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Medicaid and CHP+ for Beginners February 2009 1 Medicaid and Child Health Plan Plus (CHP+) An overview for beginners who need to know the basics Slide 2 Medicaid and CHP+ for Beginners February 2009 2 What You Need to Know Medicaid and Child Health Plan Plus (CHP+) What are these 2 programs? Who is eligible for each? What are the different categories I might hear people refer to? Slide 3 Medicaid and CHP+ for Beginners February 2009 3 Public Health Insurance Medicaid and CHP+ Government Funded Partial federal/state Safety-net for most vulnerable groups Largest source of funding for health-related services Not to be confused with Medicare Slide 4 Medicaid and CHP+ for Beginners February 2009 4 A Little History Lesson MedicaidCHP+ Title XIX (19) of the Social Security Act Title XXI (21) of Social Security Act Began in 1965Began in 1997 States contribute funds Federal Government provides a % of matching funds to States Federal Government provides a % of matching funds to States, which is capped Entitlement programOptional program. Initially only authorized for 10 years; was reauthorized through 2013 Slide 5 Medicaid and CHP+ for Beginners February 2009 5 Who do they serve? MedicaidCHP+ 0-133% of Federal Poverty Level (depending on the age of clients) 101-205% of Federal Poverty Level (depending on the age of clients) Children Pregnant Women Plus Parents w/dependent children Blind, Disabled, or Elderly Children Pregnant Women Slide 6 Medicaid and CHP+ for Beginners February 2009 6 About Medicaid Families and Children Disabled Children and Adults Different Populations = Different Needs Various Programs within Medicaid For children, parents, and pregnant women For disabled, elderly, or those in need of long-term care Elderly Slide 7 Medicaid and CHP+ for Beginners February 2009 7 Colorado Medicaid Includes benefits such as: Physician visits Prescription drugs Labs and X-rays Emergency Services Inpatient Hospital Services Outpatient Hospital Services and many more Slide 8 Medicaid and CHP+ for Beginners February 2009 8 How is eligibility for Medicaid determined? Family Size and Makeup Citizenship Income Earned Income (through working) Unearned Income (such as Supplemental Security Income) % of Federal Poverty level Different levels for different groups Other considerations Resources Disability Level of Care Slide 9 Medicaid and CHP+ for Beginners February 2009 9 Family Medicaid Insures children, adults with dependent children, and pregnant women Slide 10 Medicaid and CHP+ for Beginners February 2009 10 Family Medicaid Income Levels Parents whose income is at or below 60% of the Federal Poverty Level Children age 6-19 whose family income is at or below 100% of the Federal Poverty Level Children under the age of 6 and pregnant women whose family income is at or below 133% of the Federal Poverty Level Slide 11 Medicaid and CHP+ for Beginners February 2009 11 Medicaid Income Levels % of Federal Poverty Level Slide 12 Medicaid and CHP+ for Beginners February 2009 12 Medicaid Income Levels Family Medicaid Monthly Income Levels April 1, 2009 March 31, 2010 FAMILY SIZE Adults with a child on Medicaid or CHP+ Children ages 6-18 Children Birth 5 and pregnant women 1$542$903$1201 2$729$1215$1615 3$916$1526$2030 4$1103$1838$2444 5$1290$2150$2859 6$1477$2461$3273 Slide 13 Medicaid and CHP+ for Beginners February 2009 13 What is EPSDT? Early Periodic Screening Diagnosis and Treatment (EPSDT) PREVENTIVE health care program focusing on early identification and treatment of medical, dental, vision, hearing and developmental problems for clients ages 20 and under Primary Care Physician (PCP) or Managed Care Organizations (MCO) performs Periodic Screening exams Federally mandated, and administered in partnership with each state Slide 14 Medicaid and CHP+ for Beginners February 2009 14 Benefits of EPSDT Emphasizes preventive care and complete early treatments Provides comprehensive health care benefit package for Medicaid enrolled children, ages birth through 20 years Assures availability and accessibility of required health care services and items HMO or provider staff and EPSDT Outreach Coordinators assist Medicaid clients and their parents or guardians effectively use these resources Slide 15 Medicaid and CHP+ for Beginners February 2009 15 ESPDT Coordinators FREE Resource for Families Notifies every enrolled family of the scope of EPSDT benefits and outreach coordination support services Guides families to appropriately use their Medicaid benefits with emphasis on education, prevention, diagnosis and timely treatment Slide 16 Medicaid and CHP+ for Beginners February 2009 16 ESPDT Coordinators Assists providers in reducing the incidence of multiple appointments missed by Medicaid enrolled children and youth Identifies and refers families to other community resources such as: Housing Part C Food banks Women, Infants and Children food program (WIC) Waiver sites Prenatal Plus Head Start Slide 17 Medicaid and CHP+ for Beginners February 2009 17 Emergency Medicaid For Non-citizens who would otherwise qualify for Medicaid Non-qualified aliens (those without appropriate legal documentation) Legal aliens who have been in country