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Status Not under consideration
Categories Income Support for Medical Assistance
Created by Guest
Created on Nov 17, 2017

RELATED IDEAS

Pregnant Women Remaining on QHP

In Cúram Income Support for Medical Assistance (HCR), a pregnant woman who is eligible for Insurance Assistance (QHP with APTC and CSR) must have the option to remain on Insurance Assistance even if she is otherwise eligible for Streamlined Medicaid under the Pregnant Woman coverage category.

This requirement is based on IRS Notice 2014-71
https://www.irs.gov/pub/irs-drop/n-14-71.pdf
“An individual enrolled in a qualified health plan who becomes eligible for Medicaid coverage for pregnancy-related services that is minimum essential coverage, or for CHIP coverage based on pregnancy, is treated as eligible for minimum essential coverage under the Medicaid or CHIP coverage for purposes of the premium tax credit only if the individual enrolls in the coverage.”

Currently, there is no way to take into account a woman's choice to remain eligible for Insurance Assistance as part of an eligibility redetermination. We are requesting a way for a case worker to indicate that a woman chooses to remain eligible for Insurance Assistance, even if she would otherwise be eligible for Streamlined Medicaid, when entering changes in circumstances for the client.

Once a woman makes her choice, she should not be able to redact her choice – she cannot become eligible for MA under the Pregnant Woman category for the duration of her pregnancy.

This functionality must be available for each of a woman's pregnancies over the lifetime of a case. For example, a woman may choose to remain on QHP during a pregnancy in 2018, but may choose to transition to MA for a pregnancy that occurs in 2019.

Customer Name Minnesota
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  • Guest
    Reply
    |     Apr 24, 2019

    Hi Nikita,

    We have evaluated your request and have determined that it cannot be implemented at this time .

    Your request may be resubmitted for consideration after 12 months from the date of decline.

    Thank you for your interest in the Cúram SPM product.
    Shane McFadden, Cúram SPM Product Management team

  • Guest
    Reply
    |     Jan 25, 2018

    Thank you, an evidence approach would be fine. However we'd like to limit the need for local customization and configuration given that this is a regulatory requirement that would apply for multiple projects – we would prefer a holistic solution, not just an evidence.

    If an evidence approach is taken, at a minimum the solution should include the below:
    • An evidence (let's call it Program Election) that has a 1:1 relationship with a Pregnancy. The evidence cannot be added without a pregnancy, and not more than 1 evidence can be associated with a given Pregnancy. If there are multiple pregnancies for a given client, each Pregnancy can have a Program Election evidence.
    • If a Pregnant Woman indicates she wishes to remain eligible for QHP, then she must not qualify for Medical Assistance under the Pregnant Woman category for the duration of her pregnancy.
    • Because the woman must make a choice as to what program she will receive coverage under, eligibility rules must be modified to ensure that when a Pregnant Woman on QHP becomes potentially eligible for Medical Assistance, she is not immediately marked as eligible on an MA PDC. She should be pended/excluded in some way on an individual basis until the Program Election evidence is added.

  • Guest
    Reply
    |     Dec 8, 2017

    It appears that there are several ways that this enhancement could be supported. One would be through evidence (e.g. Medicaid opt out) and rules which could be implemented locally. Would this solution meet the business need of the RFE?

  • Guest
    Reply
    |     Nov 28, 2017

    Hi Nikita,

    Thank you for your enhancement request.
    We require some further analysis to determine whether or not this enhancement can be considered in a future release.
    I will provide another response when our investigation is complete.

    Thank you,
    Eloise O'Riordan, Cúram SPM Offering Management team