IM-52 05/12/06 OPEN ELIGIBILITY FOR MC+ CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) PREMIUM CASES LEVEL OF CARE 2

SUBJECT:

OPEN ELIGIBILITY FOR MC+ CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) PREMIUM CASES LEVEL OF CARE 2

DISCUSSION:

MC+ eligibility for CHIP Premium Level of Care (LOC) 2 children will no longer end for non-payment of the Recurring Invoice. LOC 2 cases will remain open, and coverage will be established based on receipt of premium payments. The Division of Medical Services (DMS) will notify families when coverage ends for non-payment of a Recurring Invoice.

Coverage dates for LOC 2 children will display on the individual child's MCII screens. MXIX screens will continue to show eligibility dates, not actual coverage dates, for both LOC 2 and LOC 3 children.

LOC 2 “Only” Cases:

MC+ for Children CHIP cases where all active children are LOC 2 will continue to close for non-payment of an initial premium. Families are given 90 days from the date of initial case approval or change to a premium level of care to pay the Initial Invoice. Failure to pay the Initial Invoice within the 90-day time frame will cause the system to close the case with Reason 62 - Non-payment of Premiums. Families whose eligibility closes for non-payment of Initial Invoice will need to re-apply for MC+ for Children.

MC+ cases will remain open when:

all children are LOC 2;
the Initial Invoice has been paid; and
the Recurring Invoice is not paid timely.

The “Individual Status” for LOC 2 children on ICAS and MXIX screens will show as “Active,” as their eligibility will remain open. View MCII screens on the individual children to determine actual coverage dates for the premiums paid.

Cases with LOC 2 and Poverty Level Children (LOC Q):

MC+ for Children cases which have both LOC 2 and LOC Q children will continue to close eligibility for the LOC 2 children for non-payment of the Initial Invoice. LOC 2 children will change from “Active” Individual Status to “Included.” Families will have to re-apply for MC+ for Children to determine CHIP eligibility for children whose eligibility has closed.

Children approved as LOC 2 on MC+ for Children cases with LOC Q child(ren), and whose family does not pay the Recurring Invoice, will still have an Individual Status of “Active” on ICAS and MXIX screens. Access the MCII screens on the individual LOC 2 children to determine actual coverage dates. The LOC Q child(ren) will continue to have coverage.

Invoicing and Coverage:

Families that fail to pay the Initial Invoice LOC 2 or the Initial Invoice LOC Change (generated for newly approved CHIP Premium LOC 2 cases or MC+ cases going from non-premium to premium, respectively) within 90 days will be affected as follows:

Whole case will close if all children are LOC 2 (or 3); or
For cases with LOC 2 and LOC Q children, LOC 2 children will change from an individual status of “Active” to “Included; AND
MXIX will show initial eligibility date and closing eligibility date for individual children;
MCII will not show any coverage dates as payment had not been received; and
Families will need to re-apply to determine eligibility for “Closed” or “Included” children.

Families that fail to pay the Recurring Invoice or Late Payment Notice timely (within 20 days after the Late Payment Notice is sent) will lose coverage. CHIP LOC 2 cases will be affected as follows:

Whole case will remain open if all active children are LOC 2, and children will still show an Individual Status of “Active”;
For cases with LOC 2 and LOC Q children, LOC 2 children will still show an Individual Status of “Active”;
Eligibility will remain open for all LOC 2 children (MXIX will show initial eligibility date and no closing date);
MCII will show an enrollment stop date, as coverage will close;
Family will be sent a LOC 2 Closing Letter that includes an invoice. The notice will state that payment of the Invoice will resume coverage for 30 days upon receipt of payment.

“Rolling Calendar”

The “Rolling Calendar” allows a payment to be received at any time of the month, provides coverage for 30 days from the date the premium is received, and re-initiates the Recurring Invoice cycle.

Eligibility will remain open for CHIP LOC 2 cases and children who lose coverage due to non-payment of Recurring Invoices. Families will be notified by Division of Medical Services (DMS) when coverage has ended and be given the opportunity to regain coverage by paying an attached invoice. Families will be sent a Reminder Initial Invoice LOC 2 monthly for up to six months and may pay a premium at any time while the case remains open.

Example:

Mrs. Jones' two children, Jane and John, are approved for MC+ CHIP at a Level of Care 2. She pays her Initial Invoice LOC 2 on May 15, 2006. The initial payment allows for coverage for the first month payment is received through the end of the second month. Mrs. Jones is sent the Recurring Invoice June 5 for July coverage. June 15 she is mailed the Late Payment Notice (previously called “Failure to Pay”). Her payment is not received by July 5. Jane and John's coverage ends July 5, but their case remains active.

Mrs. Jones is mailed the LOC 2 Closing Letter on July 10. She does not pay the attached invoice. August 10, 2006, Mrs. Jones is mailed Reminder Initial Invoice LOC 2 notice, does not pay it, and again is mailed the Reminder Initial Invoice LOC 2 September 11. Mrs. Jones sends in her payment and it is received September 18. The children have coverage from September 18 through October 17. A Recurring Invoice will be sent with a Confirmation letter, stating her payment has been received and that she needs to pay the attached invoice to get continuous coverage.

MCII will show the individual child's coverage dates. Do not use MXIX to inform a family that a LOC 2 or LOC 3 child has coverage, as this shows eligibility dates only. CHIP Premium payments continue to be for future coverage. Families cannot pay for and receive coverage for past time periods.

The implementation of the rolling calendar allows cases to remain open and reduces CHIP case reinstatements and re-applications. Budget adjustments and reinvestigations are still required to be completed timely.

LOC 3 Cases:

MC+ for Children CHIP cases where all active children are LOC 3 will continue to close for non-payment of either the Initial Invoice or the Recurring Invoice.

Managed Care

Families with children in Managed Care counties should be informed that breaks in payment will cause an interruption in their Managed Care coverage. Any payment that results in lapse of coverage will cause Managed Care to end, the child to be placed in a “Pseudo Plan” (fee for service) coverage for 15 days, and the Managed Care to resume after the 15th day. Managed Care will not be started upon receipt of payment. While in a pseudo plan, recipients will have to use a fee for service provider and present their red Medicaid card to verify coverage. When in managed care, they will use a managed care provider and present their managed care insurance card to verify coverage.

System Updates

Updates to the MPNI screen are being completed to accommodate the CHIP changes. The first stage of changes, which are in effect now, allow the worker to note case status, the next notice type to be sent out, the level of care, and the type of notices being sent. Changes to be implemented at a later time will show more information regarding the invoice status, dates of coverage, and help screens.

Example of MPNI Update Stage 1:

Case Status is “Pending,” as the Recurring Closing LOC 2 (LOC 2 Closing Letter ) notice was sent 20 days after the due date on the Failure to Pay notice (now known as the Late Payment Notice ). The Recurring Invoice sent 5/04/06 shows Invoice Status “Closed” as that invoice can no longer be paid for June coverage. Invoice Date 05/09/06 with Invoice Status of “Open” is in reference to the Recurring Closing LOC 2 (LOC 2 Closing Letter) notice, as the invoice included in the closing letter remains open. The next notice set to be sent out, if payment is not received, is the Reminder Initial Invoice LOC 2 , scheduled to be sent 06/08/06.

NOTE: An “Open” invoice refers to an Invoice that has not been paid, and is still open to accept payment. A “Closed” invoice is one that either has been paid or is no longer valid to receive payment.

Auto-Withdrawal

Families have the option of having the CHIP Premium automatically withdrawn from their bank account. Recurring Invoices offer the option of this service. Forms to request automatic withdrawal are found on-line at www.dss.mo.gov/dms. Families previously received ACH Confirmation forms after auto-withdrawal of the premium from their bank account. The ACH Confirmation notice will now be sent approximately 15 days prior to account withdrawal, informing families of the amount to be withdrawn.

Breaks in the payment cycle will result in the closing of a family's auto-withdrawal. Those interested in having premiums auto-withdrawn will have to resubmit a request.

Summary of Changes

The “Rolling Calendar” allows LOC 2 cases and children to stay open for non-payment of premium for a recurring invoice, as long as the individual(s) remains eligible. This reduces reinstatements and the need for clients to re-apply for assistance.
Budget adjustments and Reinvestigations are required to be done on a timely basis.
Examples of DMS forms for CHIP Premium cases are attached below. They are included for informational purposes only. Do not use or send these forms to families.
Notification will be provided as the system updates are completed.

NECESSARY ACTION:

Review this memorandum with appropriate staff.
Inform families in Managed Care counties of breaks in managed care coverage, if payments are not received timely.
Access the MCII screen for individual coverage dates.

LH/jfm

ATTACHMENTS: