Welcome

2015 Open Enrollment,

SES and CBMS

Training

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

Glossary

SES – Shared Eligibility System

MA - Medical Assistance APTC - Advanced Premium Tax

Credits CSR - Cost Sharing Reductions C4HCO or C4 - Connect for

Health Colorado

Open Enrollment 2016 Open Enrollment is an opportunity for those who want to apply for

Federal Financial Assistance to help purchase private health insurance through C4HCO for the 2016 plan year

Open Enrollment begins November 1, 2015

Open Enrollment ends January 31, 2016

It does not impact current Medicaid or CHP+ clients unless they are no longer eligible for Medicaid or CHP+

Client must receive a MA denial during the Open Enrollment Period in order to enroll in a plan

Applying for Medical Assistance (MA)

No wrong door for applications Phone, Fax, PEAK/SES, Paper, In

person SSAp, Single Purpose Application

(SPA)

Shared Eligibility System (SES)

Applicants applying for MA only through PEAK or C4

MA only application includes CHP+, APTC and CSR results

Eligibility determined individually

Questions?

CBMS C4HCO User Interface/User Experience Updates

Project 8764

Current Functionality

Many application questions need to be answered for MA applicants

Many questions from applicants about the MA application and the process

After Build Functionality

PEAK/SES changes CBMS page changes MA eligibility changes

PEAK Changes

PEAK Changes

Mandatory PEAK Questions

Apply for Benefits MA only Applications: What type of coverage is this person currently enrolled in? Who else has access to this coverage Is this person a U.S. citizen? Is ___ currently enrolled in a health plan offered by (employer)? Is anyone in your home covered by Health Insurance that you have

not already reported above? Report My Changes/RRR MA only cases:

Is this person a resident of Colorado? Is this person a U.S. citizen? Who else has access to this coverage?

RMC/RRR Summary Page

CBMS Changes

Past expenses added for APTC

Private Disability Taxable amount added to income received details page

Qualifying widow(er) with dependent child added to individual tax information page

Ethnicity page changes

CBMS Changes

Questions?

CBMS Connect for Health Colorado Big Rocks

Project 8759

Overview of Changes CBMS and PEAK changes for MA

Add expedited income path for MA only applications

Add avatar to the SES

Add summary page to SES

Allow client to review prior to submitting application

SES changes for life change events

Create Service center portal for customer service representatives

MA Standard Income Path

Standard Income Path Combo applications (MA, CDHS) Possible Non-MAGI Household (over 64 years old,

disabled, needs care) HH members not lawfully present No tax filers Married filing separately tax filing status

MA Expedited Income Path

Expedited Income Path Client can reports tax household’s annual income

MA Expedited Income Path cont.

Multiple tax households on same application

FPL thresholds 10% higher than normal FPLs for MA categories

Expedited income not matched with IEVS

AI/AN Expedited or Standard?

AI/AN income = yes than Standard AI/AN income = no than Expedited

Apply for Benefits (AFB) Expedited

Income Path applications

If the RTE determination is successful and the eligibility results are

mixed meaning there are APTC and MA individuals then the application will be assigned to the C4

caseload

If no individuals are approved for APTC/CSR then the application will

be assigned to the County of residence

If the RTE determination is un-successful the application will be

assigned to the State of Colorado inbox where C4

workers will be able to process the application

Report My Changes (RMC) Applications

If a client submits a change using Report My Changes

within 15 months of the APTC only case being closed and that application is routed down the

Expedited Path then the application will be assigned to the State of Colorado inbox.

If a client submits a change using Report My Changes

within 15 months of the APTC only case being closed and that application is routed down the

Standard Path then the application will be assigned to

the County Inbox

Meet Kyla

Application Summary Page

Review MA application prior to submitting Correct/edit information prior to submitting

Eligibility Results Page

Summary page to show client how eligibility was determined Gross income HH composition Denial reason Non countable income Deductions that are counted Expenses that are being counted

Life Change Events (LCE)

LCE’s will be asked in PEAK after the client reports changes

Summary page to confirm changes, add additional LCE(s)

Questions?

CBMS C4HCO Life Change Event Updates

Project 8761

Current Functionality

Life Change Events (LCE) based off data entry

Eligible APTC/CSR individuals are not being approved

After build Functionality

CBMS page changes Life Change Event changes

CBMS Page changes

System Determined LCEs

Questions?

CBMS C4HCO Policy Rules Engine Updates

Project 8765

Overview of Changes

Policy and rule changes regarding Pregnancy

Shared Eligibility System(SES) changes

Intercounty Transfer changes

Pregnancy Changes

APTC/CSR individual reporting pregnancy in RMC/RRR

Does the client want to remain on APTC/CSR?

SES Changes

MA closed in past 15 months

User has to go through RMC/RRR

Intercounty Transfer Changes

MA case contains Marketplace eligible (Marketplace only or mixed HH) individual = MA assigned to C4HCO

Ability to push MA case to new C4HCO caseload

Questions?

C4HCO Noticing Updates

Project 8762

Current Functionality

MA/APTC summary boxes combined MA/APTC correspondence is

confusing to clients

After build Functionality

MA and APTC are separated Eligibility Start Date added Translation page provided Denver Health contact info in NOA –

CHP+

NOA Layout Example

Questions?

Case Assignment

Case Assignment

New office within Denver Health is Colorado Medical Assistance Program (CMAP)

Separate from Denver Health MA Site

Denver Health Colorado Medical Assistance Program (CMAP)

CMAP will receive Department of Corrections (DOC) applications (only) in the PEAK Inbox, including DOC real time eligibility (RTE) exceptions from PEAK. All other PEAK RTE exceptions will be routed to the PEAK Inbox for the Head of Household’s (HOH) County of Residence

CMAP will take phone applications and, upon authorization, the case will be assigned to the HOH County of Residence

CMAP will keep and maintain all DOC and Buy-In (Adult & Children) cases

CMAP will process CHP+ enrollment fees and Buy-In premiums. CMAP will not keep or maintain CHP+ cases

Denver Health MA Site

Denver Health MA Site will process any applications they receive and, upon authorization, they will keep and maintain that case regardless if it is all MAGI, Non-MAGI, or a combination of both

Counties

All PEAK RTE exceptions (not including DOC applications) will now be assigned to the HOH County of Residence

Combo applications and Non-MAGI applications (except those Non-MAGI applications initiated by Denver Health MA Site) will continue to be assigned to the HOH County of Residence

Connect For Health

Colorado

Connect for Health Colorado

The C4HCO caseload assignment will remain unchanged

Cases with APTC or MA/APTC will be assigned to the C4HCO caseload

Who Does what?

Certified Health Insurance Agents & Brokers Help customers with application and enrollment Advice comparing rates, evaluating benefits and

purchasing health plans Receive commissions from insurance companies Services are free to the customer

Health Coverage Guides & Certified Application Educate, engage and enroll customers in health plans

through marketplace In person assistance with the individual application

process and enrollment Act in the best interest of the customers

Customer Service Representatives Help customers with Financial Assistance and

Non-Financial Assistance applications through to enrolling in a health plan

Help address or escalate questions and issues through call-in support, email and online chat

Questions?

Additional Resources Staff Development Center Inbox:

SOC_StaffDevelopment@state.co.us

Medicaid Inbox: Medicaid.Eligibility@state.co.us

Customer contact Center #(800)-221-3943

Connect For Health Colorado Call Center # 1-855-PLANS-4-YOU (1-855-752-6749)

PEAK Technical issues: CBMS.Help@state.co.us