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Health Coverage Title: Health Coverage OBJECTIVES: Participants will be able to: 1. Describe health coverage programs and services in Los Angeles County for pregnant women and their newborns. 2. Explain varying eligibility criteria and application procedures for the different health coverage programs. 3. Demonstrate how to advocate for families when there are problems accessing healthcare insurance. AGENDA: TIME PRESENTATION FACILITATORS/ SPEAKERS 8:00-8:30 am BREAKFAST AND REGISTRATION 8:30-8:35 am Introductions, Overview of Training Objectives Terrie Anciano, BS 8:35-8:45 am Pre-Test Liz Ramirez 8:45-9:00 am The Affordable Care Act Liz Ramirez 9:00-9:15 am Introduction to Medi-Cal Liz Ramirez 9:15-9:45 am Medi-Cal Programs Liz Ramirez • Presumptive Eligibility • 213% FPL Program • 138% FPL Program • Minor Consent • Income Disregard 9:45-10:00 am Medi-Cal Managed Care Liz Ramirez • Who Must Join • Medical Exemptions Request • Getting Assistance 10:00-10:15 am BREAK 10:15-10:25 am Deemed Eligible Newborn Liz Ramirez • Newborn Referral Form 10:25-10:35 am Dental Coverage Liz Ramirez 10:35-10:55 am Medi-Cal Access Program (MCAP) Liz Ramirez 10:55-11:15 am Covered California Liz Ramirez 11:15-11:30 am LA County Child Delivery Plan Liz Ramirez 11:30-11:45 am Post-test Liz Ramirez Wrap Up/Evaluations 11:45 am LUNCH/REGISTRATION FOR AFTERNOON SESSION Terrie Anciano, BS Title: Health Coverage OBJECTIVES: Participants will be able to: 1. Describe health coverage programs and services in Los Angeles County for pregnant women and their newborns. 2. Explain varying eligibility criteria and application procedures for the different health coverage programs. 3. Demonstrate how to advocate for families when there are problems accessing healthcare insurance. AGENDA: TIME PRESENTATION FACILITATORS/ SPEAKERS 12:00-12:30 pm BREAKFAST AND REGISTRATION 12:30-12:35 pm Introductions, Overview of Training Objectives Terrie Anciano, BS 12:35-12:45 pm Pre-Test Liz Ramirez 12:45-1:00 pm The Affordable Care Act Liz Ramirez 1:00-1:15 pm Introduction to Medi-Cal Liz Ramirez 1:15-1:45 pm Medi-Cal Programs Liz Ramirez • Presumptive Eligibility • 213% FPL Program • 138% FPL Program • Minor Consent • Income Disregard 1:45-2:00 pm Medi-Cal Managed Care Liz Ramirez • Who Must Join • Medical Exemptions Request • Getting Assistance 2:00-2:15 pm BREAK 2:15-2:25 pm Deemed Eligible Newborn Liz Ramirez • Newborn Referral Form 2:25-2:35 pm Dental Coverage Liz Ramirez 2:35-2:55 pm Medi-Cal Access Program (MCAP) Liz Ramirez 2:55-3:15 pm Covered California Liz Ramirez 3:15- 3:30 pm LA County Child Delivery Plan Liz Ramirez 3:30 -3:45 pm Post-test Liz Ramirez Wrap Up/Evaluations 3:45 pm LUNCH/REGISTRATION FOR AFTERNOON SESSION Terrie Anciano, BS Health Coverage SPEAKER BIO Liz Ramirez is the Director of Training and Education for Maternal and Child Health Access. Ms. Ramirez provides training and education for agencies and low-income people on access to health care. She also provides a “Core” course for agency, school, clinic and social service staff entitled, “We’ve Got You Covered” which explains dozens of health services and programs that help to ensure at least some health care for everyone in Los Angeles County. Prior to joining Maternal and Child Health Access Ms. Ramirez worked as a Health Care Advocate for Los Angeles Unified School District. She developed an outreach and enrollment program within the second largest school district in the United States. She has been committed to issues with health care access for over 18 years. Presented by, Liz Ramirez, Director of Training and Education​ [email protected] Donald Nollar, Training Specialist Extraordinaire​ [email protected] What is Medi-Cal? Medicaid Medi-Cal Federal $$$ California State $$$ = Medi-Cal 1. I Live & Intend to Reside HERE! or 2. I Live & Work HERE! Medi-Cal House Elderly (65 and over) or Pregnant People Disabled Children Adults Under age 65 Each room has its own rules... Two Kinds of Medi-Cal MAGI MEDI-CAL NON-MAGI MEDI-CAL For people ages 0 through 64 For people age 65 and over Cannot have Medicare or People younger than 65 who have Medicare MAGI CRITERIA FOR ELIGIBILITY Immigration Status *Assets Don’t Count in MAGI!! What does Immigration status determine? IF YOU ARE 65+ (OR HAVE MEDICARE AND MEDI-CAL) Assets Count! What can I have? 1 Principal Residence 1 Car $2000 for one person $3000 for a couple Cash or other liquid assets Who Get’s What? Medi-Cal Immigration Basics Full Scope Medi-Cal United States Citizens Legal Permanent Residents (Green Card holders) Qualified Immigrants Undocumented Children and Young Adults ages 0-26 Deferred Action for Childhood Arrivals (DACA) Permanently Residing in the U.S. Under Color Of Law (PRUCOL) Qualified Immigrants Medi-Cal uses this term to define immigrants who are eligible for full scope benefits. Some of the statuses include: ✓ Legal Permanent Residents (LPR) ❖NO 5 YEAR BAR IN CALIFORNIA ✓ Asylees ✓ Refugees ✓ Cuban & Haitian Entrants ✓ Certain battered spouses and victims of trafficking (U & T visa holder) ✓ Individuals paroled into the U.S. for at least 1 year Who Gets Restricted Medi-Cal? Undocumented residents of California Non-Immigrant Visa Holders age 26 and over What does Restricted Medi-Cal cover? Emergencies (what is an emergency?) Pregnancy Dialysis Long Term Care Medicaid = Medi-Cal Medi-Cal is funded by both Federal and State money: Federal $$$ + California State $$$ = Medi-Cal Many immigrants qualify for state funded Medi-Cal... Public Charge Is Medi-Cal really a Public Charge?? What is Public Charge? Some immigrants have a Public Charge test when they get their LPR “green card” status. The “public charge” test is designed to identify people who may depend on the government as their main source of support. If the government determines that a person is likely to become a “public charge,” it can deny a person admission to the U.S. or lawful permanent residence (or “green card” status). There is no Public Charge test for For complete details please visit Naturalization/Citizenship www.protectingimmigrantfamilies.org On March 9th, the Supreme Court dropped appeals that allowed the Trump Administrations punitive Public Charge policies to go into effect. The less severe 1999 Public Charge rules are now back in effect! Trump Rules (now blocked): 1999 Rules (now in effect): The public charged test looked at The public charge test only looks at non-cash assistance programs cash assistance, and government- funded long-term institutional care. Federally Funded Medi-Cal and Food Assistance programs could be Federally funded Medi-Cal and Food considered Public Charge benefits Assistance are NOT considered Public Charge benefits. For complete details please visit: www.protectingimmigrantfamilies.org Hooray! PROTECTIONS DURING A PUBLIC HEALTH CRISIS No Negative Actions! During the Public Health Crisis MC should not terminate your case unless you : 1. Move out of state 2. Request your MC be cancelled 3. Are deceased See MEDIL 20-14 https://www.dhcs.ca.gov/services/medi- cal/eligibility/letters/Documents/I20-14.pdf I don't have Medi-Cal, or, My insurance doesn't cover COVID services. What can I do? California offers COVID-19 diagnostic testing, testing-related services, and treatment services, including hospitalization and all medically necessary care, at no cost to the individual, for up to 12 months or the end of the public health emergency, whichever comes first INTRODUCING...... The COVID-19 Uninsured Group Program!! Available in clinics and hospitals Immigration status does not matter There are no income limits Eligibility can go retroactive to April 8, 2020. https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/COVID-19-Presumptive-Eligibility-Program.aspx COVID-19 Medi-Nurse Line DHCS COVID-19 Response DHCS is working with our program partners and state and federal officials to ensure Medi-Cal beneficiaries have access to medically necessary COVID-19 testing and care. The resources included contain detailed information about our actions during the COVID-19 emergency. Restricted Medi-Cal Covers COVID-19 Testing and Treatment Managed Care & Medi-Cal Do I have to pick a plan? NO YES • Youth in Foster Care • Everyone else • Former Foster Youth • Restricted Medi-Cal • Native Americans • Private Ins/Medi-Cal Medi-Cal with a plan “HMO” Fee-For-Service “Regular MC” LOS ANGELES COUNTY’S TWO PLAN MODEL LA CARE HEALTH NET Local Initiative Commercial Plan Admin: (213) 694-1250 Admin: (800) 291-6911 Member Services (888) 452-2273 Member Services http://www.lacare.org/find-doctor-or-hospital (800) 675-6110 (including contracted plans below) Blue Shield Of California Health Net Anthem Blue Cross Promise Health Plan, Member Services Member Services formerly Care First (800) 675-6110 (888) 285-7801 Member Services (800) 605-2556 Molina Healthcare LA Care Member Services Kaiser Permanente Member Services (800) 526-8196 (888)452-2273 Member Services (800) 464-4000 But, what happens if you need a doctor out of network? Or in a different medical group (IPA)? Health Plan “Carve Outs” Substance Abuse Disorder Dental Mental Health Use These Not This Health Plan “Carve Outs” Substance Abuse o Provided through the Department of Public Health Substance Abuse Prevention and Control (SAPC) (888) 742-7900 http://publichealth.lacounty.gov/sapc/ Health Plan “Carve Outs” Dental Care - also called Denti-Cal In LA County you have 2 options: 1. Keep your Denti-Cal as Fee For Service o Find a MC dentist: www.denti-cal.ca.gov or 2. Assign it to a dental plan o Access, Health Net, and
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