Completing SC Healthy Connections Medicaid annual review process could be a little tricky this year. Families may have difficulty accessing the new forms, which may mean missed deadlines and the possibility for coverage gaps. But there is help available over the phone and in person from certified enrollment assisters through the Palmetto Project’s Children’s Health SC team.
The SC Department of Health and Human Services (DHHS), the state agency that runs the federally- and state-funded health care program for South Carolina’s low-income and disabled children and families, has not been conducting annual reviews for more than a year. The agency asked for and received a waiver from the Centers for Medicare and Medicaid Services (CMS) to extend the eligibility periods for those in several Medicaid coverage categories affected by changes in the Affordable Care Act. These coverage categories — Parent/Caretaker Relative, Pregnant Women, and Partners for Healthy Children — are those affected by a new income calculation referred to as MAGI (Modified Adjusted Gross Income). This gave both the agency and enrollment assisters, like Palmetto Project’s certified insurance navigators, time to adjust to the new health insurance marketplace, new application forms, new ways of calculating income for eligibility, and so many more advances brought on by the Affordable Care Act. The upshot is that many families with children covered by Medicaid have not been required to complete the yearly process of determining if their child would still be covered by Medicaid; rather, the child’s eligibility has continued. That is, until February.
The new Annual Review Form has many changes that consumer advocates have been asking for. The form is similar to the application on HealthCare.gov. It includes information from Medicaid’s records, such as family members’ names and dates of birth. It requires only that the family make corrections to any erroneous information, add or remove household members, and provide income verification that may not be verifiable through other data hub sources, such as alimony. This is a positive change from prior annual review processes that essentially had required families to provide all of the information that already existed in the Medicaid system.
Beginning earlier this year, families started receiving correspondence from SC Healthy Connections Medicaid with the new Annual Review Form, complete with pre-filled information about the family from the Medicaid database. At least, they should have received the form. But after more than a year of continuous eligibility, many families have moved. And even if they had submitted a change of address notice to the US Postal Service, the Annual Review Form cannot be forwarded because it contains Protected Health Information (PHI). The only way a family who has moved will receive the Annual Review Form is if their address is current in the the SC Healthy Connections Medicaid database. And that will only happen if the family notifies either SC Healthy Connections Medicaid or their Medicaid Managed Care Organization (MCO).
SC Healthy Connections Medicaid member ID cards do not list an expiration date so families typically don’t know when their coverage expires. They usually find out when they are at the doctor with a sick child and the front desk person says, “Sorry, your child can’t be seen today because your insurance is not valid.” Even if there is a coverage gap, Medicaid can be approved retroactive for 90 days from the date of eligibility, but it does require that the family provide income documentation for the retroactive period. And there’s no requirement that medical providers must go back and bill Medicaid to reimburse you for expenses you have paid out of your own pocket or to cover any outstanding bills.
Families can get blank forms by visiting their county’s SC DHHS office. The agency is not mailing new forms to members. The Palmetto Project has added the Annual Review Form to its catalog of applications and forms available at ChildrensHealthSC.org. Families can download the fillable form, print it, and submit it by mail or deliver it to their county’s SC DHHS office. If need help completing the form, want to talk about changes in your family situation that you think could affect your eligibility, or have already submitted an application but haven’t been able to get the status of your eligibility, we can help. Certified insurance navigators are available throughout the state to help by phone and in-person. You can call 1-888-998-4646 to speak to someone and make an appointment.