parellaview graph # 1 overview of presentation program design options program design conclusions...

Parella View Graph # 1

OVERVIEW OF PRESENTATION

Program Design Options

Program Design Conclusions

Benefit Package Design

Husky Plus

Outreach Efforts

Evaluation and Monitoring


THE STARS IN THEIR COURSES...

William Shakespeare

A State Budget Surplus

An Enhanced Federal Match

An Election Year

A Clambake


To Medicaid, or Not to Medicaid, That Is the Question?

Concern About the Creation of a New Entitlement

- Prospects for continued federal funding beyond 2002

- Concern about individual cause of action (litigation about notices, fair hearings, etc.)

- Concern about the “T” in EPSDT: Unlimited benefit package

Concern About Ability to Draw Down Full Federal Match If We Stick to the Limits on Expansion in the BBA

- 200% FPL or

- 50 percentage points higher than current Medicaid eligibility

STAGE ONE: PROGRAM DESIGN


Federal Allotment for Connecticut ($35 Million in FFY 1998) Was Based on the Number of Uninsured Children Below 200% FPL

As of April, 1997 Connecticut Already Covered Children Born After September 30, 1983 up to 185% FPL

- Further Medicaid eligibility expansions to 185% FPL already enacted by the legislature- children born after July 1, 1981 effective July 1, 1997- children born after January 1, 1980 effective January 1, 1998

Wanted a Package for All Working Families

- no Medicaid stigma- coordinated outreach to Medicaid and Non-Medicaid- accessible outreach to Medicaid eligible populations- did not want intake through the “welfare office”- wanted a buy-in option regardless of income

STAGE ONE: PROGRAM DESIGN (cont.)


Combination Approach

- Capture enhanced Title XXI Match (65%) on previously enacted Medicaid expansions for children up through age 18 up to 185% FPL

- Above 185% FPL, a non-Medicaid expansion

- took advantage of the open-ended reference to income disregards to extend subsidized coverage to 300% FPL

- full buy-in option available above 300% FPL

STAGE TWO: CONCLUSIONS


Of the Three Non-Medicaid Options (FEHBP, Largest HMO, State Employees), State Employees Selected As Most Generous

Within State Employee Option, Three Benefit Packages Available- Blue Cross (discounted Fee For Service)- MD Health Plan (IPA model)- Kaiser Permanente (staff model)

Compared All Three Plans on Each Covered Service, Selected the Most Generous Option

Copayments Capped at $650 Per Family Per Year Premiums Capped at $600 Per Family Above 235% FPL Total Annual Cost Sharing Maximum - $1,250

PHASE THREE: BENEFIT DESIGN


Even With a Generous Commercial Insurance Benefit Package, There Was a Concern That the Needs of Children With Special Health Care Needs Would Not Be Accommodated

Options Were:- Bring back Medicaid- Offer a risk adjusted rate for special needs kids, similar to

what we do in Husky A (Medicaid Managed Care)- Provide a supplemental, wraparound package that would

not count against the 10% cap on administrative costs Selected the Supplemental Package

- Children will be dual eligible, simultaneously receiving benefits from Husky B and Husky Plus

- Husky Plus modeled on care coordination under existing Title V program

- Title V eligibility expanded to 300% FPL

PHASE FOUR: HUSKY PLUS


Plan Established for Children With Special Physical Needs

- Two Title V centers of excellence selected as providers- Connecticut Children’s Medical Center- Yale Childrens Hospital

- Title V steering committee becomes the steering committee for Husky Plus

A New Plan Established for Children With Special Behavioral Health Needs

- Yale Child Study Center designated as plan coordinator- Community providers selected by RFP process

Both Plans Funded With $2.5 Million for SFY 1999

PHASE FOUR: HUSKY PLUS (cont.)


Children Determined to Be Medically Eligible for Both Plans Based on Designated Screening Tools to Measure Level of Impairment

In Each Plan, Care Coordinators Develop a Treatment Plan in Coordination With the Primary Care Provider and the Utilization Review Staff in the Child’s Husky B Plan

Each Plan Has Final Decision Over Payment Decisions for the Services in Their Benefit Package

- The Goal Is Collaboration and Consensus

- If the Husky B and the Husky Plus Plan Cannot Agree on Who Pays for a Service in the Treatment Plan, the Final Decision Goes to the Department

PHASE FOUR: HUSKY PLUS (cont.)


PHASE FIVE: OUTREACH

Medical Assistance for Children Has Now Become One New Program (Husky) With Three Distinct Parts:- Husky A (Medicaid)- Husky B (Title XXI expansion)- Husky Plus (special needs)

Coordinated Marketing and Outreach for All Three Programs

- De-stigmatize Medicaid- Bring in the Medicaid eligible children- Take advantage of the new name for the program

A Four Page Application Developed for Husky A & B

- Application process invisible to the client between the two programs


A Single Point of Entry Servicer (SPES) Contracted to Screen and Process Applications for the Two Programs

- Benova, the Medicaid managed care enrollment broker, selected as the SPES

- Benova screens all applications for Medicaid eligibility.

- if Medicaid eligible, application referred to a DSS office

- Benova and the DSS offices are linked electronically

- Benova and DSS staff are co-located at each other’s offices

- If the applicant is eligible for Husky B, Benova processes the eligibility in their own system

- Benova processes managed care enrollments for both Husky A & Husky B

PHASE FIVE: OUTREACH (cont.)


Outreach Effort Is Coordinated With Funded Projects in Schools, School Based Health Centers, Community Health Centers, and Hospitals

Future Plans Include Presumptive Eligibility for Husky A (Medicaid) at WIC Sites, Healthy Start, and Child Care Providers

Outreach Is Critical, Not Only to Reach Uninsured Population, but to Negate the Impact of Adverse Selection

PHASE FIVE: OUTREACH (cont.)


In Husky A, There Is a Comprehensive Data Reporting Mechanism in Place With the Health Plans on a Range of Measures Including Encounter Data

Desire Was to Not Make Husky B Like Medicaid but to Follow a Commercial Model

In Connecticut, We Do Have Legislation That Requires HMOs to Submit Comprehensive HEDIS Data to the Department of Insurance

- HEDIS data is for the entire plan book of business

Couldn’t Accept Not Having at Least HEDIS Data That Was Specific to Husky B Reported Annually

- HEDIS will be supplemented by a report on well child visits (EPSDT-LIGHT)

PHASE SIX: EVALUATION AND MONITORING


No Encounter Data on Husky B Plans

For Husky Plus, We Felt the Data Set of Paid Services Would Be Small Enough That We Could Require Quarterly Encounter Data From Both Husky Plus Physical and Husky Plus Behavioral

We’re Going to Measure Our Success in Enrolling Uninsured Kids Against the Same Data the Interval Census (CPAS) Data

- Remains to be seen whether the census provides an accurate baseline on the number of uninsured children

PHASE SIX: EVALUATION AND MONITORING (cont.)


August, 1997 Balanced Budget Act Passes

October, 1997 Husky Legislation Enacted

January, 1998 State Plan Submitted

April, 1998 State Plan Approved

June, 1998 Enrollment Begins

July, 1998 Services Begin in Managed Care Plans and Husky Plus

KEY DATES


Phase One: Enthusiasm

Phase Two: Disillusionment

Phase Three: Panic

Phase Four: The Assessment of Blame

Phase Five: The Punishment of the Innocents

Phase Six: Praise for the Non-Participants

SIX PHASES OF EVERY PROJECT


HUSKY ACTIVITYJUNE 1, 1998--AUGUST 9, 1998

APPLICATIONS RECEIVED BY THE SPES

# of Children

Via Mail 2,797Community Presentations 3DSS Field Office Walk-Ins 128DSS Referrals from Caseworkers 64Phone 1,287

Total 4,279

APPLICATION STATUS

# of Children

Approved for HUSKY B 981Referred to DSS for HUSKY A Review 1,801Withdrawn 19Denied 252Pending 1,226

Total Reviewed 4,279


HUSKY B

APPLICATIONS APPROVED BY INCOME BAND

Income Band # of Children

185-235% FPL 585

185-235% FPL 348

300% + FPL 48

Total 981

APPLICATIONS DENIED BY REASON CODE

# of Children

Documentation not returned 12Incomplete Application 9Insurance Coverage Within Past 6 Mos 17Application not Signed 4Not Connecticut Resident 5Other Medical Insurance 154Over 19 Years of Age 2Receiving HUSKY A 49

Total 252

parellaview graph # 1 overview of presentation program design options program design conclusions...

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