Welcome to the Summer edition of the SignUpNow Outreach eNewsletter. SignUpNow (SUN) is an initiative of the Virginia Health Care Foundation (VHCF) that is focused on increasing enrollment of eligible uninsured children in Virginia's FAMIS programs. Please forward this newsletter to colleagues and encourage them to register via the "Join Our Mailing List" button to receive the SignUpNow Outreach eNewsletter themselves. |
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Supreme Court Decision on Health Care Law Casts Doubt on Medicaid Expansion in Virginia | |
The Supreme Court's long awaited decision regarding the Patient Protection and Affordable Care Act (ACA) provided clarity on the constitutionality of the law. Unfortunately, the decision left final resolution of Medicaid expansion in each state unsettled. In short, the Court ruled that Congress cannot mandate that the states expand Medicaid. That decision will be up to each individual state. This is a significant decision for Virginia and dramatically impacts Virginia's safety net population, because the Commonwealth has the 48th lowest Medicaid eligibility level in the nation, (approximately 30% of FPL depending on location).
Of all individuals in Virginia who can obtain health insurance coverage under ACA, an estimated 80% (420,000) would be covered under the Medicaid expansion. Instead of this new Medicaid eligibility becoming automatic, its implementation will require action by both the Governor and General Assembly. The Governor has indicated that he is thoroughly reviewing the implications of the Medicaid expansion. It is most likely that the issue will not be decided until the 2013 General Assembly. Several Virginia legislators from both parties have expressed concern that waiting until next year for a decision will not leave Virginia enough time to implement the law by January 1, 2014.
Stay tuned!
For more information about the Supreme Court ruling and the impact on Medicaid expansion, please visit: http://www.urban.org/health/index.cfm.
For detailed information about provisions and timelines regarding ACA, please visit: http://women.webmd.com/features/health-reform-law-timeline. |
Legal Immigrant Pregnant Women and Children Now Covered by FAMIS & Medicaid Without Waiting! | |
The 5-year bar for coverage of legal immigrants in the FAMIS, FAMIS MOMS and Medicaid for Pregnant Women programs have been lifted. Laws passed during the last legislative session allow for Medicaid coverage for legal immigrant pregnant women during the first 5 years of lawful residence in the United States, and they also provide coverage under FAMIS for legal immigrant children and pregnant women during their first 5 years of lawful residence.
The new laws, which became effective July 1, 2012, change eligibility in FAMIS MOMS and Medicaid for Pregnant Women. It is estimated that these changes will enable the programs to provide prenatal care to about 1,000 pregnant legal immigrants with incomes below 200% of the Federal Poverty Level ($46,100 for a family of 4) in FY13. Coverage for labor and delivery charges for FAMIS MOMS eligible women will also be provided. (Medicaid eligible legal immigrants can already receive labor and delivery coverage as a Medicaid emergency service.)
The new laws also change eligibility in FAMIS, allowing legal immigrant children between 134-200% FPL to be covered, as well. This will extend coverage to about 288 more children per year.
The same policy previously in place for lawfully residing non-citizen children under age 19 under Medicaid will apply to lawfully residing children under FAMIS, as well as to pregnant women under Medicaid and FAMIS MOMS. The definition of lawfully residing children and pregnant women has also been expanded to include certain non-immigrant individuals with special protected status. Because all programs will follow the same alien status policies, children and pregnant women are to be enrolled in the appropriate program based on their income. The policy changes are contained in the Medicaid Manual subchapter M0220 and Chapters 21 and 22. | |
2012 Child Health Champion |
Eduardo Mantilla-Torres, Program
Coordinator for Project Connect at Alexandria Neighborhood Health Services, Inc. (ANHSI), was recognized as this year's Child Health Champion with an Unsung Hero Award at the Virginia Health Care Foundation's 2012 Heroes in Health Care celebration. This award is given to an individual who has gone "above and beyond the call of duty" in the execution of his/her job related to assisting families with applying for and enrolling in Virginia's FAMIS programs.
Eduardo has helped enroll 4,800 children in Virginia's FAMIS programs. It takes a unique combination of passion, attention to detail, perseverance and commitment to be an effective Outreach Worker. Eduardo has all that and more. View a short video about Eduardo's work. |
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Managed Care Expansion
The DMAS managed care program expanded to the far southwest (FSW) region of the Commonwealth effective July 1, 2012. This region includes the following localities: Bland, Buchanan, Carroll, Dickenson, Grayson, Lee, Russell, Scott, Smyth, Tazewell, Washington, Wise, Bristol, Galax and Norton.
Due to the MCO Expansion in the FSW region, the MEDALLION PCCM program ended on April 30, 2012, and is no longer an option for Medicaid/FAMIS Plus members residing in that area of the state. Medicaid and FAMIS managed care participants in the FSW region will now select their health plan from one of 6 participating managed care organizations (MCOs): Amerigroup Community Care, Anthem HealthKeepers Plus, Optima Family Care, MajestaCare (a health plan of Carilion Clinic), Southern Health CareNet, and Virginia Premier Health Plan. These MCOs will provide coverage for approximately 45,000 eligible Medicaid and FAMIS individuals in the area.
FAMIS and Medicaid enrollees, providers and DSS workers received letters telling them of the upcoming changes in early spring and were then invited to attend trainings in Big Stone Gap, Bristol and Abingdon in May. DMAS Managed Care staff also organized a health fair on June 2nd in Abingdon. FAMIS recipients in the FSW have been advised that they now have co-pays between $2 and $5 for regular doctor visits and that some services such as hospital stays may require a co-pay of $25. The FAMIS Covered Services document with detailed information about the co-pays can be found on the FAMIS website.
Smiles For Children Brochure Available
FAMIS Marketing and Outreach staff worked with Smiles For Children to develop a new brochure about the dental program. The colorful brochure, which is primarily aimed at FAMIS and FAMIS Plus enrollees, provides information about the importance of regular checkups and how to access dental providers. It serves as a visual reminder to encourage usage of the program.
Currently, the brochure is available for printing from the Smiles For Children section on the FAMIS website as well as in the materials section.
Interactive Voice Response System Enhancements at the CPU
The Interactive Voice Response system (IVR) for the FAMIS Central Processing Unit (CPU) is an automated telephone system that allows applicants, enrollees or their authorized designees to obtain information on a case without having to go through a Customer Service Representative (CSR). Potential applicants can also get information about the FAMIS programs through the IVR. The IVR has recently received some updates to provide better information to callers:
- Information is available on how to report the birth of a newborn, including name, date of birth, gender and race.
- Applicants who applied through the CPU, but were referred to the FAMIS Plus Unit at the CPU because they were likely FAMIS Plus eligible, can check the status of their applications through the IVR.
- If the caller does not have the Family ID, they can use the Social Security number and birth date of an applicant to access information about their case.
- The IVR provides dates when deficiency letters were sent. The option is also available to route to a CSR for more information.
- The IVR will provide the final determination status of an application and the date the results were mailed to the applicant.
- The IVR will allow the caller to request the reprinting of the most recent application on file and to have it sent to the applicant.
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The IVR is automatically accessed by calling (866) 873-2647. Callers always have the option of contacting a CSR through the IVR, if more information is needed.
Enroll My Newborn
A new feature is being added to the FAMIS website which will allow pregnant FAMIS teens or FAMIS MOMS to easily provide information about their newborn for purposes of automatic enrollment. The Member Services page of the website will be updated to include an "Enroll My Newborn" feature in the drop down section.
The page can be accessed from the "Applying/Renewing" section of the FAMIS website or from the Member Services page. After initial verification of the mother by entering specific case information, this new feature will allow a FAMIS MOMS recipient to easily enter information about her newborn (name, date of birth, race and gender) and submit the information electronically to the FAMIS CPU for processing. It is anticipated that this enhancement will be implemented by mid-July 2012. |
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Virginia Health Care Foundation Staff Update |
 Doug Davis joined VHCF in April as the Deputy Director of Programs and Operations. Doug has been involved in health care for over 20 years working at BCBSVA/Trigon/Anthem/Wellpoint, First Health Services and Computer Sciences Corporation. During his career he has
held numerous leadership positions in program and project management, provider network management, business process improvement and IT systems development and implementation. Throughout these diverse roles, Doug's emphasis has been primarily Medicaid related with experience implementing and managing new programs in Kentucky and Virginia. For four years he was the Executive Director managing the Medicaid Management Information Systems (MMIS) and Programs for DMAS in Virginia. We are excited to have Doug as part of our VHCF team!
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A teacher in the Tidewater area had a student who was uninsured and had a heart condition. The teacher had contact information for an Outreach Worker who had come to the school to educate the staff about the FAMIS programs. She shared it with the mother and encouraged her to call the Outreach Worker, which she did. The Outreach Worker began working with the family immediately to complete a FAMIS application. The father was self-employed and the amount of income he was earning had decreased over the course of the year. The Outreach Worker turned in the application with several months of profit and loss statements.
The mother received a letter asking her to turn in a year of profit and loss statements. In the meantime, her child's condition had worsened and required surgery. The Outreach Worker called the CPU to explain the urgency of the situation and to get some clarification on the profit and loss statements. Because of the girl's condition, the case was elevated and it was determined that there was enough information to make a determination. The case was expedited and the child was enrolled that day. She successfully completed her surgery and is on her way to a full recovery.
Many thanks to the Outreach Workers, the employees at the CPU, and the employees at the local departments of social services for the extra effort they put in to helping enroll children in the FAMIS programs! | |
FAMIS Program Enrollment as of June 1, 2012:
- Children enrolled in FAMIS: 64,514
- Children enrolled in FAMIS Select: 337
- Children enrolled in FAMIS Plus: 521,010*
(*includes children in the CHIP Medicaid Expansion) - Pregnant women enrolled in FAMIS MOMS: 1,484
- Pregnant women enrolled in Medicaid for Pregnant Women: 14,934
- Men and Women enrolled in Plan First: 25,489
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If you have colleagues who would benefit from receiving SignUpNow Outreach, please forward this email to them and encourage them to subscribe to our mailing list. We look forward to providing additional information on children's health insurance in the near future.
Sincerely,
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