in Clark and Skamania Counties on April 1. Molina Healthcare of Washington (MHW), and Community Health Plan of Washington (CHPW) are the two plans who will provide this program. FIMC will provide medical, inpatient and outpatient mental health services, and substance use disorder services. There will be no Regional Support Network/Behavioral Health Organization (BHO) in Clark and Skamania Counties. MHW and CHPW will provide and coordinate all covered services. 21
Behavioral Health Organizations Behavioral Health Organizations (BHO) will implement on April 1. BHOs will provide managed mental health and substance use disorder services through nine BHOs. Regional Support Networks will be no more. BHO s will operate statewide except in Clark and Skamania Counties. 22
Apple Health Foster Care Apple Health Foster Care (AHFC) will implement statewide. The program will be called Apple Health Core Connections. AHFC is a managed care program that serves children and youth in foster care and adoption support, and young adult (18-26) alumni of the foster care system. Coordinated Care of Washington is the single MCO selected as the result of a competitive process. Apple Health Core Connections will provide medical and outpatient mental health services and a robust program of health care coordination and care management services. 23
Exemption for Homelessness For new requests: Effective March 1, 2016 living homeless is no longer a criteria for exemption or disenrollment from Apple Health Managed Care; For clients with an existing exemption: HCA is working with advocates, MCOs and providers to provide information on this change; These clients will remain exempted until June 1, 2016 Medical necessity is still a criteria for exemption; More information is forthcoming. 24
Managed Care Resources Apple Health Managed Care Changes April 2016 http://www.hca.wa.gov/medicaid/healthyoptions/pages/cha nges_april_2016.aspx Questions: hcamcprograms@hca.wa.gov Webinar trainings: http://www.hca.wa.gov/hcr/me/pages/webinars,-video,- and-presentations.aspx Health Care Integration Update - Sessions 1 thru 3 Earlier Enrollment Provider Training 25