DHCS submits, as requested, monthly enrollment reports to CMS. The LIHP reports are by Medicaid Coverage Expansion (MCE) and Health Care Coverage Initiative (HCCI) component, and are submitted by each local LIHP in the second month following the close of the reporting month. The numbers reported are point-in-time. The counts of enrollees change as enrollees are determined eligible with an enrollment effective date of the first day of the month in which they applied. This results in continual adjustments to prior month’s enrollment throughout the program year and into the following program year. These adjustments and any corrections in reporting will not be shown in revised reports. These adjustments are reflected in quarterly and annual enrollment reports. Due to these continual adjustments the numbers reported in monthly reports may not match those reported in the quarterly or annual enrollment reports.
Quarterly Reports - Applicants, Enrollment, and Appeals and Grievances
Fiscal Year 2013-2014
Applicants, Quarter 2 (October - December)
Enrollment, Quarter 2 (October - December)
Appeals and Grievances, Quarter 2 (October - December)
Applicants, Quarter 1 (July - September)
Fiscal Year 2013-2014
Low Income Health Program Reporting Requirements Background:
The Low Income Health Program (LIHP) includes two components distinguished by family income level: Medicaid Coverage Expansion (MCE) and Health Care Coverage Initiative (HCCI). MCE enrollees have family incomes at or below 133 percent of the federal poverty level (FPL). HCCI enrollees have family incomes above 133 through 200 percent of the FPL. Local LIHPs may elect to operate only an MCE program, but must operate a MCE in order to implement a new HCCI. The local LIHP can set the income levels below the maximum allowable amount according to the Special Terms and Conditions (STCs) approved by the Center for Medicare and Medicaid Services (CMS).
In addition to being classified by family income, enrollees are designated as “Existing” or “New” based on guidelines set forth in the STCs.
- Existing MCE or HCCI enrollees are enrollees whose enrollment was effective on November 1, 2010.
An existing enrollee continues to be existing even as they may move from one component of the program to the other based on changes in the enrollee’s FPL.
After an existing enrollee is dis-enrolled, they will be considered a new enrollee if they re-enroll at a later date.
- New MCE or HCCI enrollees are enrollees whose enrollment was effective after November 2010.
This includes enrollees who were enrolled during the period legacy counties with prior HCCI programs transitioned from the HCCI to the LIHP. Legacy counties had the flexibility to continue enrollment during this transition period. Santa Clara County did not enroll new applicants until July 1, 2011.
Enrollment is effective on the first of the month in which the application was received except for a non-legacy LIHP, which did not have a HCCI Program prior to November 1, 2010, and implemented the LIHP after the first of a month. During this first month of implementation, the enrollment effective date is the date the local LIHP was implemented. After this initial implementation month, enrollment follows the normal effective date of the first of the month.
Additionally, non-legacy LIHPs who offer retroactive enrollment from one to three months follow the same process. The enrollment cannot be retroactive to a date before the implementation date. Retroactivity is in place only after the necessary timeframe (one to three months) has passed since the implementation date.
Monthly and Quarterly Reports:
Each local LIHP provides monthly aggregate reports of enrollment to the Department of Health Care Services (DHCS) broken down by program component and existing or new enrollee. The enrollment numbers provided in monthly aggregate reports represent a snapshot of enrollment during the reporting month. They are not cumulative from month to month.
Each quarter, enrollment numbers are re-analyzed and updated for all historical program months to date, and are reported in a quarterly enrollment report. These revised enrollment reports are prepared based on individual enrollment records for each LIHP recipient, which capture retroactive enrollment and disenrollment, and changes in program component or enrollee type. The quarterly reports provide a count of the unduplicated number of enrollees in each month and in total during the quarter and program to date. They also provide the total number of member months, which is the number of months of enrollee time contributed by all enrollees together during the reporting period.
Quarterly reports contain program applicant statistics. Applicant statistics include the number of applications received for each program component, and for which the program component is unknown because family income has not been determined at the time the report is submitted.
Older reports are moved to the Report Archives
page. Each quarterly report includes data for the reporting quarter and for previous quarters. When a quarterly report is posted, the prior quarter’s report is archived. In addition, the enrollment reports for the three months included in the new quarterly report are also archived.
Caveats and Interpretation:
Multiple factors which affect enrollment reporting should be considered when analyzing these reports and include, but are not limited to the following:
Enrollees whose FPL change results in a move from one program component to the other would be reported in the appropriate MCE or HCCI category dependent on the FPL status at that time and in the quarterly report would be considered an unduplicated enrollee in both MCE and HCCI.
Enrollees who were existing enrollees, but who have been dis-enrolled and re-enrolled will also be counted in the appropriate existing and new categories at the respective times and in the quarterly report would be considered an unduplicated enrollee in both categories.
Enrollment continues to change over time due to eligibility determination on pending applications, and disenrollment. The eligibility determination timeframe may adjust prior monthly statistics in the quarterly report if changes in eligibility status were not completed within the reporting month.
Retroactive enrollment from one to three months may result in additional adjustment in the monthly and quarterly reports.
Different reporting systems are used for the monthly and quarterly reports. The more accurate and comprehensive quarterly reports are used to continuously update the monthly statistics with submission of an electronic file whereas the monthly reports are aggregate data entered directly in the monthly report. These continual adjustments occur monthly, quarterly and annually. Due to the continual adjustments prior monthly enrollment reports submitted to CMS may not match those reported in the quarterly or annual CMS reports.
Local LIHPs are still developing and debugging their reporting systems. As these system issues and data entry errors are resolved the quarterly reports adjust and correct the monthly statistics quarterly. Confirmation of data accuracy is not always possible within the required report timeframes. Any corrections needed are updated in the subsequent quarterly report. Bottom of Form.
The monthly and quarterly enrollment reports included here should not be expected to reflect the number of MCE enrollees that transitioned to Medi-Cal managed care or to match reports generated from MEDS. The majority of local LIHPs have separate free-standing management information systems for enrollment. These separate systems use their own unique client identifiers and do not allow for all-inclusive un-duplication of enrollees across the nineteen local LIHPs. Additionally, these free-standing systems do not interface with DHCS’ Medi-Cal Eligibility Data Systems (MEDS) which is California’s Medicaid management information system. For LIHP transition purposes, LIHP enrollees were required to be entered into MEDS, and the process was begun to eliminate duplicate records for enrollees statewide.
Quarterly Appeals and Grievance reports:
DHCS submits, as required, quarterly appeals and grievance reports to CMS. These reports capture data as required in the LIHP contract Exhibit A, Attachment 13, and the California Bridge to Reform Demonstration hearings and appeals process for LIHP, as approved by CMS. The reporting timeframe begins July 1, 2011 with the ten legacy counties reporting. As other local LIHPs are implemented they will begin to report. The reports are by appeals and grievances and data reported reflects the activity that occurred within the quarter. Only appeals/grievances received and/or resolved in the specific quarter are reported. For example an appeal received in the 1st quarter will be reported in the 1st quarter report as received. If it is not resolved in the 1st quarter and is resolved in the 2nd quarter, it will be reported in 2nd quarter report as resolved.