Health Advocates Discussion on Medicaid Expansion enrollment

Medicaid Expansion

People can begin applying for Medicaid on 10/1.  The YES NM Portal will be up and running.  According to federal regulations, between 10/1 and 12/31, they are required to assess eligibility on current or "legacy" eligibility.  The feds do not want to assume someone is eligible for Expansion because they pay 100% of the cost.

She described several scenarios:

Scenario 1:  We know the individual is eligible for Expansion and they come in on 10/2 to apply.  The average time to process an application is 15 days, but they have 45 days.  If they determine they are not eligible for current or "legacy", under regulation, they have to send a denial letter.  The letter says that the consumer will be assessed for eligibility for Medicaid expansion and they will be notified.  HSD will run those assessments in November.  The consumer will get a 2nd letter indicating they will be eligible for Expansion beginning January 1.  They will be run through the Aspen system in December and get a 3rd letter - officially notifies them of coverage beginning January 1.  She said she'd provide a copy of the denial letter so we can prepare consumers for this.

Scenario 2:  The individual applies for Medicaid, but they are not eligible for Expansion.  They are a candidate for the Exchange.  The consumer is sent a notice that explains this and their application is forwarded to the FFM.  There is no need to apply again.  <I'm sorry - I'm unclear what happens here on our end.>

Scenario 3:  The individual applies through the Exchange.  The Exchange determines eligibility.  If eligible for Medicaid, the Exchange sends a notice to the consumer.  They will send the account to HSD on 11/1.  They can’t do anything until 11/1.  On 11/18, Aspen will be able to process the info that the feds send HSD and properly process them.  

No one will have to reapply in January.  You are supposed to notify ISD if your income changes, but they don't follow up or make sure about this.  She was adamant, "No one will have to reapply or verify income again."

She said that anyone who is in Category 29 Family Planning will automatically transition over to Medicaid Expansion in January.  Native Americans will roll over as Medicaid Exempt.

Based on this conversation with her, we recommend that anyone applying in October should apply for Category 29.  

Individuals currently enrolled in SCI will roll over into Medicaid Exempt.   They will identify Native Americans as best they can using their system.

PE/MOSAA

Based on outcomes of tribal consultation, Julie went to Secretary Squier and asked that an exception be made for I/T/s to do PE for adult expansion and the Secretary agreed to do this.  Thinks they can do the same for the Urban Indian Health Program.  Should provide a notice of this shortly.

YES NM

YES NM will be up and running on October 1.   http://www.yes.state.nm.us/

You can apply just for Medicaid using YES NM.   Once the application is completed it’s sent electronically to ISD.  You may need to scan and upload documentation, e.g. utility bills.  Required documents will be posted on the site.

People will still be able to apply using a paper application and also by phone.  There will be a Medicaid Expansion hotline to do this, but they're not sure how the telephone application will work.