 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
|
|
|
|||||||||||
| |||||||||||||
B. Community Care North Carolina/Carolina ACCESS Managed Care
F. Women, Infants, and Children Program (WIC)
G. Special Health Care Needs Identification
I. Family Planning Waiver Program
Because a Work First application is also an application for Medicaid, the caseworker is required to explain the following programs to meet Medicaid application requirements. Document the explanation of these benefits in the case record.
• Health Check/EPSDT |
• Adult Health Screening |
• Community Care of North Carolina/ |
• Medical Transportation Services • WIC |
• Family Planning Services • Special Health Care Needs Identification • National Voters Registration Act |
• Emergency Medicaid • Family Planning Waiver Program • Lifeline/Link Up Program |
1. Explain the Health Check Program
a. Health Check pays for health care for children under age 21 who are authorized for Medicaid in any aid program/category, except MQB and those approved for emergency Medicaid only.
b. Explain that transportation and assistance in locating a provider is available. (Complete a Medical Transportation Assistance Notice of Rights DMA 5046.)
c. Explain that letters will be sent to the applicant’s home reminding them of services available through the Health Check Program, which include a recommended screening schedule.
d. Give the applicant the name and the telephone number of the local Health Check Coordinator to answer questions, assist in locating a provider, and scheduling appointments. If the county does not have a local Health Check Coordinator, use the CCNC/CA listings of providers.
Community Care North Carolina/Carolina ACCESS (CCNC/CA) is a managed health care program for Medicaid recipients. Members are linked with a primary care provider (PCP) who delivers or coordinates needed medical services, refer to the Family and Children’s Medicaid manual.
1. Determine if the applicant is required to participate in CCNC/CA. Refer to the Family and Children’s Medicaid manual for a list of mandatory participants.
2. Explain the CCNC/CA program to each optional or mandatory applicant.
Cover the following points:
a. The applicant chooses a CCNC/CA enrolled Primary Care provider for each person on the application. If the applicant is a mandatory participant and fails to choose a PCP within 10 days of the request to choose, the caseworker must assign an appropriate CCNC/CA Primary Care provider to each recipient.
b. If the applicant has not been a patient of the CCNC/CA Primary Care provider, request a new patient appointment immediately after receiving the Medicaid approval notice.
c. Recipients should make appointments for check-ups and sick visits with their CCNC/CA Primary Care provider.
d. If the recipient needs to see any other doctor, including a specialist, the recipient must get the visit approved by their CCNC/CA Primary Care provider first.
e. If the recipient sees another doctor without approval from the CCNC/CA Primary Care Provider, Medicaid will not pay for the visit.
f. Each CCNC/CA Primary Care provider has an after-hours telephone number, which should be printed on the recipient’s Medicaid card if the office is closed and care cannot wait until the office reopens. The PCP information will be printed on a notice, which is mailed to the recipient after they are approved for Medicaid.
g. Medicaid recipients should only go to the hospital Emergency Room for life-threatening conditions.
h. The recipient should call the Primary Care provider before going to the hospital Emergency Room for non emergency treatment. Medicaid will not pay for non-emergency treatment in the hospital Emergency Room unless the Primary Care provider directed the recipient to go to the hospital Emergency Room for care.
i. A recipient can change their CCNC/CA Primary Care provider by contacting their caseworker.
3. Have the applicant choose a CCNC/CA primary care provider for each person on the application. Explain to the applicant they will not be linked with this provider until the application is approved. Refer to the Family and Children’s Medicaid manual.
4. Give each applicant the DMA- 9016, The Benefits of Being a Member CCNC/CA, The Benefits of Being A Member, handout. Include the primary care provider's name and contact information if known.
5. At approval, enter the corresponding provider number in the Carolina ACCESS field on the 8125/8126 for each applicant. Refer to the EIS Training Packet for further instructions.
6. Contact the local Carolina ACCESS plan representative with any questions or special situations.
1. Explain Family Planning Services to individuals of childbearing age, including minors, both male and female. Services include:
a. Counseling - Talking about fears and concerns; what you have heard from relatives and friends; how you and your partner feel.
b. Education - Learning about human sexuality; how your body works; need for birth control.
c. Birth Control Methods - Learning about how each method works; deciding which method is best for you and your partner and why.
d. Medical Examinations - Arranging for a doctor to examine you to be sure you are healthy.
e. Abortion and Sterilization Services - Talking about choices and helping arrange for needed medical services.
2. The applicant's decision concerning family planning services program will not affect their eligibility for Medicaid.
3. If services are desired, referral to the Services unit is made on appropriate county forms.
4. Record on the base document that the availability of Family Planning Services was explained to the applicant and their decision.
1. Explain the Adult Health Screening provides for one annual health assessment for adults age 21 and over with the expectation that the screening will prevent serious illness through early detection and treatment.
2. The screening is delivered through:
a. County health departments,
b. Clinics, and
c. Participating physicians in private practices.
3. Adult Health Screening is comprised of the following components:
a. Health history,
b. Physical examination,
c. Laboratory procedures, and
d. Counseling, education and limited intervention.
4. Document in the case record that the applicant was informed of Adult Health Screening
1. Inform the applicant that if he/she does not have or cannot arrange medical transportation on his/her own, the applicant is entitled to help from the agency in arranging and/or paying for medical transportation once authorized for Medicaid, except for M-QB and FPW coverage and North Carolina Heath Choice for Children. Have the applicant complete and sign the DMA-5046 at application and review. Retain a copy for the record.
2. Inform the applicant that the agency is not obligated to pay for transportation to an out-of-town/county provider at a greater distance due to the applicant's choice, if a local source is suitable.
3. Give the applicant the name of the person or unit that handles transportation requests at the agency.
4. Refer to the Family and Children’s Medicaid manual for specific transportation requirements.
1. WIC is available to Medicaid recipients who are:
a. Children up to age five years, and
b. Women who are pregnant, breast feeding, or within six months postpartum.
2. WIC is a supplemental food and nutrition education program that provides supplemental foods to improve diets and reduce chances of health problems caused by poor nutrition.
3. WIC participants receive vouchers which they redeem at participating grocery stores to receive the WIC foods. WIC foods include infant formula, infant juice, and infant cereal, as well as milk, cheese, eggs, juice, cereal, and dry beans and peas.
4. If the applicant meets the criteria in F. 1. a. and b. above refer the applicant to the WIC lead agency.
1. Explain that federal law requires that North Carolina identify children with special health care needs.
2. Have the applicant complete the DMA 5069, Special Health Care Needs Questionnaire and document the case file accordingly. (refer to Family & Children’s Medicaid manual)
1. Non-qualified immigrants and qualified immigrants during the 5-year disqualification period are eligible for Medicaid for emergency medical services only.
2. This means those individuals for whom citizenship and identity are questionable, the qualified immigrant who is not eligible for full coverage during the 5 year period from date of entry, and the non-qualified immigrant can only be authorized for Medicaid for the day(s) the individual is approved for emergency medical service. (refer to Family & Children’s Medicaid)
1. Explain Family Planning Waiver Program to individuals of childbearing age who are not sterile, women ages 19- 55 and men ages 19-60. Services include:
a. Contraceptive supply visits to support the effort to continue a pregnancy spacing plan.
b. Screening and treatment for sexually transmitted infections.
c. Most methods of birth control
d. Annual family planning exam that includes a Pap smear and breast exam for women and a testicular exam for men.
e. Sterilizations for men and women over age 21.
f. Screening for Human Immunodeficiency Virus (HIV).
2. The applicant's decision concerning participating in the family planning waiver program will not affect their eligibility for other Medicaid.
3. Record on the base document that the availability of Family Planning Waiver Program was explained to the applicant and their decision about participation.
The Lifeline Assistance Program is designed to promote universal service by helping low-income individuals afford telephone service. Lifeline Assistance allows those eligible low-income customers to receive a credit each month on their telephone bill.
The Link-Up Program provides low-income persons a discount toward the cost of obtaining local telephone service.
1. Lifeline/Link-Up Assistance Programs Requirements
a. Customers must receive Work First Family Assistance, LIEAP, CIP, Weatherization, Housing Authority or Section 8 Assistance, Food and Nutrition Services, Medicaid, or Supplemental Security Income;
b. Have the telephone service listed in their name; and
c. Receive the telephone bill.
NOTE: Verification of receipt of Work First Family Assistance or other low-income assistance must come from the authorizing agency.
2. Lifeline Program Procedures for Applications/Reapplications in the Work First Program
a. Explain the Lifeline and Link-Up Assistance Programs to the applicant.
b. If the applicant meets the eligibility requirements and wants to apply for the Lifeline Assistance Program, have the individual sign the Lifeline/Linkup Application/Verification for Telephone Discount DSS-8168-I. Hold the DSS-8168-I until you process the Work First application. Verification of the telephone bill is not required for the individual to apply for the Lifeline Program.
c. If the application is approved, complete the information on the DSS-8168-I. Enter the head of household’s social security number in the appropriate block on the form. Ensure the information written on the DSS-8168-I is correct and legible.
d. Mail the completed DSS-8168-I, without delay, to the appropriate telephone company. File a copy in the case record.
e. Upon receipt of the DSS-8168-I, the telephone company verifies the recipient’s name and telephone number and keys the information into its system. The recipient receives the credit with his next billing cycle.
f. If the application is denied or withdrawn, file the form in the case file if applicable. If individual is receiving Medical Assistance, Food and Nutrition Services Low Income Energy Assistance Program (LIEAP), or Crisis Intervention Program (CIP), forward the application to the appropriate program. Do not forward to the telephone company.
3. Lifeline Program Procedures for Ongoing Work First Cases
a. Explain the Lifeline Assistance Program to the individual if the recipient is not currently receiving the credit.
b. Complete the DSS-8168-I if the household meets the eligibility requirements. Enter the payee’s social security number in the appropriate block. Ensure information written on the DSS-8168-I is correct and legible.
c. Mail the completed DSS-8168-I, without delay, to the appropriate telephone company. File a copy in the case record.
d. Upon receipt of the DSS-8168-I, the telephone company verifies the recipient’s name and telephone number and keys the information into its system. The recipient receives the credit with his next billing cycle.
4. Procedures for Receiving Link-Up Assistance for New Phone Service
A person requesting new telephone service will apply at the local telephone company for service. The telephone company either will mail the application form to the proper local agency or will give the individual the application form to be taken to the proper local agency to be signed and for the agency to verify that the individual is receiving benefits that make the individual eligible for Link-Up Assistance. Complete the form, and return it to the telephone company. In order for the person to receive the discount, the telephone company should not install the telephone until they receive the form. When the telephone company receives the DSS-8168-I, the Link-UP discount will appear on the first bill.
The purpose of the NVRA is to make available more opportunities for people to vote. Caseworkers must ensure voter registration forms are available to individuals during their visits. If the individual asks for assistance in completing the voter registration form, caseworker must provide assistance. Inform the individual that the Board of Elections processes applications to register to vote. Questions concerning voter registration must be directed to the local Board of Elections.
Document the applicant/participant’s response to the voter’s registration questions on the WFFA Application Workbook DSS-8228 or comparable instrument.
|
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
| |||||||||||||