4 Multilingual Resources for Newly Insured Individuals

There are new multilingual resources available from Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) to help newly insured patients understand their heathcare benefits, connect to primary care and preventive services. The following resources are available in Arabic, Chinese, English, Haitian Creole, Korean, Russian, Spanish, and Vietnamese:

Could clients with Medicare Part B qualify for WWC services as underinsured?

Question: Clients with only Medicare Part A qualify for WWC clinical services. Could clients with Medicare Part B qualify as underinsured if they are unable to pay their co-pay/co-insurance?

Answer: Clients who have Medicare Part B as health insurance are not eligible for WWC clinical services. If they are under 65, however, they can be enrolled in WWC care coordination.

In general, Medicare Part A covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services. Medicare Part B cover two types of services, medically necessary services and preventive services. Part B will cover a screening mammogram once every 12 months and diagnostic mammography when medically necessary in women 40 or older. Part B also covers Pap tests, pelvic exams, and clinical breast exams every 24 months for all women and every 12 months for those considered high risk for cervical cancer.

Additional information can be found here: https://www.medicare.gov/coverage/your-medicare-coverage.html.

Remember: Check insurance status before each procedure!

Recently we have had a few agencies report to us that clients seen through WWC Clinical Services last fiscal year (June 30, 2014 to June 29, 2015) were actually billed to and paid by Medicaid. While agencies are not required to switch funding from WWC Clinical Services to Medicaid for services rendered between the client’s enrollment notification date and back-dated enrollment date, it is not allowable to charge the same service to two funders (i.e., WWC Clinical Services and Medicaid). When another funder has been charged for services rendered in a previous fiscal year, agencies must refund CDPHE funds paid for these services by sending CDPHE a check. If your agency identifies a change in funding source for services performed during the active fiscal year, simply update the funding source for affected procedures and the funds will be automatically reversed on your next grant activity statement.

While we know this may be inevitable for services performed last fiscal year, below are some best practices to help you avoid this in the future. We will remind agencies during our major mid-year and end-of-year data entry pushes. 

• Follow the new policy that insurance status be assessed before each clinical service is provided with WWC funds. 
• Verify regularly that WWC Clinical Services clients have not retroactively been billed to Medicaid. 

Please contact Emily, Marina or your WWC program coordinator with any questions.

2 Webinar Opportunities from the Centers for Medicare and Medicaid Services

• Special Enrollment Periods and Resources for the Uninsured)

September 29 at 3:00 pm ET
(2:00 pm CDT, 1:00 pm MDT, Noon PDT)
Register

Individuals and families can enroll in the Health Insurance Marketplace during special enrollment periods if they experience certain circumstances. Special Enrollment Period circumstances include graduating from college and losing health insurance, getting married or divorced or having a baby, losing employer insurance or turning 26 and losing coverage on a parent’s health plan. Join this webinar to learn more about special enrollment periods and how to enroll in the Health Insurance Marketplace. For those who are uninsured and don’t qualify for the special enrollment period, learn what resources are available and when to enroll in the Health Insurance Marketplace.

• Best Practices in ACA Outreach and Enrollment

October 8 from 2 pm – 3:30 pm ET
(1:00 pm CT, Noon MT, 11:00 am PT)
Register

Learn from faith leaders who have conducted successful outreach and enrollment campaigns before and during open enrollment. On October 8, we will hear from Abrar Quader from the Compassionate Care Network (CCN) which helped enroll people who are Muslim, Hindu and Sikh. CCN received a navigator grant from the Illinois state marketplace.

Training opportunity: Building Better Health: Enroll 2015

The statewide health coverage open enrollment event, Building Better Health: Enroll 2015, is quickly approaching. The event is sponsored by Colorado Health Foundation.

4 Resources for Helping Clients Understand Insurance

The Care Coordination Grant Program focuses on insured clients, including helping them understand and use their insurance. This is something that may be new to them (and to you as you assist them), here are four resources we've found about helping the newly insured understand insurance, in no particular order.

How to Determine Eligibility

What assistance am I eligible for? What programs are available? You probably hear these questions many times a day. 

One of the first steps in the Care Coordination Grant Program is determining if the client is eligible for Medicaid or subsidies through the exchange. Colorado PEAK provides this "Am I Eligible?" tool.