Clone of Certified Enrollment Counselors Page
This page is intended for Certified Enrollment Counselors only.
This page is intended for Certified Enrollment Counselors only. If you need enrollment assistance, please visit www.smcgov.org/healthcoverage
ACE – 65 year old – Question: When does a T-ACE member’s coverage end if she is turning 65? Does it end on the last day of the month she turns 65 or the last day of the month before her 65th birthday?
Answer: The T-ACE member’s coverage terminates on the last day of the month before they turn 65.
ACE – 65 year old – Question: When can a T-ACE member apply for Medi-Cal if they are turning 65 soon? Do they have to wait until they turn 65 to apply for Medi-Cal?
Answer: ACE members can apply for Medi-Cal the month before they turn 65 – their coverage will begin the month in which they turn 65.
ACE – Billing – Question: Can an ACE member set up a payment plan for a surgery co-pay? If so, who should they contact – HPSM or the Business Office?
Answer: They can arrange with admitting at time of registration or contact billing office directly.
ACE – Eligibility - Question: Is there a 3 month wait to apply for T-ACE for an individual who drops their individually purchased commercial insurance health plan, including Covered California Health Plans?
Answer: No, the 3 month waiting period only applies to individuals with employer-sponsored insurance.
ACE – Eligibility - Question: Are applicants eligible for ACE if they have access to employer sponsored insurance but choose not to take it?
Answer: 8/13/12 Yes, patients who were offered employer sponsored insurance but chose not to enroll due to unaffordability or other reasons can apply for the ACE program. Applicants who are currently enrolled in an employer sponsored program are not eligible for ACE. Applicants who have recently dropped their employer sponsored insurance are subject to a three month wait period before enrolling in ACE, unless one of the following occurs:
- Loss or change of jobs,
- Applicant moved into an area where employer-sponsored coverage is not available,
- The employer discontinued health benefits to all employees,
- Coverage was lost because the individual providing the coverage died, legally separated, or divorced,
- Health coverage was provided under a federal Consolidated Omnibus Budget Reconciliation Act (COBRA) policy, and the COBRA coverage ended,
- The applicant reached the maximum coverage of benefits allowed in the current insurance in which he/she is enrolled.
ACE – Eligibility – Question: Can a Medicare patient qualify for ACE for Dental services only?
Answer: Marmi/Kathy: No. Medicare patients cannot qualify for ACE, not even for dental services alone. If Medicare doesn’t cover dental, then that person could qualify for DHC. DHC does cover non-covered services when someone has another insurance plan.
ACE – Enrollment - Question: What happens if during a renewal the ACE member is found eligible for DHC?
Answer: The ACE member’s coverage will terminate at the end of the original coverage period.
ACE – Enrollment - Question: When will the ACE program terminate for a member who reports a change of income and is found eligible for DHC?
Answer: The ACE member’s coverage will terminate at the end of the month in which the income change was reported. DHC will begin the first day of the following month.
ACE – Enrollment - Question: If during a renewal the ACE member is no longer eligible based on a change of immigration status how do I process?
Answer: If applicant is no longer eligible due to a change in immigration staus process in CalHEERS. CHA must send an e-mail to HPSM ACE unit requesting disenrollment due to change in status. No other action need in OeA.
ACE – Enrollment - Question: If applicant is no longer eligible for ACE due to income change how do I process?
Answer: If applicant is no longer eligible for ACE based on income, OEA will determine eligible for DHC. If this occurs during open enrollment or there is a life qualifying event, screen for Covered California.
ACE – Enrollment - Question: Is it possible to only require the Rights and Declaration at initial enrollment time and not at renewal time?
Answer: 8/13/15 KVANKI – No. Applicant must sign the Rights & Declaration at every application/modification.
ACE – Medi-Cal Denial – Question: When can a patient re-apply for ACE if she/he was terminated for non-compliance from Medi-Cal?
Answer: If a patient has been terminated from ACE due to non-compliance from Medi-Cal, when the patient returns to reapply for ACE, you CAN complete both the ACE and ER MC application at the same time, as long as the applicant submits all required verifications. You must check notes in CALWIN to ensure that the applicant is submitting all required verifications and has filled out all missing forms.
ACE – Medi-Cal - Question: How do we complete a MAGI for Restricted Services?
Answer: If applicant qualifies for ACE FW and Restricted Medi-Cal, OeA will route the application to Medi-Cal for Restricted MAGI Medi-Cal determination. Medi-Cal will use the OeA ACE application as the application for Restricted MAGI Medi-Cal. You can also apply for Restricted Medi-Cal in CALHEERS.
ACE – Medi-Cal - Question: Are ACE FW applicants required to apply for Medi-Cal?
Answer: Yes, they must apply for Restricted Medi-Cal. The application will be routed to HSA through OEA.
ACE – Renewal – Question: Are ACE patients mailed new ID cards when they renew?
Answer: No. ACE patients are only mailed new ID cards when there is a change of name, date of birth, when there is a break in coverage or when there is a program change.
ACE – Retroactive – Question: Can an ACE participant request retro for ACE Fee Waiver if their income changed two months prior and they are just reporting it now?
ACE – Services – Question: Does ACE cover long term care?
ACE – Services – Question: Does ACE cover short term skilled nursing care?
Answer: 6/1/16 Yes. Refer to ACE
Handbook, Section 8, Page 29.
• Maximum of thirty (30) days per admission
Prior authorization is required.
ACE – Temp ACE – Question: Can someone be enrolled in Temporary ACE / T-ACE (Temp ACE) if they have linkage to Classic Medi-Cal SOC?
ACE – Temp ACE – Question: Who is eligible for Temp ACE?
Answer: Uninsured San Mateo County residents are eligible if they are U.S. Citizens, Legal Permanent Residents (LPRs) or other County residents with other Satisfactory Legal Immigration status with income between 138% - 200% FPL.
ACE – Temp ACE – Question: How long will the coverage period for Temp ACE last?
Answer: Enrollees will be eligible for Temp ACE from the 1st day of the month of their application date until December 31st of the current enrollment year. Unless they end up qualifying for other public coverage before December 31st
ACE – Temp ACE – Question: Will Temp ACE be available to those who enrolled in Covered CA during open enrollment but their coverage hasn’t started yet? For example, Covered CA enrollment was completed on 2/28/16, Covered CA coverage will begin on 4/1/16. Applicant comes in on 3/10/16 because of an emergency room stay on 3/8/16.
Answer: Yes. In this example, the coverage period for Temporary ACE should be from 3/1/16 through 3/31/16. The CAA would need to notify HPSM to disenroll the participant on 3/31/16. If any visits occurred during the Covered CA Open Enrollment period, the applicant would have to apply for DHC.
ACE – Temp ACE – Question: Will participants in Temp ACE have to pay the tax penalty for the individual mandate?
Answer: Yes. Temp ACE participants may still have to pay the penalty because TempACE is not a health insurance program. Depending on individual circumstances, the participant could be eligible for an exemption from the requirement to have health insurance. If the participant is granted an exemption, they would not be subject to a tax penalty.
ACE – Temp ACE – Question: Can a Temp ACE eligible client who does not want to apply for Classic Medi-Cal because she has linkage just choose DHC to cover a past visit?
ACE – Verifications – Question: Does ACE accept a vehicle registration as proof of county residency?
Answer: Yes. Any verification is acceptable as self-declaration is acceptable.
ACE – Verifications – Question: Can a RSDI award letter be used as proof of income even thought it’s not dated within 90 days?
Answer: RSDI Award letters are acceptable proof of income and you can confirm the income on MEDS as well. DO NOT send patients to go home and get a current document with proof.