1. T H U R S D A Y , S E P T E M B E R 2 6 , 2 0 1 3
Same Page
V O L U M E 1 , I S S U E 1 1
EDITION
Affordable Care Act
Greetings and Salutations! We have known for many months that due to
the implementation of the Affordable Care Act (ACA), major changes were
on the horizon. This edition of the “Same Page” should be used as a
resource in addition to the training that you received. As always, if you
need additional information do not hesitate to reach out to your support
staff.
INSIDE THIS
ISSUE:
ACA Purpose 1
September 30 2
Help Desk
Tickets
2
One HLPG 3
Self Attestation 3
Words of
Wisdom
3
Reasonable
Compatibility
4
Miscellaneous
Changes
5
Medical Case
Assignment
5
Helpful Contact
Information
6
AwDC
Transition
6
PEAK Updates 7
Connect for
Health Colorado
7
Frequently
Asked Questions
8
The main goal of the ACA is to provide insurance coverage, both public
and private, to reduce the number of Americans who are uninsured.
ACA Purpose
Do you have a story idea for the “Same Page”? Contact Genene Duran at GeneneLDuran@maximus.com

2. P A G E 2
Same Page
Please note that on September 30 the EDBC button will be grayed out .
You will be able to complete the data entry and cases will remain in a
pended status until batch processing occurs on Tuesday 10/1/13 under
the new MAGI rules.
September 30, 2013
Help Desk Tickets
1. If the case is not authorized by 9/30/13 a
HDT will be needed for MAGI cases.
2. A HDT will be needed for retroactive coverage before 10/1/13
(Eligibility prior to 10/1).
3. A HDT should be submitted if the following error message is
received: “Eligibility cannot be run prior to 10/1 and pre 10/1
eligibility must be updated.”
ALL HDT’s MUST READ AS FOLLOWS:
“Cannot run MA eligibility prior to 10/1/13
for ongoing case.”

3. Self Attestation = Client Statement
One Medical High Level Program Group
(HLPG)
P A G E 3V O L U M E 1 , I S S U E 1 1
Currently both PEAK and CBMS contain multiple HLPG’s including Family Medicaid
(FM), Child Health Plan Plus (CHP+), Long Term Care (LTC), Adult Medicaid (AM), Medicare
Savings Program (MSP), and Low Income Subsidy (LIS).
After October 1 all programs will be consolidated to one HLPG (not including PE), with
45 different subcategories and aid codes. Clients will be run through all applicable medical
subcategories/aid codes prior to receiving a denial or termination.
Words of Wisdom: “Your living is determined not so much by what life brings to you ... as by the
attitude you bring to life. “ -John Home Mills
Self Attestation will now be accepted for all factors of eligibility (including income and
pregnancy), except those required by law which include citizenship, identity, and
immigration status!
Self Attestation can be accepted from the following:
 The applicant
 An adult in the applicant’s household or family
 Authorized representative
 Someone acting responsibly for the individual (if minor is incapacitated)

4. P A G E 4
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Reasonable Compatibility
Reasonable Compatibility refers to an allowable difference or discrepancy between the
income an applicant self attests and the amount of income reported by an electronic
data source (i.e. IEVS).
For all MAGI programs, if there is more than a 10% discrepancy between the self
attested income and the electronic data source (i.e. IEVS) results, the case will be
affected and at that time the applicant will receive the opportunity to establish his/her
financial eligibility.
Income attestation and data sources are considered reasonably compatible when:
 Both attestation and data are below Medicaid MAGI levels
 Both attestation and data are above Medicaid MAGI levels
 Attestation is above Medicaid MAGI levels (regardless of whether obtained data is
above or below Medicaid MAGI levels.)
In these instances, eligibility will continue to be determined without the need of
additional information or documentation. HOWEVER, If income information is not
determined reasonably compatible, additional information is required. A reasonable
explanation of the discrepancy shall be requested. Reasonable explanations include:
Stopped working, Hours changed, Wage or salary changed, Change in employment,
Marriage, legal separation, or divorce, and death in family. If the applicant is unable
to provide a reasonable explanation, paper documentation shall be requested.
Required documentation for income will be the same as it is today (check stub,
employer letter, etc).

5. P A G E 5V O L U M E 1 , I S S U E 1 1
Miscellaneous Changes
1. Needy newborn coverage will be locked for 12 months regardless of if they are
remaining in the home or not.
2. Foster care children will be covered by Medicaid until they are 26 years old.
3. Clients will be eligible for coverage as of the 1st of the month of the application, not the
apapplication date.
Medical Assistance Case Assignment
1. MAXIMUS will maintain the ongoing case for all MAGI cases that enter through our door. If
the authorization results in a combo MAGI/NON-MAGI or a Non-MAGI only then the system
shall assign the case to the county of residence.
2. All applications resulting in a MAGI determination shall remain assigned to MAXIMUS for
the ongoing case.
3. All applications entered through PEAK/C4HCO and “exception out” in that a real time
eli eligibility determination can not be made (i.e. interface down, etc) shall be assigned to
MA MAXIMUS.

6. P A G E 6
Same Page
Helpful contact information
AwDC Transition
Connect for Health Colorado
(C4HCO)
Website: getcoveredco.org
Phone: 1-855-PLANS-4-YOU
Medicaid Client Services
Website: Colorado.gov/hcpf
Phone: 1-800-221-3943
Medicare
Website: medicare.gov
Phone: 1-800-MEDICARE
(633-4227)
State Health Insurance Assistance
Program (SHIP)
Phone: 1-888-696-7213
Social Security Administration
Website: ssa.gov
Phone: 1-800-772-1213
Entity Contact

7. P A G E 7V O L U M E 1 , I S S U E 1 1
PEAK Updates
 Single Streamlined Application will be available on PEAK
 Real time eligibility determination for MAGI programs
 CHP+ and Buy-In enrollment and Premiums will be accepted via PEAK (Dec. release).
 PEAK inbox will consist of MAGI eligibility exceptions, NON-MAGI Medical, and DHS
Programs
Connect for Health Colorado (C4HCO)
 The mission of Connect for Health is to increase access, affordability and choice for
individuals and small employers purchasing health insurance.
 Beginning October 2013 C4HCO and HCPF will have systems that interoperate (i.e. share
data in a secure way) to determine eligibility for all insurance affordability programs
(Medicaid, CHP+, Advanced Premium Tax Credits (APTC), and Cost Sharing Reductions
(CSR)).
 Individuals must first be deemed ineligible for Medicaid/CHP+ before they are
determined for APTC/CSR eligibility.
 Individuals making up to 400% FPL may be eligible for APTC/CSR.

8. P A G E 8
Question Response
Why do I need health insurance?
How much does insurance cost?
Health insurance protects you from high costs when you
need medical care. Depending on your insurance plan,
you’ll usually pay a monthly premium & possibly a
deductible, plus copayments for services.
When can I enroll?
Enrollment in the Marketplace begins October 1, 2013.
Coverage begins January 1, 2014.
I have pre-existing conditions-can I still apply/enroll?
Yes-you can no longer be denied due to preexisting
medical conditions.
How can I apply?
You can apply through the PEAK website, in-person at
your county social services office, by mail, or over the
phone.
Do I have to submit an application for each program/plan?
No- a single medical application will be used to deter-
mine your eligibility for all medical programs.
What can I do on PEAK?
By the end of the year, you will be able to apply for
Medicaid, verify your eligibility, add/remove people
from your case, order medical cards, pay enrollment
fees/premiums and much more.
How will I be notified?
When will I be notified?
You will receive a Notice of Action (NOA) letter indi-
cating your, and if applicable, your family’s eligibility
determination. If you applied online, you can also veri-
fy eligibility through PEAK. Note: If you applied for
non-medical assistance programs, like food assistance,
you will receive multiple notices.
Who is eligible for ACA/Medicaid/Medicare?
Anyone meeting the following criteria is eligible:
*Currently living in the U.S.
*Must be a U.S. citizen or national
*Must not be currently incarcerated
Individuals who meet the income requirements (see
below) should apply for Medicaid; individuals who do
not qualify for Medicaid & who do NOT have afforda-
ble employer insurance can purchase insurance through
the Exchange (Connect for Health Colorado). Individu-
als over 64 are automatically eligible for Medicare.
Can I get Medicaid?
If you are a U.S. citizen or national, under 65 years of
age, with income below 133% FPL (about $14,000 for
an individual & $29,000 for a family of four), then you
may now qualify for Medicaid.
What is M.A.G.I.?
Modified Adjusted Gross Income (M.A.G.I.) is a new
form of income calculation used to determine Medicaid
eligibility across states. The calculation is based on
Adjusted Gross Income (A.G.I.) as defined in Internal
Revenue Code 36B(d)(2).
I thought health plans were required to keep children under
the 26 on their family’s plan, why was my child removed
from Medicaid?
The new health law requires private insurances to keep
individuals under 26 on their parent’s plan; the law does
not require public assistance programs like (Medicaid)
to do so. On Medicaid, once a child reaches the age of
19, they are removed from their parents’ policy and
must apply for Medicaid on their own OR can contact
the Marketplace (Connect for Health Colorado) for ad-
ditional options.
What are tax credits?
Do tax credits apply toward Medicaid costs (like my copays?)
The new tax credit available through the Marketplace
(Connect for Health Colorado) helps reduce your
monthly health plan premium costs. Credits are sent
directly to your insurance & applied towards your pre-
mium. Tax credits only apply towards qualified health
plans purchased through the Marketplace (Connect for
Health Colorado) & cannot be applied towards Medi-
caid copayments or premiums.
Does ACA cover breast pumps?
No- the ACA requires private insurances to provide
breast feeding supplies but specifically excludes public
assistance programs (like Medicaid) from this require-
ment.
ACAFrequentlyAskedQuestions