This is a listing of the current trainings available to HealthWatch groups by ABC for Health staff. The trainings are listed by category and all have flexible lengths. The specific content of the trainings can be commuted to meet your needs. To schedule a training or if your HealthWatch group would like a training on a topic that is not listed, please contact Barbara Katz, Parent Consultant at ABC for Health to discuss your needs. Barbara can be reached at barbk@safetyweb.org or by phone at 608.261.6939 ext 207

Overview of Health Benefits Counseling and the Health Care Financing Landscape

What is health benefits counseling and why does it matter? This introductory session provides a framework to understand how health benefits counseling works, the complex and fragmented financing landscape it works within, and how it benefits the families served and their health care providers. (1 hour)

Health Insurance Basics
This training reviews the common types of insurance policies and their general structure, as well as explores how the insurance market works, how it is regulated, and how to negotiate it successfully. We’ll look at such practical issues as evaluating a policy, and researching an insurer’s complaint history. (1 hour)

Insurance Consumer Rights and Responsibilities
Fulfilling your responsibilities as an insurance policyholder is a key to avoiding problems with your insurer. In addition, being confident of your rights is a critical first step in advocating for yourself when problems arise. This training session covers issues such as medical underwriting and unfair discrimination, ADA protections, policy termination and cancellation, COBRA continuation and conversion rights, the effects of the Family and Medical Leave Act (FMLA) and of the Health Insurance and Portability and Accountability Act (HIPAA), prior authorization and referral procedures, and grievances and appeal rights. (30 minutes or 1 hour)

Fighting Back Health Insurance Claim Denials
The blessing of health insurance can easily be turned into a curse when claims are denied or prior authorizations are refused. As health care costs continue to rise, the incentives to deny claims and to limit access to benefits through prior authorizations and managed care systems grow stronger. It takes a strong advocate to argue successfully against an insurance company. In this training, participants learn about the common reasons for claim denials, effective advocacy strategies for overturning improper claim denials, and specific regulations and case law protecting those with insurance. (30 minutes or 1 hour)

Managed Care Issues for Special Populations
Managed care is increasingly being adopted as the system of choice for private insurers and government programs to provide health coverage to their enrollees while controlling their costs. Though managed care systems can make access to services easier, especially preventative services, people with specialized needs often encounter barriers in choosing their provider, gaining access to specialists, equipment, medications and other services. This training orients the participant to the kinds of problems faced by people with special needs and offers some advocacy strategies to help these clients in both public and private managed care systems. (30 minutes)

Managed Care Rights and Responsibilities*
Navigating the complexities of managed care is a daunting task. This training identifies the essential rules governing a participant’s rights and responsibilities and explains the origins of those rules. (30 minutes or 1 hour)
* For specific training on enrollment process, ABC for Health can help you connect with Automated Health.

The Medical Home for a Child with Special Health Needs
The Medical Home concept is regarded nationally as a very positive way to delivering medical service to children with special health care needs. Conceived by the Maternal and Child Health Bureau of the United States Department of Health and Human Services and the American Academy of Pediatrics (AAP), the Medical Home is designed to be a most effective means for delivering medical services to children with special health care needs. This training provides background information and explains the key components of the medical home concept. (30 minutes to 1 hour)

Overview of Medicaid in Wisconsin
In order to understand Medicaid and work your way through its complex bureaucracy, it is important to know how Medicaid operates and how it is regulated at both the federal and state levels. In this training, we provide an introduction to the Medicaid bureaucracy, explaining how Medicaid is funded, what roles the federal government and state play in setting policy, where to get up to date information in changes in regulations and procedures governing Medicaid, who the experts are within the system, and how to access their knowledge. (30 minutes)

Introduction to Medicaid Eligibility
Because the Medicaid program has developed incrementally through a series of expansions to new populations and income groups, eligibility for Medicaid is very complex. This training gives a framework for understanding the many different eligibility categories, their individual financial and non-financial eligibility requirements, and how they relate to each other. (30 minutes or 1 hour)

Understanding the Medicaid Deductible and the FFU
The “spend-down” option of Medicaid allows individuals who are ineligible for Medicaid solely because of excess income to use medical bills to reduce their income to within the guidelines. This deductible option is a vital tool in getting health coverage for medically needy families. This training focuses on the often-complicated process of figuring deductibles and how the “Family Fiscal Unit (FFU)” can affect the determination. It also provides examples of how deductibles and the FFU can be used to benefit families. This information can be especially important when families can consider using Medicaid as backup coverage to a private health insurance plan. (1 hour)

HealthCheck and Other Medicaid Benefits
The benefits covered by Medicaid are quite comprehensive, but procedural hoops can get in the way of families seeking these benefits. This training provides an overview of Medicaid benefits, with an emphasis on learning how to use prior authorizations and HealthCheck “other services” to maximize Medicaid coverage. (30 minutes or 1 hour)

Prior Authorizations
The prior authorization process can be a frustrating and intimidating endeavor. This training takes an in-depth look at the purpose, requirements and appeal rights for prior authorizations. (30 minutes or 1 hour)

Medicaid Appeals
In this training, participants will review the appeals option for Medicaid applicants and recipients, looking at the hierarchy of appeals levels and what to expect and prepare for at each stage of the process. (30 minutes or 1 hour)

*These trainings will be coordinated with the Social Security Administration and the Disability Determination Bureau. An ABC for Health representative will be present to provide an advocate’s perspective.

The Disability Determination Process
Any individual who seeks Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), or Medicaid on the basis of disability undergoes the same review process at the Disability Determination Bureau (DDB). The DDB determines whether the individual meets the level of disability required for eligibility for these programs. The process is quite complex and one’s chances for success are much greater with a solid knowledge of what examiners look for and what kinds of evidence they need in making their decisions. The information in this training familiarizes participants with the process and identifies some key tools and approaches to use in helping individuals put together an application that fully and accurately represents their disability. This training is particularly useful for those who might be applying for the Katie Beckett waiver program or who are transitioning from children’s services to adult services. (1 hour)

Supplemental Security Income (SSI) Eligibility Basics
Eligibility for Social Security is an important route to getting health care coverage through Medicaid. In this training, the participant will learn about income and asset guidelines, work requirements, work incentive programs, and other factors that affect eligibility. (30 minutes or 1 hour)

Supplemental Security Income (SSI) Appeals
This training focuses on the different levels of appeal available to the Social Security applicant or recipient, their appeal rights, what to expect at each level of the process, and effective strategies for gathering and preparing evidence and handling the hearing. We’ll also identify some resources available to help launch appeals. (30 minutes or 1 hour)

Children’s Disability Related Programs
Financing programs for children with special health needs have multiplied since the 1960s. In this training, we review such options as the Birth to Three program, Katie Beckett, Medicaid, special education, Family Support programs, and a host of other private and public programs and resources targeted to helping children with special health needs and their families. (30 minutes or 1 hour)

Understanding Assets
Assets are a complicated matter, but they can make the difference between being found eligible or ineligible for assistance programs. In this training, we review what assets are, how they count in different programs, and some strategies for managing assets to secure or retain eligibility. We’ll also briefly touch on other financial issues, such as tax deductions and handling income from fundraisers. (30 minutes)