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TennCare, Medicaid, and the Marketplace For Your Clients

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Page 1: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

TennCare,Medicaid,andtheMarketplace

ForYourClients

Page 2: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

*  TennCareisTennessee’sMedicaidprogramforchildren,caretakers,pregnantwomen,andafewotherselectgroupswhomake138%ofFPLorlower;itiscomprehensivecare*  CoverKidsisforchildreninaslightlyhigherincomebracket(255%ofFPL);someco-paysarerequiredforsomeservices*  TheMarketplaceisforthosewithincomesatpovertylevelorabovewhocannotobtaininsurancethroughtheiremployers

TennCare,CoverKids,orMarketplace?

Page 3: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

•  LivedinMurfreesborothelast10years

•  Homelessafterlosingchildcareandthenherjob

•  Noincome;SNAPbenefits

CarrinaandDestiny

DoIhaveinsurance?CanIgetit?

Page 4: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

DoIhaveTennCare?

PresumptiveNewbornEligibility

• Usuallycompletedatthehealthdepartment,clinic,orhospital• Mustapplyathealthcare.govwithin60daystomaintaincoverage

CarrinaandDestiny

Page 5: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

Childrenuptoage19cangetTennCare.

TennCareforChildrenIncomeLimitsHHSize 1 2 3 4 5 6 7Child6-18:138%FPL

1354 1832 2311 2789 3268 3767 4224

Child1-5:147%FPL

1442 1952 2461 2971 3481 3990 4500

<1:200%FPL 1962 2655 3349 4042 4735 5459 6122

3/10/2016

Page 6: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

*  Kidsunder19cangetcoverageunderthestate’sCHIPprogram,calledCoverKids.*  Cannotbeenrolledinanotherhealthplan.*  Applythroughthefederalmarketplace.

CoverKidsIncomeLimitsHHSize 1 2 3 4 5 6 7255%FPL 2502 3386 4270 5153 6038 6922 7806

3/10/2016

Page 7: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

CarrinaandDestiny

DoIhaveinsurance?CanIgetit?

Page 8: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

CarrinaandDestinyDoIhaveinsurance?Probably–throughTennCare,althoughTennCareisnotaninsurancecompanyCanIgetit?Yes!

Page 9: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

JakewasjustreleasedfromincarcerationinKentuckyRe-gainedcustodyofMadisonfromvariousfamilymembersandmovedtoTNParttimejobTransitionalhousingprogramAppliedforSNAPbenefitsanddidnotreceiveassistancewithTennCare(?)

CanIgetTennCare?How?

JakeandMadison

Page 10: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

WhoiseligibleforTennCare?

• Children• Pregnantwomen• Parentsandcaretakerrelatives• Disability-related• BreastandCervicalCancer• FormerFosterChildren

Page 11: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

Whoisacaretakerrelative?

Someonewholiveswiththechildandmakesdecisionsregardingthechild’swelfare.

Page 12: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

InordertoqualifyforTennCare,youcannotbereceivinghealth

carebenefitsfromanotherstate’sMedicaidprogramYoumustbearesidentofTennessee.

Youmustcancelpoliciesheldinanotherstateandwaitforthatstatetocancelthebenefits.

Callforhelp!

Page 13: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

* Healthcare.gov* Requiresanemailaddressandamailingaddress* Documentation* 2hourprocess

HowdoIapplyforTennCare

Page 14: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

*  TennCareShelterEnrollmentProject*  LocalClinics*  GetCoveredTennessee*  CertifiedAccountCounselor*  HealthNavigator

Wheretofindhelp…

Page 15: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

WhatifIamdenied?

Page 16: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

CanIgetTennCare?How?

JakeandMadison

Page 17: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

CanIgetTennCare?Yes!How?Healthcare.gov

JakeandMadison

Page 18: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

WhenwasthelasttimeMadisonsawaprovideroranyonewhoevaluatedherhealth?WhenwillthatbeconvenientforJake?

JakeandMadison

Page 19: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

•  CametoyourprogramfromClarksvilletoescapeanabusivespouse

•  Emmadoesnotseemtorespondtonoisesaroundher

•  NowEmmahasafeverandacoughthatisprogressivelygettingworse

•  LucyhasTennCarebuthasnotneededmedicalcaresincearrivinghere

HowcanIfindadoctor?WhatwillTennCarecover?

LucyandEmma

Page 20: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

Callthenumberonyourinsurancecardtofindyourassignedprovider

IfyouvisitanewTennCareprovider,youwillneedtocompletepaperworktonotifyTennCareofthechange–

youcanalwaysswitchback,ifneeded

Page 21: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

WhatdoesTennCarecover?

* Everything!* Transportation* Sickandwellchildvisitstoaprovider* Dental* Vision* Substanceabuseservices* Behavioralhealth

Page 22: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

TennCarecanalsoprovideacasemanagertoyou!!!

Requestthecasemanagerusingthenumberonyourcard.

Page 23: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

WhereshouldIgo?

EmergencyRoom PrimaryCare

Page 24: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

Wherewillyouseekmedicalcarewhileyouarehere?

DecideBEFOREthecrisis.

Page 25: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

HowcanIfindadoctor?WhatwillTennCarecover?

LucyandEmma

Page 26: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

HowcanIfindadoctor?CallthenumberonyourinsurancecardWhatwillTennCarecover?Everything!

LucyandEmma

Page 27: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

•  25yearsold•  Droppedoutofschoolat5thgrade;

justleftrehab•  Chronicallyhomeless;historyof

substanceabuse•  Complainsofchronicbackand

abdominalpain,nausea,headaches•  Parttimejob;difficultykeepingjobs

andcommitmentsduetohealthissues

CanIgethealthinsurance?What can I do about my health issues?

Sydney

Page 28: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

TheCoverageGap:• Unqualifiedimmigrants• Thosewhoseincomeislessthan100%FPLandhavenochildrenwithnoemployerinsuranceoptions• Thosewhosespouseshavefamilyplansthattheycannotafford(non-workingspousemaynotbeabletogetcoverage)

Page 29: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

Optionsforthoseinthecoveragegap…

Insuranceoptions

*  Apply!*  Ageoutoffostercare?*  Victimofhumantrafficking?*  Disabilitydetermination?

Treatmentoptions

* www.needymeds.org* Clinicsfortheuninsured* Hospitalswithindigentcareprograms

Page 30: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

EmergencyMedicaidServicesApplyonthedayyouareadmitted!OnlylifethreateningemergenciesWillonlycovertheemergencyepisode

Page 31: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

CanIgethealthinsurance?What can I do about my health issues?

Sydney

Page 32: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

CanIgethealthinsurance?ProbablynotWhat can I do about my health issues? Housing, employment, d&a treatment - all will likely fail if she cannot get well.

Sydney

Page 33: TennCare , Medicaid, and the Marketplace · Do I have TennCare? Presumptive Newborn Eligibility • Usually completed at the health department, clinic, or hospital • Must apply

*  EnrollmentEvents*  StaffTrainings*  ResidentTrainings*  Resources

AdvocacyandReporting!

TennCareShelterEnrollmentProject


TennCare Office Reference Manual

TennCare Oversight Activities - Coordination · DENNIS J. GARVEY, JD DIRECTOR, OFFICE OF PROGRAM INTEGRITY BUREAU OF TENNCARE Program Integrity in Tennessee: TennCare Oversight –

WITH PRESUMPTIVE APPOINTMENT DATES

TennCare Program Provider Independent Review Process An Information Guide for Providers of TennCare Services February 17, 2011

Missouri Department of Social Services Presumptive ...dss.mo.gov/fsd/health-care/files/provider-training-for-presumptive... · Determining Presumptive Eligibility Calculating MAGI

Presumptive Eligibility Training Agenda Presumptive... · Presumptive Eligibility Training Agenda Presumptive Eligibility (PE) Policies ... Data Completion The application collects

Presumptive Eligibility for Pregnancy Providers · Presumptive Eligibility for Pregnant ... Current Presumptive Eligibility •Pregnant woman only ... (46), and their pregnant Daughter,

2012 Presumptive State

TennCare Quarterly and Annual Report

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TN TennCare Spring Newsletter 2021

Presumptive Blood Testing

TENNCARE REQUEST FOR RELEASE OF ESTATE RECOVERY CLAIMcircuitclerk.nashville.gov/probate/forms/formpro_Estatetenncare.pdf · BUREAU OF TENNCARE—ESTATE RECOVERY 310 Great Circle Road,

Division of TennCare TennCare II Demonstration...November 2019 1 Amendment 42 to the TennCare II Demonstration Tennessee has a long history of innovation in its Medicaid program. Since

Presumptive Eligibility - Pennsylvaniakeepkidssafe.pa.gov/cs/groups/webcontent/documents/...Presumptive Eligibility & ACA The Affordable Care Act (ACA) expanded Presumptive Eligibility

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Healthy Families, Health Communities TennCare Bureau of

Presumptive Blood Tests

Canadian Firefighter Presumptive Disability Laws · Canadian Firefighter Presumptive Disability Laws What are presumptive disability laws? In Saskatoon, Saskatchewan firefighters

BUREAU OF TENNCARE Long Term Care - User ManualBUREAU OF TENNCARE. Long Term Care - User Manual. BUREAU OF TENNCARE . Long Term Care User Manual TCMIS – Bureau of TennCare ... The

PRESUMPTIVE EVIDENCE

KENYA REVENUE AUTHORITY PRESUMPTIVE TAX …ciat.gdf.gov.it/documenti/1.3-2809 - Alice Owor- Presumptive...1 29/09/2015 KENYA REVENUE AUTHORITY . PRESUMPTIVE TAX METHODS . Presentation

Hospital Presumptive Eligibility

TennCare - TN.gov

TennCare/Medicaid EHR Provider Incentive Program · Physician Assistant practicing in an FQHC or ... TennCare /Medicaid EHR Provider Incentive ... • TennCare reviews and Attestation

Division of TennCare TennCare II Demonstration

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Actuarial Review of the TennCare and TennCare …...Aon Consulting Employee Benefits Consulting Actuarial Review of the TennCare and TennCare Partners Programs Development of Fiscal

TENNCARE POLICY MANUAL - TN.govTENNCARE POLICY MANUAL Policy No: PRO 08-001 (Rev. 9) ... Johnny's TennCare exempts him from copay for TennCare covered services. Therefore, he is entitled

Presumptive Eligibility

WebVisions2016 Presumptive Design Workshop

TennCare Preferred Drug List (PDL)

Presumptive Eligibility (PE) Quick Reference Guide for Qualified … · Presumptive Eligibility Quick Reference Guide Page 2 of 22 This Presumptive Eligibility (PE) Quick Reference

UNITED HEALTHCARE COMMUNITY & STATE TENNCARE COMPLIANCE TRAINING … Compliance Training… · UNITED HEALTHCARE COMMUNITY & STATE TENNCARE COMPLIANCE TRAINING 2018 . MARCH® VISION

STATE OF TENNESSEE BUREAU OF TENNCARE DEPARTMENT …