Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
6 Cards in this Set
- Front
- Back
What is Covered California? |
· Think of Covered California as a one stop shopHealth coverage Marketplace · Consumers can apply for Medi-Cal and Purchase Health Coverage in one place · www.coveredca.com
|
|
If the consumer can apply online, why do we need HSS’s? |
· Covered CA is just a tool to allow the consumers to apply, HSS’s are needed to apply program regulations and determine what the applicant is eligible for. · Applications are screened and any application with potential Medi-Cal eligibility is sent to the appropriate county for evaluation
The HSS (you) will then determine which Medi-Cal Program or Covered CA Insurance Plan the applicant is eligible to. |
|
How to determine eligibility? |
· Not a manual procedure, use 2 systems to determine eligibility |
|
· CalWin |
o All applications are entered into CalWino Determines eligibility for some Medi-Calprograms by running EDBC o Conncects to CalHEERS to run eligibility for MAGIMedical and Covered CA Health Plans o Keeps record of all applications and houses all Medi-Cal cases for annual renewals
|
|
· CalHEERS |
o Is the back end of www.coveredca.com o Receives online applications through Covered CA o Keeps record of all applications and houses only Covered CA Health Plan cases for annual renewal o Receives information from CalWIN to determine eligibility for MAGI and Covered CA Health Plans |
|
What if the consumer comes into the office instead of applying online? |
· No problem – The application is entered into CalWIN and once EDBC is run the Eligibility Determination Request (EDR) is sent to CalHEERS, once received and evaluated CalHEERS will return a DeterminationEligibility Response (DER) to CalWin o Can take minutes to hours. · If anyone in the Household is eligible toMedi-Cal.. the county is responsible for the case, including all changes reported and annual renewals · If the consumer is only eligible to Covered CA healthplans the State is responsible for the case, including all changes reported and annual renewals |