HEALTHCARE REFORM UPDATE OCTOBER 25, 2013 COLORADO AIDS DRUG ASSISTANCE PROGRAM Please share the following

g information in response to frequently asked questions regarding the process of transitioning uninsured ADAP members to Medicaid or to private insurance through Colorados health insurance marketplace, Connect for Health, Colorado. The first and foremost item we wish to bring to your attention is the CLIENT CONTACT AND ENROLLMENT FORM (attached). Use of this document is essential to ADAPs efforts to track our efforts to ensure that individuals who are eligible to transition to Medicaid or to Connect for Health Colorado are contacted. ANY CASE MANAGER, SOCIAL WORKER, HEALTH COVERAGE GUIDE, MEDICAID ELIGIBILITY SCREENER, or any other individual who assists a client with enrolling in insurance MUST complete this form and fax it to the ADAP office at (303) 691-7736. The client contact and enrollment form serves two purposes: 1. Lets the ADAP, as well as any other clinic and/ or case manager /social worker that works with that client know that an effort is being made to transition him/her to insurance. The form should be used even if you were unable to complete the enrollment. 2. The ADAP will enter the information into the database, and indicate the enrollment is pending. This will assure that the client is not contacted multiple times, and help us target our outreach to those who have not been contacted. Clinics and other agencies will have the ability to generate reports to show progress toward our goals. Updates: Supplemental Wrap- Around Program (SWAP): The Colorado ADAP has unveiled a PILOT project of the new Medicaid prescription wrap around benefit. The SWAP is intended to pay HMAP formulary co-pays for individuals enrolled, or formally enrolled in ADAP that have qualified for Adult without Dependent Medicaid since the early expansion of Colorado Medicaid began in May of 2012. The pilot of SWAP is targeted to this group of individuals (approximately 160 people) that were disenrolled from Colorado ADAP when they qualified for Medicaid. This meant that they needed to pay $1 or $3 copays for their medications when they previously received them for free. The application for this pilot program was sent to all individuals who were disenrolled in this period, and provided to the HMAP pharmacies. For the most part, these clients needed to be recertified for ADAP in order to use the program. If an individual newly transitions to Medicaid from HMAP any time between now and January 1, 2014 they will automatically be enrolled in SWAP without submitting a separate application. Similarly,

anyone who is on HMAP and recertifies as they are scheduled (in their birth month, or six months after) will be auto-enrolled into SWAP if they have applied for (and have been approved for) Medicaid expansion effective January 1st. They will receive a new SWAP card and instructions for how to use it sometime in December (or upon enrollment if they dont apply for Medicaid in time for a January 1 2014 effective date). What about people who have Medicaid now (but have not been on ADAP before, or were on ADAP years ago? It is estimated that 500-600 people in Colorado might fit this description. At this time, Colorado ADAP does not have the staffing to accept new applications for these type of numbers, but we will open SWAP up to these individuals probably in late winter / early spring. Medicaid Enrollment Update: The PEAK website has experienced some difficulties since the rollout on October 1st, but there has been an estimated 16,000 applications so far, and approximately 9,000 applications are in waitlist status. Anyone on the waitlist itself will automatically be enrolled on January 1st with no action required. Remember: Anyone who applies through PEAK or CBMS between now and December that does not qualify under current rules will initially receive a denial letter, before later receiving a hold on letter that tells them they may qualify for Adult without Dependent Children (AwDC) Medicaid effective January 1, 2014. It will explain to them that they do not need to reapply for the benefit. The PEAK website is intended to give real time eligibility responses to applications made online. The success of this process is variedsome people have received real time denials. Those that have not received real-time denials, and qualify for Medicaid, have been receiving determination letters in relatively short order. Some of these letters have confusing wording, so clients should be aware that they can contact Maximus at (800) 359-1991 to get more details about what their letter means and if any additional information is needed. PLEASE NOTE: If you are working with a client who already has some form of food assistance (SNAP, WIC, AND, etc.) through HCPF, they are able to go into, or set up, an account on the PEAK website that will enable them to very simply apply for AwDC Medicaid in a very expedited manner. Connect for Health Colorado and Health Coverage Guide Update: The ADAP Health Coverage Guides are hard at work across the state contacting clients to discuss their coverage picture moving forward. Some technical issues with functionality on both the Connect for Health and Colorado PEAK have hindered our efforts somewhat. ADAP did expect some hiccups while these online processes were rolled out. As such, the Health Coverage Guides are meeting with the clients in the interim to shop plans and create accounts. More and more clients will be contacted in the coming months as this process is simplified and we are able to complete the application process during our appointments. Bridging the Gap, Colorado (BTGC) Medicare Update: Applications for BTGC 2014 were packaged and mailed this week and should be arriving to clients homes now. It contains information about changes to Medicare Part D Prescription Drug Plans (PDP) and Medicare Advantage Plans with prescription drugs (MAPD), premium costs, and other information. Update: We initially thought that all members with SILVERSCRIPT PDP plans would need to move to another PDP. We have since found

out that it is under sanctions from the Centers for Medicare and Medicaid Services (CMS) and is closed to NEW enrollees. Anyone on Silverscript that is happy with their plan is not required to change plans. Personnel Issues: Colorado AIDS Project: Dana Kennedy has been hired to coordinate the Health Insurance Assistance Program contract with CDPHE. She replaces Michael Hollar who left the position earlier this month. Jeremy Osenga will be leaving CAP at the end of the month, and CAP is in the process of hiring a replacement. West CAP: Martha Monroe and Katherine Muhvich have resigned, and Elizabeth Pertile has been chosen to take over the Health Insurance Assistance Program there. University Hospital, CHIP, and Denver Health Eastside Clinic: Melissa Webb and Allison Greenstein have been hired to work with MEDICAID eligible clients. They will be enrolling individuals through the PEAK website at the clinics, as well as the Denver Colorado AIDS Project offices. A third person is being hired to work with Melissa and Allison. Denver Health: In addition to Ruth Moreno, two individuals have been hired to assist clients enroll in Medicaid through CBMS, PEAK, or written applications. We thank you for taking the time to keep in the loop about the complicated process of implementation of the Affordable Care Act. Please feel free to email any questions you may have to me at todd.grove@state.co.us Todd Grove Colorado AIDS Drug Assistance Program (303) 692-2783 Please remember to like us on facebook for regular updates: www.facebook.com/COADAP.