CHILD HEALTH PROGRAM - Kaiser Permanenteinfo.kaiserpermanente.org/info_assets/childhealthprogram/... · 2014-03-20 · 35 February 14, 2014 . The Child Health Program is a low -cost

CHILD HEALTH PROGRAM

Webinar Training Session

February 14, 2014 Raphael Hoch – Sr. Project Manager

Charitable Health Coverage Operations (CHCO)

Agenda

Introductions/Webinar Overview

Transition to Child Health Program

Child Health Program Applications Process KP Individuals and Families (KPIF) Application Community Benefit Subsidy Application

Appendix/Q&A

• After our webinar, you may also email questions re: completing Child Health Program

applications to: [email protected] (Subject line must read: Application Question)

2 | © 2011 Kaiser Foundation Health Plan, Inc. For internal use only. February 14, 2014

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Why the Change from Child Health Plan to Child Health Program?

KP had to change the way we structured and administered our Child Health Plan in order to comply with Affordable Care Act (ACA) requirements:

ACA ‘guaranteed issue’ requires KP accept every individual who applies for coverage within KP service areas.

This means Child Health Plan eligibility limitations (e.g., under 19, low household income, etc.) were no longer allowed.


Child Health Program Applications Instructions

KP Individuals & Families (KPIF) application

& Community Benefit Subsidy application


Child Health Program - 2 Applications Required


For regulated Health Plans offered by KP.

Applicant can get same plan on the

exchange (Covered CA), but our Community Benefit subsidy is not be available there.

KP Individuals & Families (KPIF) application

Child Health Program - 2 Applications Required


Community Benefit Subsidy application For eligibility determination for our Community

Benefit subsidy which reduces Health Plan premiums and copays.

Child Health Program Applications Instructions



Instruction Sheet























Q & A

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Thank You

APPENDIX


RESOURCES

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You may email questions re: completing Child Health Program applications to: [email protected] (Subject line: ‘Application Question’)

Child Health Program – Community Partner site: http://kp.org/childhealthprogram/support

Specifically designed for our Community Partner agencies in our Northern and Southern California service areas. This site provides information and resources to help you assist parents and legal guardians applying to Kaiser Permanente Child Health Program. Check often for updates (please do not share link with clients).

Child Health Program - Updated Public site: info.kp.org/childhealthprogram

This site contains new program information, applications, forms, etc. (our former site, info.kp.org/childhealthplan, will redirect you to our new Child Health Program site). To request Child Health Program Enrollment Application Kits Email [email protected] and include:

• Quantity of English and/or Spanish Child Health Program Enrollment Application Kits requested • Your name, Agency/Organization, Street Address, City, State Zip, Phone Number

Charitable Health Coverage Operations 1-800-255-5053 (TTY users dial 711) Hours of Operation: M,W,F - 8:AM – 3 PM (closed from 11:30 p.m. - 12:30 p.m.); T, TH - 12:30 p.m. – 3 PM. For escalations only (regarding an issue with your client’s application status): John Trotman California Lead - [email protected] Karlynn McCane California Lead - [email protected] Lupe Gutierrez California Lead - [email protected] (Please do not share our Leads’ contact information with applicants, applicant family members, or prospective members)

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The Child Health Program is a low-cost health insurance plan for uninsured children. More than 80,000 children in California are covered In existence for more than 12 years Monthly Payment: $0, $10 or $20 per child for up to three children No copays at KP facilities Includes medical, dental, vision and mental health coverage

What makes CHP unique? Non-citizen and undocumented children are eligible to apply for membership Family income up to 300% of the Federal Poverty Level

KP’s Charitable Health Coverage Operations in Oakland, CA determines eligibility and enrolls children in the Child Health Program (CHP), formerly Child Health Plan, and similar KP programs in Colorado, Georgia, Mid-Atlantic, and Ohio.

Child Health Program Overview

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KP Northern California Service Areas The following counties are in the Northern California service area: Alameda San Joaquin Contra Costa San Mateo Marin Solano Sacramento Stanislaus San Francisco Portions of the following counties are in the Northern California service area: Amador Placer El Dorado Santa Clara Fresno Sonoma Kings Sutter Madera Tulare Mariposa Yolo Napa Yuba

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KP Southern California Service Areas

The following counties are in the Child Health Program Southern California service area: Imperial Riverside Kern San Bernandino Los Angeles San Diego Orange* Ventura *All Zip Codes in Orange County are eligible. A complete list of eligible zip codes is available at info.kp.org/childhealthprogram Counties Currently Open: Los Angeles (except Antelope Valley) Orange Riverside San Bernandino San Diego

KP Southern California Service Areas


Key Changes in 2014

Why are we changing Child Health Plan? Child Health Plan

Community Benefit subsidy embedded in plan

$8 or $15 premium

Low copays / out of pocket expenses

Ability to enroll throughout the year

Two-year plan

Child Health Program

Health Plan (KPIF) and Community Benefit Subsidy are separate

$0 or $10 or $20 premium

No copays when visiting KP facility

Enrollment limited to open enrollment period once per year.

Qualifying events allow for enrollment outside of open enrollment period

Two-year plan (up to 12/31/2015)


About Child Health Program

KP Individuals and Families (KPIF)

Platinum Plan

Community Benefit Subsidy (premium & copay)

• KP CA health plan • Platinum (metal tier) plan offers the

most comprehensive coverage. • Separate application

• Administered separately from KPIF • Lowers KPIF monthly premiums • Reduces KPIF copay amounts to $0

(at KP facilities) • Pediatric Dental

• DeltaCare USA • Comprehensive dental services as per ACA • No separate premium

• Applicants must meet eligibility criteria • Separate application

CHILD HEALTH PROGRAM • Available only outside of Covered California Exchange • Applications accepted only during open enrollment periods


Who is Eligible for Child Health Program?

Up to age 19 – 18 year olds may apply for themselves and/or their child(ren)

In families with income < 300% FPL With no other access to health insurance Most documented children in families with income < 300% FPL will be

eligible for either Medi-Cal or a federal subsidy from Covered California

Note: Eligibility for California Children’s Services (CCS) no longer disqualifies child from program

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Child Health Program - Eligibility

Eligible income guidelines for applicants 18 years of age applying for themselves. $0 premium 0-138% FPL Income range: $0 - $15,970 $10 premium 139-200% FPL Income range: $15,971 - $22,980 $20 premium 201-300% FPL Income range: $22,981 - $34,470


Premium Rates Have Changed*

Current Child Health Plan 2 payment rates based on income

2014 Child Health Program 3 payment rates based on income

Membership FPL%

Premium

0 – 250% $8

251 – 300% $15

Membership FPL%

Monthly Payment

0 – 138% $0

139 – 200% $10

201-300% $20

*Aligns with Medi-Cal premiums

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Families can choose a personal physician for their child.

Monthly payment are $0, $10 or $20 per month, per child, depending on the family’s income.

Program includes medical, dental, vision and mental

health coverage.

The plan’s monthly payment is for up to 3 children. After 3 children, there is no cost for each additional child.

No copays for services at KP facilities.

Child Health Program – Summary of Benefits

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Child Health Program – Summary of Benefits

Supporting Documents

Proof of Income EMPLOYED Submit Paystubs Must be within 4 weeks from application date and must include the name of parent working and paystub dates.

SELF-EMPLOYED Complete Profit & Loss Statement (included in the enrollment kit) 3 month history OR 1040 tax return with schedule page CASH SALARY Submit letter from employer

Company letterhead and statement How much applicant is paid and how often

OR Complete an Affidavit form (please find attached in post training follow-up email)

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Form in your binder

Form in your binder

Company Letterhead • Statement that applicant works for XYZ employer

• How much applicant is paid • How often applicant is paid


If a child has been denied health coverage or does not qualify for health coverage due to citizenship issues, please ask applicant to supply either a copy of child’s birth certificate (preferred), copy of child’s passport, or affidavit* (see below).

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*Affidavit or signed letter stating the same information found on a Birth Certificate including the Child's Name, Sex, Birth Date, Birth Country, Birth Location (City, County, Province etc.), and Parents’ Names.


Proof of Guardianship (if required)

Kaiser accepts any one of three kinds of guardianship documents:

Form GC-250, Letter of Guardianship Document Applicant provides this form, has to be approved by the court

OR

Power of Attorney for a Minor Child Applicant provides this form, requires notary signature

OR

California Caregiver Authorization Affidavit (Does not require an attorney or a notary) See form in your binder or go to: www.saccourt.ca.gov/forms/docs/pr-023.pdf

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What Causes Denials and Delays?

Application Denials Application Delays

Over age limit

Over income limit

Resides out of service area

Application comes from a county closed to new enrollment

Has other active group coverage

No proof of non-U.S. citizenship

No signature or incorrect signature (Example - unmatched signature or single signature)

No date on application or outdated app

Lack of income documentation

Lack of guardianship documentation (if required)

Home address with P.O. Box (P.O. Box okay for mailing documents to)

Missing date of birth of child

Applying for an unborn child

Unclear documentation (Example - unreadable handwriting)

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Special Enrollment Period: April 1, 2014 - Nov 15, 2014

Qualifying Events Birth Adoption (or placement for adoption) Marriage Permanently moved into a KP service area from out of state

Loss of minimum essential coverage (loss of eligibility, loss of employer contribution, or exhaustion of COBRA) Becomes a citizen If enrollment or non-enrollment was unintentional, inadvertent, or erroneous

If a carrier violated a material provision of the contract in relation to the enrollee

If an individual is determined newly eligible or ineligible for advance payment of the premium tax credit or cost sharing reductions If coverage through an employer will no longer be affordable or provide minimum value for the upcoming plan year If an individual meets other exceptional guidelines in accordance with HHS