Learn More About Institutional Deeming for Medicaid

Health Information Specialist, Heather Dane, shares her story about utilizing Institutional Deeming for her daughter, Mikayla. Factual information about deeming courtesy of Beth DeHoff, Pediatric Practice Liaison, Children’s Health Services Research, IU School of Medicine; and also a mom of a child with special health care needs.


When my daughter, Mikayla, was born at 32 weeks gestation the doctors told us to expect her to be in the NICU until close to her actual due date. That meant that she was going to be there for approximately eight weeks. They were pretty close with their approximation. She came home 49 days later. 

This was not the first time I was faced with having a child with special health care needs. My son, Joseph, has special health care needs as well, so I was already familiar with most of the programs I needed to apply for. I filled out the application for the DD and SS waivers. I made an appointment with the Social Security office to get benefits started. I made contact with First Steps.

The one thing I wasn’t familiar with, but was fortunate enough to have friends who were, was a process called Institutional Deeming for Medicaid Disability. In this case, the child must be hospitalized for more than 30 days and be considered medically eligible, but the parents’ income and resources are not considered. To be medically eligible, the child must be determined to have a medical condition that will last a lifetime and is substantial enough to inhibit growth and/or the ability to learn, and/or create developmental delays. This can include significant prematurity as well as serious illness and disability. Mikayla was not just premature but also had an extremely low birth weight for her gestational age, and was diagnosed with a rare neurological condition which would affect her development and overall health. 

To apply for this program, you must specify you are applying for Medicaid Disability on the basis that the child has been hospitalized for more than 30 consecutive days, in which case parental income and resources will be waived. I went to the hospital social worker and asked her to apply for us on day 30 and she did. But anyone can do it. It is helpful to include copies of the child’s birth certificate; social security card; a parent’s driver’s license with current address; the front and back of medical and dental insurance cards; a signed statement from the child’s doctor of the child’s diagnosis, date the condition started, and the expected prognosis; and any medical records that pertain to the reason for hospitalization, such as hospital progress notes and doctors’ notes. If you do not provide these documents, the Medicaid caseworker will have to obtain them from you and your child’s medical providers before the review. Applications may be made on the standard Indiana Application for Assistance, but you must note that you are applying for Medicaid Disability on the basis that the child has been hospitalized for more than 30 days and that parent income and resources should be waived. If your child is granted Medicaid through this process, coverage should continue until a year following the application’s approval.

Mikayla was granted Medicaid Disability through this process and it saved us thousands of dollars. At one point during that 49-day stay, I had the hospital’s finance office contact me and ask to meet. They began to tell me that she was getting close to her lifetime cap with our private insurance (at that time, the Affordable Care Act was just a few months away from going into effect so the lifetime cap was still an issue) and wanted to know what my plan was on how to pay for her stay once that happens. Thankfully, I was able to tell them that we were applying for Medicaid Disability through Institutional Deeming.

Information about Hoosier Care Connect Health Plans

On April 1, 2015, the new Hoosier Care Connect program will begin serving eligible aged, blind and
disabled Medicaid members.  Individuals enrolled in Medicare, and those residing in an institution or receiving services through a home and community-based services (HCBS) waiver, will not be eligible for Hoosier Care Connect.

As a Hoosier Care Connect member, you will receive all Medicaid covered benefits in addition to care coordination services. Care coordination services will be based on your needs.  You will need to choose a health plan that, along with your doctors, will coordinate your care. If you do not choose a health plan by June 15, 2015, a plan will be chosen for you.

You will still have Medicaid and will receive full Medicaid benefits as a member of Hoosier Care Connect.

You will continue to receive any services that have been authorized for up to 90 days or until the authorization ends.

What is a health plan?

A health plan is a group of doctors, pharmacies and hospitals that work together to help you get the health services you need. You may choose one of the following three health plans: Anthem, Managed Health Services (MHS) or MDwise. All plans offer the same Medicaid services but may work with different doctors or hospitals and may offer special programs that you would like.  A Health Plan Summary sheet with more information about the health plans is included below

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Action Needed

 Review the Health Plan Summary Sheet to learn more about the different health plans (Anthem,
MHS and MDwise) and decide which is best for you. Call the Hoosier Care Connect Helpline to
learn more and to see if your doctor works with the health plan you choose.

 Call the Hoosier Care Connect Helpline to choose your health plan.  It is better for you to
choose, so you can get the care you need from your own doctor who knows your medical history.

 Choose a health plan by June 15, 2015, or one will be chosen for you.

 Continue to use your existing Medicaid card during this transition.

Need more information?

 Call the Hoosier Care Connect Helpline for more information at 1-866-963-7383.

 You can also attend a meeting to learn more or ask questions.  Meetings will be held in different
locations across the state.

Survey about #Autism Services in Indiana

¤ What do you think about current resources and services for individuals

with Autism Spectrum Disorder (ASD) in Indiana?

¤ What has worked in supporting families, caregivers, and individuals 

with ASD? What has not? 

¤ What changes do you think should be made?

This 10-15 min survey is your chance to provide input that will inform changes and the next steps!

Survey: tinyurl.com/autismneeds

We seek input from all perspectives: family members, individuals with ASD, medical providers, school personnel, justice system employees, and other community service providers. 

Share the link with your friends or colleagues! 

Conducted by the HANDS in Autism® Interdisciplinary Training and Resource Center on behalf of the Indiana Family and Social Services Administration (FSSA).

Questions about the survey or HANDS in Autism?

HANDSinAutism.iupui.edu | hands@iupui.edu | 317.274.2675

Introducing Our Newest Specialists!

Our team is growing! We've excited to be part of a new project, CareShare for Kids: Better Screening, Evaluation and Coordination in Indiana. Our specialists will be supporting families who get a new diagnosis of developmental delay and/or autism. We're all family

members, too, and we know how overwhelming it can be to get a new diagnosis. We hope to be able to support these parents and connect them with the resources to give their child the best possible opportunities and outcomes. If you, or someone you know, needs help navigating systems and services in Indiana, please contact us: 317 944 8982 info@fvindiana.org. We are supported by grants and donations, so our services are FREE. 

Melody Holmes is our specialist for the South Bend/St. Joseph County area.  Melody and her husband are the parents to Stephen, 18, and Natalie, 13.  Stephen had hearing loss and other unique idiosyncrasies early in his life but overcame many of them through First Steps intervention and theatre.  Natalie has experienced multiple medical challenges from infancy, many of which were not diagnosed until she was five years old and some as late as February 2015. Natalie’s primary health challenges include neuromuscular disease with mitochondrial dysfunction, Chiari malformation 1.5, connective tissue disorder and high intracranial pressure.  Natalie courageously faces every challenge and sets an example of how to adapt to life to reach her goals.

Melody has worked in the not-for-profit sector for 15 years. She has largely focused on child abuse/neglect prevention, parent education and child development.  She also volunteers as a child advocate and support group leader.  Melody loves to support families by connecting them with local, state and national resources. Additionally, she hopes to encourage families to develop a strong and consistent medical home as well as practice clear, gentle, and effective communication as they navigate through the medical and special needs maze.

Emily McKinley is our Electronic Communication Specialist. She previously served as a Health Information Specialist for Family Voices. Emily and her husband have three beautiful sons, who are preschool and elementary age. One of her sons received services through First Steps and from other providers. His hard work and early intervention have put him on the road to success! Emily and her family are tremendously grateful for the compassionate, caring providers who they have encountered on their journey and wish to bring comfort and resources to others.

Emily’s interests include assisting families who are beginning their journey after receiving a special needs diagnosis, health care reform, maintaining special diets on a budget, sensory processing, and assisting military families.

Emily has enjoyed an interesting and varied professional career, which has included experiences as a medical writer, volunteer program manager, and freelance writer and editor. Emily has been a lifelong volunteer and is proud to have advocated on behalf of many individuals and for many organizations, including Easter Seals, military spouses and families, children in foster care, Toys for Tots, Big Brothers and Big Sisters, animal shelters, and others.

Aura Roblero is one of our bilingual specialists serving the Indianapolis/Marion County area. She is the mother of three beautiful children: two boys, 16 and 14 years old, and a little girl, 8, with Down syndrome whom she absolutely adores.

Being a mother of two healthy and happy boys gave her the most satisfying experience in life, but what she did not know was that life was preparing her to raise a little girl with special health care needs. The situation was challenging for her and her family as this new world unfolded for them.

During this process, Aura learned how to successfully manage the many challenges that one encounters when raising a child with special needs. She also learned that there were support groups to help her manage and solve problems as well as strengthen her ability to advocate for her daughter. Finding her path was very confusing and painful. However, Aura considers herself lucky to find people and organizations like Family Voices Indiana. They helped her become more confident and positive. She is excited to have the opportunity to be a helping hand to other families who are facing difficult times. She will use the knowledge and skills she has in order to educate and teach others how they can be the best advocate for their own child. 

Kaitlin Thompson is one of our specialists for Evansville/Vanderburgh County. Since she was a child, Kaitlin has been advocating for Hoosiers with disabilities and special health care needs, including speaking in front of local elected officials and state legislators. She has volunteered with young children and families facing crisis situations and has provided input to health care facilities and service providers to improve the quality of care for pediatric patients and their loved ones. She and her two adult siblings have special health care needs, giving her a unique perspective on the issues families seeking assistance from Family Voices Indiana face.

In addition to her personal experience, she holds a Bachelor of Science in Psychology, a Professional Certificate in Patient Advocacy, and is currently enrolled in a Master of Science in Developmental Disabilities program.

Kaitlin is thrilled to be a part of the Family Voices Indiana team. She is excited to bring her passion for helping families navigate the sometimes challenging and ever-changing systems of health care and disability support services to the team. She believes every family has a unique culture and set of strengths they bring to raising their families and interacting with professionals.

Stacey Webb is our specialist for the Jeffersonville/Clark County area. She is the mother of three children, Thomas, Lucas and Presley. Both Thomas and Lucas were born with a rare genetic disorder, Metachromatic Leukodystrophy (MLD).

Stacey currently works as an LPN in the pediatric home health setting as well as in the pediatric long -term care setting.

Stacey believes that with shared knowledge, guidance, respect and support we can produce improved and enriched outcomes and opportunities for children with special needs. She is looking forward to connecting families to resources while also providing support and advocacy.

Erica Walker is one of our specialists for Fort Wayne/Allen County. She has two children, aged three and five. Mallory was born with a rare brain malformation called Hemimegalencephaly that resulted in catastrophic epilepsy. Carter has multiple diagnoses including ADHD and speech delay. After learning how to navigate the many programs and services available, she began volunteering as a champion for About Special Kids. She is also a Service Coordinator for First Steps. She absolutely loves working side by side with families to assist and encourage them on their special health care needs journey. She is eager to work with Family Voices and expand her knowledge base to others in the community. With her personal and professional experience she hopes to empower others to advocate for their special needs family member. It truly does take a village to raise a child!

CMS Announces #ACA Special Enrollment Period for Tax Season

Eligible consumers have from March 15 through April 30 to enroll in coverage

The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

For those who were unaware or didn’t understand the implications of the fee for not enrolling in coverage, CMS will provide consumers with an opportunity to purchase health insurance coverage from March 15 to April 30. If consumers do not purchase coverage for 2015 during this special enrollment period, they may have to pay a fee when they file their 2015 income taxes.

Those eligible for this special enrollment period live in states with a Federally-facilitated Marketplace and:

• Currently are not enrolled in coverage through the FFM for 2015,
• Attest that when they filed their 2014 tax return they paid the fee for not having health coverage in 2014, and
• Attest that they first became aware of, or understood the implications of, the Shared Responsibility Payment after the end of open enrollment (February 15, 2015) in connection with preparing their 2014 taxes.

The special enrollment period announced today will begin on March 15, 2015 and end at 11:59 pm E.S.T. on April 30, 2015. If a consumer enrolls in coverage before the 15th of the month, coverage will be effective on the first day of the following month.

This year’s tax season is the first time individuals and families will be asked to provide basic information regarding their health coverage on their tax returns. Individuals who could not afford coverage or met other conditions may be eligible to receive an exemption for 2014. To help consumers who did not have insurance last year determine if they qualify for an exemption, CMS also launched a health coverage tax exemption tool today on HealthCare.gov and CuidadodeSalud.gov.

"We recognize that this is the first tax filing season where consumers may have to pay a fee or claim an exemption for not having health insurance coverage," said CMS Administrator Marilyn Tavenner. “Our priority is to make sure consumers understand the new requirement to enroll in health coverage and to provide those who were not aware or did not understand the requirement with an opportunity to enroll in affordable coverage this year.”

Most taxpayers, about three quarters, will only need to check a box when they file their taxes to indicate that they had health coverage in 2014 through their employer, Medicare, Medicaid, veterans care or other qualified health coverage that qualifies as “minimum essential coverage.” The remaining taxpayers - about one-quarter - will take different steps. It is expected that 10 to 20 percent of taxpayers who were uninsured for all or part of 2014 will qualify for an exemption from the requirement to have coverage. A much smaller fraction of taxpayers, an estimated 2 to 4 percent, will pay a fee because they made a choice to not obtain coverage and are not eligible for an exemption.

Americans who do not qualify for an exemption and went without health coverage in 2014 will have to pay a fee – $95 per adult or 1 percent of their income, whichever is greater – when they file their taxes this year. The fee increases to $325 per adult or 2% of income for 2015. Individuals taking advantage of this special enrollment period will still owe a fee for the months they were uninsured and did not receive an exemption in 2014 and 2015. This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015.

The Administration is committed to providing the information and tools tax filers need to understand the new requirements. Part of this outreach effort involves coordinating efforts with nonprofit organizations and tax preparers who provide resources to consumers and offer on the ground support. If consumers have questions about their taxes, need to download forms, or want to learn more about the fee for not having insurance, they can find information and resources at www.HealthCare.gov/Taxes or www.IRS.gov. Consumers can also call the Marketplace Call Center at 1-800-318-2596. Consumers who need assistance filing their taxes can visit IRS.gov/VITAor IRS.gov/freefile

Consumers seeking to take advantage of the special enrollment period can find out if they are eligible by visiting https://www.healthcare.gov/get-coverage Consumers can find local help at: Localhelp.healthcare.gov or call the Federally-facilitated Marketplace Call Center at 1-800-318-2596. TTY users should call 1-855-889-4325. Assistance is available in 150 languages. The call is free.

For more information about Health Insurance Marketplaces, visit: www.healthcare.gov/marketplace

CMS Blog: http://blog.cms.gov/2015/02/20/what-consumers-need-to-know-about-corrected-form-1095-as/

from CMS

A #Valentine's Gift that Touches the Hearts of Families

Want to give a gift that keeps giving this Valentine's Day? Consider a donation to Family Voices Indiana.



Family Voices Indiana

Did you know…

♥ 1 in 5 children are children with special health care needs?

♥ Family leaders at Family Voices are family members themselves?

♥ Family Voices provides free resources and support to families who need it?

Your gift can help……

$10 ♥ a phone card for our family leaders to provide 1:1 support

$25 ♥ a one hour health care financing training for families

$50 ♥ a two hour health care financing training for families

$75 ♥ brochures for 350  families

$100 ♥ an exhibit table at a disability fair for community outreach

Please help make a difference and donate today! 

We’re also grateful to accept donations of services, volunteer hours, or other support…….

Happy Valentine's Day!

Informational Meetings about Hoosier Care Connect #FSSA

Please join the Indiana Family and Social Services Administration at one of the following community meetings to learn more about the new Hoosier Care Connect program.  Hoosier Care Connect FAQs here.

Representatives from the health plans: Anthem, MDwise and Managed Health Services (MHS) will also be present to help answer your questions about their coordinated health care services.

If you can't attend the meeting , there will be a webcast available as well.

Valparaiso

Monday, March 2, 2015

6:00 p.m. 

Ivy Tech Community College Valparaiso

Auditorium

3100 Ivy Tech Drive

Valparaiso, IN 46383

Fort Wayne

Tuesday, March 10, 2015

6:00 pm

Ivy Tech Community College Northeast

Coliseum Campus – McNagny Auditorium (CC1200)

3800 N. Anthony Blvd.

Ft. Wayne, IN 46805

Bloomington

Monday, March 16, 2015

6:00 pm

Ivy Tech Community College Bloomington

Hoosier Times Student Commons Room

Connie and Steve Ferguson Academic Building

200 Daniels Way

Bloomington, IN 47404