Provider Notice issued 09/11/13

Implementing Healthcare Reform in Illinois: Information for Medicaid Medical Providers Transitioning to an Online Application Called Application for Benefits Eligibility (ABE)

This notice is to provide an update on implementing healthcare reform in Illinois, including transition to an online application called Application for Benefits Eligibility (ABE).

Beginning in October, Illinois will have a new, web-based application system known as the Application for Benefits Eligibility (ABE). Through ABE, applicants or Assisters can apply online for the following programs:

All Medicaid programs including:

• All Kids

• Family Care

• Moms & Babies

• Medical assistance for seniors and persons with disabilities, and

• The new “ACA Adult” group for those adults 19-64 with incomes at or below 138% of FPL or $1,320 a month for an individual. Coverage for the ACA Adult group starts January 1, 2014; people can apply starting October 1, 2013.

• The new Former Foster Children group for those young adults between 18 and 25 years of age who were on Medicaid when they aged out of foster care. Coverage starts January 1, 2014. They will be eligible regardless of income.

• The Medicare Savings Program (MSP)

• SNAP (Supplemental Nutrition Assistance Program or food stamps)

• Cash Assistance

Transition Period and Paper Applications

• ABE will replace all existing online applications starting in October. All current online applications for these programs will be taken down around September 15. During this transition period, you can complete paper applications and mail them to your local Family Community Resource Center (FCRC) found at the DHS office locator. [Note: you may not hold paper applications since it could affect the benefit start date]

• Beginning in October, we strongly encourage Medicaid providers to use ABE for all new applications. If you must use paper, a new medical benefits application and multi-purpose paper application will be available for download from the HFS and DHS websites.

Note: Remember, if someone has Medicaid today, they have qualified health coverage. They should not reapply!

Continued Access to Verification Systems

As a Medicaid provider, you will continue to have access to the Medical Electronic Data Interchange (MEDI) System and the Recipient Eligibility Verification (REV) System. We expect that you will continue to use these tools to check for existing coverage before beginning a new application in ABE.

Training in ABE

• HFS will provide an “Introduction to ABE” for our community partners and medical providers and make user guidance webinars available on operating the new system. This will take place in early October. Dates will be forthcoming.

• We hope that as providers get comfortable using ABE, you will help applicants enroll in all of the programs for which they may be eligible, including SNAP and Cash Assistance. After all, a family with access to quality healthcare, financial assistance and nutritional food will lead healthier lives.

The Illinois Assister Program

Assister Programs were created under the Affordable Care Act (ACA) so that community-based organizations could help support enrollment, outreach and education in both the Health Insurance Marketplace (the Marketplace) and Medicaid. All Assisters will receive training and be certified. Some Assisters receive grant funding.

• Navigators (federal grant program) and In-Person Counselors (IPCs – State grant program) have been awarded grants. Staff for these entities will go through both federal (computer based) and state (computer-based and in person) training and be certified by the Illinois Department of Insurance (DOI). This training has begun.

• Another group of Assisters are Certified Application Counselors (CACs).

• This category is for organizations like community health centers, hospitals and other medical providers as well as non-federal governmental or non-profit social service agencies, such as SNAP outreach agencies, that would like to help people enroll in the Marketplace and Medicaid.

• The organization that submits the CAC application is responsible for making sure that all of the staff and volunteers it certifies as individual CACs take and pass the training, comply with the requirements to be a CAC, including privacy and security requirements, and sign an agreement that he/she will comply with the CAC requirements. Private contractors may fulfill CAC roles.

• CAC staff and volunteers must also go through federal and state computer-based training and be certified by the Illinois DOI to be listed as Illinois Assisters. The list of Illinois Assisters can be found at the Health Insurance Marketplace, Affordable Care Act website. If you have questions about what it means to be a CAC or you want to apply to become a CAC go to the Certified Application Counselor organization website. [Note: Illinois is a Federally-Facilitated Marketplace for this purpose].

• With respect to ABE, if an organization signs into ABE as a Navigator, IPC or CAC, the application will be created in the organization’s Assister account, not the applicant’s account. Therefore, the applicant will not have direct account access and must work through the Assister to provide supporting documentation or to check on the status. However, these organizations are free to help an applicant set up his/her own account giving that applicant direct account access in the future.

• The final group of Assisters is Community Partners. There is no certification required for this group and they will not appear on any published Assister list but they can help people enroll in the Marketplace and apply for Medicaid through ABE since these are both public applications. Community Partners cannot tell consumers that they are state certified Assisters. We encourage Community Partners to go through the CAC federal computer-based training on the Marketplace. You must create your own account to take this training at the Health Insurance Marketplace.

• Hospitals are free to continue to help enroll Medicaid applicants only, through ABE. No new training or certification is required.

Hospital Presumptive Eligibility (HPE)

Federally mandated HPE is scheduled for implementation in Illinois in late February. Illinois will be establishing an HPE program, consistent with federal requirements. HFS is in the process of developing guidance for HPEs in Illinois and will work in collaboration with the hospital associations in the state.

Hospitals choosing to participate in HPE will be required to, among other things:

• Register with the State, take training and enter into a written agreement.

• Maintain documentation supporting its PE determinations.

• Submit HPE enrollments electronically through hospital HPE accounts in ABE. This functionality will not be available until February.

• Submit HPE enrollments as part of a full application for benefits that the hospital must help its patients complete in ABE or complete on their behalf.

• Check for existing Medicaid eligibility through MEDI or REV before submitting any MPE enrollment.

• Identify an HPE manager and be held accountable for all HPE enrollments.

More information will be provided to hospitals as HFS continues to develop the HPE program.

For more information on the Affordable Care Act and implementation in Illinois go to the HFS Affordable Care Act webpage.