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STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

Aging and Long-Term Support Administration

Home and Community Services Division

PO Box 45600, Olympia, WA 98504-5600

H13- 067- Procedure

October 30, 2013

|TO: |Home and Community Services (HCS) Division Regional Administrators |

| |Developmental Disabilities Administration (DDA) Regional Administrators |

| |Area Agency on Aging (AAA) Directors |

|FROM: |Bea Rector, Interim Director, Home and Community Services Division |

| |Don Clintsman, Deputy Assistant Secretary, Developmental Disabilities Administration |

|SUBJECT: |Medicaid Expansion within the Affordable Care Act |

|Purpose: |To inform staff of the changes as a result of Medicaid Expansion that began October 1, 2013. |

|Background: |On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable |

| |Care Act, into law. The law includes provisions to: |

| |Expand coverage to more people; |

| |Change the methodology for determining financial eligibility for certain groups; and |

| |Create an online application process. |

|What’s new, changed, or | |

|Clarified |Effective October 1, 2013: |

| |Medicaid coverage is being re-branded as Washington Apple Health (WAH). All federal and state-funded |

| |medical programs including long-term care programs are now included under this new term. |

| |There is a new methodology for determining eligibility for healthcare coverage for families, pregnant women, |

| |children and new adults known as Modified Adjusted Gross Income (MAGI). |

| |There is a new healthcare coverage application form which is available online, by phone, or on a new paper |

| |application form (HCA 18-001). |

| |TANF (Temporary Assistance for Needy Families) cash and medical programs are de-linked. TANF cash recipients |

| |will no longer automatically receive medical coverage. |

| | |

| |Effective January 1, 2014: |

| |Medicaid will be expanded to include individuals between the ages of 19 and 65 who are not eligible for |

| |Medicare and have income up to 138% FPL (gross) based on their Modified Adjusted Gross Income (MAGI). |

| |ABD (Aged, Blind, Disabled) cash assistance and medical programs are delinked. ABD cash recipients will no |

| |longer automatically receive medical coverage. |

| | |

| |Individuals who are eligible for the expanded Medicaid coverage will receive services through a new benefit |

| |services package known as the Alternative Benefit Plan (ABP). The FMAP (federal match) is increasing for |

| |this newly eligible group for both the medical costs and any long-term care services authorized. The new ABP|

| |services package includes coverage for nursing home care and Medicaid Personal Care (MPC) but does not |

| |include coverage for home and community-based waiver services authorized by either HCS or DDA. |

| | |

| |New ACES eligibility codes have been created for all the new MAGI-based programs. Some clients currently |

| |receiving classic Medicaid under the ABD cash or medical care services (MCS) programs will be assigned new |

| |ACES codes beginning January 1, 2014. Families, children and pregnant women will be transitioned to new ACES |

| |coverage groups at the time of their annual eligibility review starting in November 2013. Along with new |

| |ACES codes, new SSPS codes have been created in order to serve newly eligible clients. |

| | |

| |How will individuals apply for Medicaid as of October 1, 2013? |

| |Individuals in need of long-term care or DDA services can apply for services by: |

| |Visiting a local HCS or DDA office, consistent with current practice; |

| |Going online to the Washington Connection web application at and |

| |following the prompts, consistent with current practice; |

| |Going online to the newly-designed Washington HealthPlanFinder web application at |

| |and following the prompts; |

| |Calling a Washington HealthPlanFinder Customer Service Representative at 1-855-WA-FINDER (1-855-923-4633); |

| |Please note: The Washington HealthPlanFinder through the Health Benefit Exchange was not created for current|

| |classic Medicaid/Medicare recipients; it was created for individuals/families who do not have, or cannot |

| |afford, health insurance. (Classic Medicaid includes SSI-related and long-term care programs and Medicare |

| |savings programs). |

| | |

| |If an individual applies using either of the web applications and requests LTC or DDA services, a |

| |notification will be sent to financial to begin the financial eligibility determination process. |

| | |

| |Individuals that do not have access to computers who wish to apply through the Washington HealthPlanFinder |

| |may apply using kiosks that will be available in local Community Services Offices (CSOs); can call the toll |

| |free HealthPlanFinder number (1-855-923-4633); or may contact a local in-person assister in their area (see |

| |list of available assister organizations, attached below). |

| | |

| |How quickly will an application get processed? |

| |If an individual begins their application using the Washington HealthPlanFinder, they will receive immediate |

| |(real-time) notification that they are eligible or ineligible for Washington Apple Health (WAH). |

| | |

| |However the Washington Healthplanfinder site does not make the determination of whether an individual is |

| |eligible for long-term care or DDA services. If the individual is requesting LTC/DDA services and applies |

| |using the Washington HealthPlanFinder, they must continue the application via a link to WA Connection to |

| |answer supplemental LTC questions. Once they answer the supplemental questions online, an automatic referral|

| |will be made to financial to begin the eligibility process. |

| | |

| |If they do not complete the supplemental questions online, HCA Form 18-005 (see link below) will be |

| |automatically mailed to the applicant requesting additional information to determine eligibility. |

| | |

| |Applicants who choose not to, or who are unable to, use the online tools will need to fill out HCA Form |

| |18-001 and 18-005 to apply for LTC/DDA services. There is no change in the process for an individual who |

| |applies through the Washington Connection site or at an HCS office. A financial worker will still need to |

| |review the application for WAH. |

|ACTION: |If an individual needs help completing their medical application using Washington Connection or the |

| |Washington HealthPlanFinder, refer them to an Assister in their area using the list, attached below. |

| |For individuals needing LTC/DDA services, HCS/AAA/DDA staff will look in ACES and use the most current |

| |version of the Medicaid Program Coding Chart (10/01/2013 version attached) to determine program eligibility. |

| |Beginning January 1, 2014, case managers will use new SSPS codes for clients receiving the Alternative |

| |Benefit Plan (ABP) coverage when the ACES coverage group is N05 (see code lists, attached). |

| |All HCS and AAA offices must order the HCA 18-001, Washington State Health Care Authority Application for |

| |Health Care Coverage and the HCA 18-005, Washington Apple Health Supplemental Form (used for long-term |

| |care/Aged/Blind/Disabled coverage). These are used for individuals who do not want to, or who are unable to,|

| |go through the online application process. |

| | |

|Related | |

|REFERENCES: |There are many resources available for staff who want to learn more or who need more in-depth training or |

| |information: |

| | |

| |The Washington Health Benefit Exchange Website: |

| | |

| |The HealthPlanFinder: |

| | |

| |YouToons Health Reform Video: |

| | |

| | |

| |ADS Affordable Care Act Website: |

| | |

| |The Health Care Authority Medicaid Website: |

| | |

|ATTACHMENT(S): |New SSPS Codes: |

| |DDA Codes: |

| |[pic] |

| |HCS/AAA SSPS Codes: |

| |[pic] |

| |Medicaid Program Codes: |

| |[pic] |

| |HCA Medical Income Standards: |

| |[pic] |

| |Medicaid Apple Health Supplemental Form for Clients requesting LTC: |

| | and scroll down to 18-005. |

| | |

| |Assister Lead Organizations Contact Information: |

| | |

| | |

| | |

| |Catherine Fisher, Financial Unit Manager |

| |(360) 725-2318 |

| |Catherine.Fisher@dshs. |

| | |

| |Shaw Seaman, DDA Communications |

| |(360) 725-3443 |

| |Shaw.seaman@dshs. |

| | |

| |Kristi Knudsen, Communications Program Manager |

| |(360) 725-3213 |

| |Kristi.knudsen@dshs. |

| | |

| | |

|CONTACT(S): | |

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