Application for State of Florida Medicaid Card

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Application for State of Florida Medicaid Card Powered By Docstoc
					Charlie Crist, Governor
Robert A. Butterworth, Secretary

               Medicaid Eligibility for
                 Pregnant Women
                   The Application Process

                            September 19, 2007


             Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families,
                            and Advance Personal and Family Recovery and Resiliency.
            How to apply
There are three ways to apply for pregnancy Medicaid:

 Presumptively Eligible Pregnant Women (PEPW) –
Pregnant women may go to a Qualified Designated
Provider (QDP) to receive temporary Medicaid coverage
for their prenatal care, usually on the same day they
apply.

 Simplified Eligibility for Pregnant Women (SEPW) –
Sometimes called MomCare, this process was created in 2001
to allow eligible pregnant women to be approved for full
Medicaid coverage quickly and simply.

 ACCESS Florida Application –
If the pregnant woman wishes to receive other benefits, such as
cash, food stamps or benefits for other family members, she
must complete a “regular” paper ACCESS Florida Application
(AFA) or WEB application. Normal processing guidelines apply.
                                                           2
           How to apply (continued)
• Presumptive Eligibility for Pregnant Women
  (PEPW)
  – Complete the paper application (Health Insurance Application
    for Pregnant Woman, CF-ES 2700)


• Simplified Eligibility for Pregnant Women
  (SEPW)
  – Complete the paper application (Health Insurance Application
    for Pregnant Woman, CF-ES 2700)


• Other Medicaid, including Medically Needy
  – Complete either the electronic (WEB-APP) or paper ACCESS
    Florida application (AFA)

                                                                   3
           Submit Application for….
• Presumptive Eligibility for Pregnant Women
  (PEPW)
  – to a Qualified Designated Provider (QDP).


• Simplified Eligibility for Pregnant Women
  (SEPW)
  – to the DCF ACCESS office in person, by mail or by fax.


• Other Medicaid, including Medically Needy
  – to the DCF ACCESS office in person, on-line, by mail or by
    fax.


                                                                 4
        Qualified Designated Providers

• County Public Health Units (CPHU) (aka:
  County Health Departments)
  Florida Department of Health


• Children’s Medicaid Services (CMS)
  CMS Programs -- Children's Medical Services Homepage


• Regional Perinatal Intensive Care Centers
  (RPICC) (i.e., certain designated regional
  hospitals)
  CMS RPICC Family Brochure Information

                                                         5
      Eligibility Determination
              Procedure
• Presumptive Eligibility for Pregnant Women
  (PEPW)
  – Presumptive eligibility determination by QDP using
    procedures outlined in CF-Operating Procedure
    165-9. Application forwarded to DCF within 5 days
    of determination.
• Simplified Eligibility for Pregnant Women
  (SEPW)
  – Simplified eligibility determination by DCF using
    abbreviated verification procedures.
  Other Medicaid, including Medically Needy
  – Normal application processing by DCF.                6
               Required Verification
• Presumptive Eligibility for Pregnant Women (PEPW)
   – Proof of pregnancy from a medical provider.
   – Verbal Statement of Income
• Simplified Eligibility for Pregnant Women (SEPW)
   –   Proof of pregnancy from a medical provider.
   –   Proof of citizenship and identity for US citizens.
   –   Proof of non-citizen status for non-citizens.
   –   Proof of self-employment income and other verification as
       needed, such as a Social Security Number.
• Other Medicaid, including Medically Needy
   –   Proof of pregnancy from a medical provider.
   –   Proof of citizenship and identity for US citizens.
   –   Proof of non-citizen status for non-citizens.
   –   Proof of income and assets for all household members.
   –   Other verifications, such as a Social Security Number.      7
       Extent of Medicaid Coverage

• Presumptive Eligibility for Pregnant Women (PEPW) –
  Limited Coverage:
   – Covers the pregnant woman only.
   – Covers pregnancy related outpatient services and
     prescriptions only.
   – Only one presumptive period per pregnancy allowed.
• Simplified Eligibility for Pregnant Women (SEPW) –
  Full Coverage:
   – Covers the pregnant woman only.
   – Covers all Medicaid services, including inpatient services and
     delivery.
• Other Medicaid, including Medically Needy – Full
  Coverage:
   – Covers all Medicaid services for all eligible household
     members, if requested.
                                                                      8
           Duration of Medicaid Coverage

• Presumptive Eligibility for Pregnant Women (PEPW)
   – Begins the date of application and lasts until DCF makes a
     determination of ongoing eligibility, or 60 days (whichever is less).

• Simplified Eligibility for Pregnant Women (SEPW)
   – Begins the first day of the application month and lasts through two (2)
     post-partum months.
   – Up to three (3) months retroactive coverage available, if eligible and
     requested, provided woman was pregnant during the retroactive
     period.

• Other Medicaid, including Medically Needy
   – Other Medicaid: Begins the first day of the application month and lasts
     through two (2) post-partum months.
   – Medically Needy: Begins the date that Share of Cost is met.
   – Up to three (3) months retroactive coverage available, if eligible and
     requested.

                                                                               9
      Policy Manual References
• Presumptive Eligibility for Pregnant Women
  (PEPW)
  –   PEPW 2030.0704
• Simplified Eligibility for Pregnant Women
  (SEPW)
   – SEPW 0630.1500

• Other Medicaid, including Medically Needy
  – Family Related Medicaid Application for Assistance
    0630.0000

                                                    10
                         PEPW DETAILS
• Standard Filing Unit (SFU):

  Definition – those family members who are living together and
  whose needs and income are considered in the pregnant woman’s
  Medicaid eligibility budget calculation. This includes the unborn
  child (or children if multiple births are anticipated).

   – Eligibility for PEPW Medicaid coverage is dependent on the pregnant
     woman’s Standard Filing Unit (SFU) having countable income less than
     or equal to 185% of the Federal Poverty Level (FPL).




                                                                        11
                  PEPW SFU EXAMPLES

• Mary, age 20 and unmarried, is pregnant. She lives with her parents
  and minor brother, age 17 (has no income).
   – Her SFU includes:         Mary
                               Her unborn child
                               Her parents
                               Her brother

• Denise, age 22, is pregnant. She is separated from her husband.
   – Her SFU includes:         Denise
                               Her unborn child



                                                                    12
                  PEPW SFU EXAMPLES
                                (continued)
• Joan is 25, pregnant and living with Dan, the father of her unborn
  child.
   – Her SFU includes:          Joan
                                Her unborn child
                                Dan

• Jennifer, age 20, lives with her husband and 2 year old son. She is
  pregnant with twins.
   – Her SFU includes:           Jennifer
                                 Two unborn children
                                 Her husband
                                 Her son



                                                                       13
                   Processing PEPW on the
                      FLORIDA System
• Both FMMIS and FLORIDA must be reviewed to
  determine if the pregnant woman is already receiving
  Medicaid.
   – If yes, no further action is necessary.
   – If no, complete the following steps:
       • Have the pregnant woman complete and sign the application
         form (CF-ES 2700). Copy her identification, if available.
       • Complete client registration and the pregnant woman driver
         (ASPW) on FLORIDA, using information from the application.
       • If eligible, give (or mail) her temporary proof of Medicaid
         eligibility (AMIC).
       • Forward the application and any documentation (i.e., proof of
         identity, proof of pregnancy) to the local DCF ACCESS office
         using local procedures.
       • Add the case to the tracking log (CF-ES 2679).
                                                                    14
             Manual PEPW Determination
• Complete the following steps:
   – Have the pregnant woman complete and sign the application form (CF-
     ES 2700). Copy her identification, if available.
   – Use information from the application to complete the PEPW manual
     intake form (CF-ES 2695).
   – Health Department staff must complete the Financial Eligibility Form
     (DH -3130)
   – All other QDP staff complete the Medicaid Presumptive Eligibility
     Worksheet (CF-ES 2680)
   – Add the case to the tracking log (CF-ES 2679).
• If the pregnant woman is eligible for PEPW:
   – Complete the Notice and Proof of Presumptive Eligibility for Medicaid
     form (CF-ES 2681), leaving the Medicaid ID number blank.
   – Forward all forms and any documentation (i.e., proof of identity, proof of
     pregnancy) to the local DCF office within 5 calendar days.
• If the pregnant woman is NOT eligible for PEPW:
   – Forward all forms and any documentation (i.e., proof of identity, proof of
     pregnancy) to the local DCF office within 5 calendar days.              15
                  PEPW Process Flow
   Positive          Complete PEPW           Complete DCF
pregnancy test        determination        referral form (CF-
   obtained.           using CF-ES             ES 2039).
                           2700
                       application.*




Attach proof of       Send CF-ES            DCF determines
pregnancy and         2039, CF-ES              ongoing
    identity.        2700, and proof          Medicaid
                         to DCF.              eligibility




  DCF sends                            *See slide #14 for FLORIDA
                     PEPW closed.
updated CF-ES                          procedures and slide #15
 2039 back to                          for manual procedures.
    QDP.
                                                                    16
        PEPW Operating Procedure
• Click on the following hyperlink to review the
  PEPW Operating Procedure.


  DCF Operating Procedure 165-9 - Presumptive
     Medicaid Eligibility for Pregnant Women




                                                   17
             U.S. Citizenship and Identity
            Verification Policy for Medicaid
• This policy does not apply to PEPW (see slide # 7).
• Most individuals who indicate they are U.S. citizens on
  the application must provide verification of their
  citizenship and identity.
   – Exceptions: Individuals who are…
       •   SSI recipients,
       •   Social Security Disability (SSDI) recipients,
       •   Children in state foster care or adoption,
       •   Medicare (any part) recipients.
• Medicaid cannot be authorized prior to receipt of
  verification.
• For a list of acceptable verification documents go to:
   – http://www.dcf.state.fl.us/ess/docs/dra_verify.pdf
                                                            18
                            SEPW Income
                          Verification Policy
• Income verification is not required prior to disposition of the SEPW
  application, unless the income is questionable.
• DCF staff must…
    – Verify income using data exchange, prior to disposition of the
      application, whenever possible.
    – If the applicant’s statement of income on the application, or the data
      exchange information from the same income source, does not exceed
      185% of the federal poverty level (FPL), the income can be considered
      as verified.
    – If the income on the application is questionable or incomplete, the
      applicant and/or employer must be contacted by phone to obtain
      necessary clarifying information. Otherwise, it will be necessary to pend
      the application for written income verification.
    – If income is not verified prior to approval, it must be verified following
      approval, using data exchange information, whenever possible. It may
      also be verified via mail or telephone collateral contact with the
      employer.

             NOTE: This same income verification policy is followed for the
                         Medicaid Family Planning Waiver                      19
       Medicaid for Pregnant Women

• Women closed to Pregnancy Medicaid
  coverage at the completion of 2
  postpartum months are automatically
  enrolled in the Medicaid Family Planning
  Waiver Program for the first year of
  eligibility. The woman must actively apply
  for the second year of the program.
  – Assigned a Medicaid eligibility category of FP
  – Need to keep their “gold card” for FP services

                                                 20
           Emergency Medical Assistance
                 for Aliens (EMA)
• Non-citizens who would be Medicaid eligible on all factors, except
  for their citizenship status, may be eligible for Medicaid to cover
  medical emergencies, including the birth of a child.

• Before Medicaid may be authorized, applicants must provide proof
  from a medical professional stating the medical treatment was due
  to an emergency condition and the dates of the emergency.
  Medicaid can be approved only for the period of the verified
  emergency.

• Non-citizens who are in the US for a temporary reason, such as
  tourists, students, or those traveling for business, are not eligible for
  EMA, or any other Medicaid benefits.



                                                                          21
Charlie Crist, Governor
Robert A. Butterworth, Secretary




                                       The End

            Questions? Call 1-866-76ACCESS
                    (1-866-762-2237)

             Mission: Protect the Vulnerable, Promote Strong and Economically Self- Sufficient Families,
                            and Advance Personal and Family Recovery and Resiliency.

				
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Description: Application for State of Florida Medicaid Card document sample