County Commissioners’ Association of Ohio
Winter Conference
Doug Lumpkin
December 9, 2013
Agenda
Topic
Ohio Integrated Eligibility Project Overview
Medicaid Extension
Presumptive Eligibility
Community Partner Assistance
Last updated 12/13
1
Integrated Eligibility
Project Overview
Ohio’s Integrated Eligibility Objectives
Objectives
The Ohio Integrated Eligibility project will transform the state’s health and human services benefit
delivery for years to come.
The projects will:
• Redesign business processes helping offices gain efficiencies
• Transform and improve the way over 15,000 county and state workers support Ohioans
• Improve the efficiency of state and local services
• Simplify eligibility following the new guidelines through automated-technology processes
• Support multiple HHS programs servicing millions of Ohioans
• Optimize technology used by health and human services agencies
Last updated 12/13
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Ohio’s Integrated Eligibility Vision

The future vision for Ohio Benefits is to be an enterprise platform for healthcare related
programs in Ohio

It gradually replaces the existing self-service portal (eGateway) and CRIS-E platforms

Medicaid applications are the first benefit to be processed through the new Ohio Benefits selfservice portal and Ohio Integrated Eligibility system with coverage starting January 1st 2014

Other benefits programs including SNAP and TANF continue to run through eGateway and CRISE, until they are incorporated in future phases of the project

Eventually other income-tested health and human services programs will be transitioned into
the Ohio Benefits and the Ohio Integrated Eligibility system
CURRENT STATE
TRANSITION
FUTURE STATE
Phasing out of E-Gateway & CRIS-E
E-Gateway & CRIS-E
Incorporation of Ohio Benefits and Integrated Eligibility system
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Residents Have Multiple Channels to Apply for Benefits
When applying for benefits, there are multiple avenues but a single seamless process.
Below are the three different avenues for a resident to apply for benefits in Ohio.
Now Online!
In Person
Ohio Benefits enables residents to
apply for a variety of services 24/7
through a user friendly selfservice website.
Residents can still visit their
local county JFS office to
apply for benefits.
Phone
Phone representatives are
available to assist residents
with Medicaid applications
through the Medicaid hotline.
Benefits.Ohio.gov
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5
New Resident Tool for Applying for Medicaid
NEW Ohio Benefits
MAGI applicants
The Ohio Benefits website is secure and integrates with the new Ohio Integrated Eligibility
System. It allows residents to create and access their cases.
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6
Readiness Efforts & How We Will Ensure Success
In-person Representatives
 County JFS Coordinators – One per county
 County JFS Readiness Managers – One per region
Open Lines of Communication
Training
Telephone
Email
Social Media
Channels that are
available to offer
you support
Meetings
Representatives
Public Awareness
Materials
Legislation
Two-way communication
 Weekly teleconferences with County
Coordinators
 Monthly in-person working sessions with County
Readiness Managers
Training
 Ohio customized Web-Based Training (WBT) for
MAGI and non-MAGI workers
 Ohio customized Instructor Led Training for
MAGI workers
 Training Environment with exercises for ILT and
training simulation practice
 Online help available in the new Integrated
Eligibility system
Help Desk
 Residents – Leverage existing Ohio Medicaid
Consumer Hotline
 County Staff – Leverage existing Ohio
Department of Medicaid Technical Assistance
Hotline for policy and technical issues
Last updated 12/13
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Integrated Eligibility — Project Update
Federal Data Hub Verifications
The connection between Ohio and the Federal Data Hub for verifications such as SSN, citizenship, and
incarceration status is being finalized.
Federal Account Transfers: December Timeframe
Ohio  Federal government
 Ohio will send applications to the federal government for residents that did not qualify for
Medicaid. This transfer is expected to begin sometime during December.
Federal government Ohio
 Ohio will receive applications from the federal
government from residents who applied through the
marketplace but may be eligible for Medicaid in Ohio.
This transfer is expected to begin near the end of
December.
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Medicaid Extension
Visual Medicaid Extension Population Information
Gold: Marketplace Eligibility
Blue: Current Ohio Medicaid Eligibility
White: Coverage gap that will be covered by the extension of Medicaid
Last updated 12/13
Diagonal lines: Eligible for Ohio Medicaid Spenddown
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Medicaid Extension: FAQs
Who?
How many?
Who is newly eligible for Medicaid
coverage?
How many Ohioans will be newly
eligible under Medicaid extension?
A new group of residents, (childless
adults*) living up to 138% of the FPL,
are now eligible for Medicaid in Ohio.
Through the recent eligibility change,
Ohio is expected to see an additional
275,000 low-income residents come
onto the Medicaid rolls.
•
•
This new group includes parents
between 91-138% of the FPL
This group is also defined as adults
between the ages of 19 to 64, who
are between 0 – 138% FPL and are
not eligible under another category
of Medicaid
**Based on a monthly average
through 2015
*Childless adults: Includes residents
with children over the age of 18
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Medicaid Extension: FAQs (continued)
Where?
When?
Where should the newly covered
Medicaid population apply for
benefits?
When can the group newly eligible for
Medicaid coverage apply?
Benefits.Ohio.Gov will begin
accepting Medicaid applications for
newly eligible adults in the coming
weeks. Further information on when
newly eligible adults can apply will be
provided on the Ohio Benefits
website.
Last updated 12/13
The newly eligible population can begin
applying on December 9, through
Benefits.Ohio.Gov with coverage
beginning on January 1, 2014.
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How will Ohio be Impacted by Extension?
In 2010, 593,912 residents (6.9%) statewide were uninsured with income below 138% of poverty.
Source:
Census,
Small Area Health Insurance Estimates (2010).
LastUS
updated
12/13
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Presumptive Eligibility
Presumptive Eligibility Details
Process in which certain qualified entities are able to perform a simplified eligibility review and grant
immediate medical assistance to people applying for Medicaid (or CHIP, if applicable)
Who Can Submit PE
Applications?
What Groups are Eligible?
•
Children
•
Pregnant Women
•
•
•
Parent Caretaker
•
•
Deemed Newborns
•
ODJFS County Offices
Federally Qualified Health
Centers (FHQCs)
Federally Qualified Health
Centers Look Alike
Medicaid Participating Hospitals
What Type of Coverage is
Available Through PE?
•
Full Medicaid Services
•
Ambulatory Prenatal Care
When does PE begin?
Once eligible, PE begins immediately on
the date a qualified provider determines
eligibility (not the day the PE application
was filed)
When does PE end?
1) When the resident is determined ineligible for full
Medicaid benefits
2) If a full Medicaid application is not filed, PE ends the
last day of the following month in which the individual
was determined to be presumptively eligible
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Integrated Eligibility Project Timeline
2013
2014
2015
Launch of Ohio Benefits and Ohio
IE system
Jan. 2014 MAGI
Dec 9 2013 Medicaid
Medicaid
Categories
Extension Applications
Coverage Begins
Accepted
Presumptive
Eligibility
All Medicaid benefits in Ohio Benefits and
Ohio IE system
January 2015
SNAP and TANF
SNAP, TANF, and Medicaid benefits in Ohio Benefits and Ohio IE system
The Ohio Integrated Eligibility project is made up of several phases:
•
•
•
•
•
October 1, 2013 – Launch of Ohio Benefits!
December 9, 2013 – Ohio Benefits begins accepting applications for coverage beginning January 1.
January 2014 – Medicaid coverage begins for newly eligible individuals; increased functionality in Ohio Benefits to
support presumptive eligibility.
November 2014 – Increased functionality in Ohio Benefits to support the remainder of Medicaid eligible individuals.
January 2015 – Increased functionality in Ohio Benefits to support SNAP and TANF.
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Nonprofits / Community Partners Can Assist Residents
Nonprofits, Community Partners may assist residents in checking their eligibility and reviewing
guidelines at:
• Benefits.Ohio.Gov
Things to Note:
Find more information at the following websites:
• Healthtransformation.ohio.gov (Integrated Eligibility project information)
• Medicaid.Ohio.Gov (Medicaid policy)
• HealthCare.Gov (federal Health Insurance Marketplace)
Thank you for your continued support!
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Questions?
Last updated 12/13
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