Introductions. Darryll Grubbs (Moderator) Jennifer Burnsynski (OCSE) Alisha Griffin (NJ) Ted White (TX)
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1
2 Introductions Darryll Grubbs (Moderator) Jennifer Burnsynski (OCSE) Alisha Griffin (NJ) Ted White (TX)
3 Today s Outline I. RECENT EXPERIENCE OCSE, NJ, TX II. GOING FORWARD OCSE, NJ, TX
4 Part I RECENT EXPERIENCE
5 Recent Experience: OCSE
6 Recent Experience: New Jersey MEDICAL SUPPORT FACILITATOR PROJECT 1115 GRANT
7 Primary Focus To improve overall case management; establish orders for and ensure the provision of Medical Support/Health care Coverage for children in the New Jersey Child Support Program
8 Inception Pre Medical Support Regulations Pre Affordable Care Act Pre NJKiDS Pre New Jersey Health Care Act Expanded access to Individuals Mandated HC for Children New Jersey Mediation Act 1982
9 Model Early Intervention Pre order establishment Facilitation and Outreach Collaborations : Child Support Medicaid Judiciary Non Dissolution Cases (new) 3 Counties: Ocean Hunterdon Camden
10 Operational Elements Intake: Health Information Outreach: Other party and Information Precourt Education/Establishment Recommendations to Court Orders Implemented
11 Outcomes Total Orders: 1,086 Order with HC: 939 = 86.51% Orders without HC: 147 = 13.51%
12 Outcomes Continues Outcome of Medical Support Order Outcome of Medical Support Order Compared to Child's Pre-Order Enrollment Status Number of Cases with Pre-Order Status CP Ordered NCP Ordered Both Ordered Enrolled in CP's Insurance Enrolled in NCP's Insurance Enrolled in Both CP and NCP's Insurances Child's Pre-Order Enrollment Status Enrolled in Other Insurance Enrolled in FamilyCare Enrolled in Medicaid Enrolled in Both Public and Private Options Subtotal of Pre-Order Enrollments Not Enrolled Total
13 Outcomes Continues Increased Cooperation with Court Better Informed decisions Connected Children to coverage Pre order and beyond Build better relationship with families Education Families on Options Facilitate Enrollment Model Improved Case Management Timesaving in Hearings Enhance Public Initiative and use of appropriate and affordable coverage
14 Next Steps 1). Governance Committee Establishment 2). Tracking Recommendations 3). BPR/Reassignment of Staff or Contracts 4). Interim Changes HIQ Decision Matrix 5). Improved Interface with Medicaid and CHIP integration with other reform activites/ HIX
15 Recent Experience: Texas NiñosSanos Section 1115 Grant ChildLINK 2009 Legislative Initiative
16 Niños Sanos Section 1115 Grant 3 year grant (plus 4 th year no cost extension) Sept through Aug Objective: Collaboration with Medicaid/SCHIP agency to increase health insurance outcomes Plan: Each agency to devote three 0.5 FTEs to actively seek insurance information in the shared caseload (IV D cases where Medicaid or SCHIP is involved)
17 Niños Sanos Section 1115 Grant The results 0.5 FTE did not make sense in practice; we could not share an imaginary 50% of any real person Compromise: Texas IV D program paid 50% of the cost of three full time Medicaid/TANF/SCHIP eligibility caseworkers (and some administrative support) to be housed in three child support offices
18 Niños Sanos Section 1115 Grant Other challenges Lengthy contract process because funds had to be exchanged Slow hiring process, followed by turnover and a second hiring process Differing agency objectives
19 Niños Sanos Section 1115 Grant Additional Deliverables Medical Support Practices reports Medical Child Support: Strategies Implemented by States (June 16, 2009) Medical Child Support: State Strategies Revisited (July 12, 2011)
20 Niños Sanos Section 1115 Grant Lesson learned: Shared caseload did not support this level of intervention Many cases were already on Medicaid (or SCHIP or TANF), so there were few instances where the unique skills of the eligibility worker were needed, resulting in little benefit to the Medicaid/TANF/SCHIP agency. The skill set of the Medicaid/SCHIP/TANF eligibility worker was not well suited to seeking insurance for members in the IV D caseload.
21 Niños Sanos Section 1115 Grant Lesson learned: Texas IV D staff does not fully understand the practices of Texas TANF, Medicaid and SCHIP; Texas TANF, Medicaid and SCHIP staff does not fully understand the practices of the Texas IV D agency. In the three pilot offices, Texas IV D staff developed a much better understanding, which led to non project benefits to the caseload.
22 Niños Sanos Section 1115 Grant Lesson learned: Collaboration projects in general Focus collaboration efforts so that the measurable outcome is the same for both agencies.
23 ChildLINK 2009 Legislative Initiative Sections and of the Texas Family Code The objective: A default child only group insurance option (at no cost to the state) if parents could not, or would not, provide health insurance RFP to obtain services of: 1) a health insurance provider and 2) an independent third party administrator
24 ChildLINK 2009 Legislative Initiative The role of the independent third party administrator added complications. Was never intended as true third party administrator (process claims for self insured). Was to be an entity to keep Texas IV D agency out of the business of enrolling children and processing premiums.
25 ChildLINK 2009 Legislative Initiative The nature of child support collections did not fit well with a system that demands regular premium payments. Much effort needed to craft a system that allows families to pay into an escrow like account used to pay premiums and cover short lapses.
26 ChildLINK 2009 Legislative Initiative Unfortunate timing: The RFP was released on March 15, The PPACA was signed on March 23, No bids for the health insurance component & no bids for the third party administrator component. Potential bidders cited uncertainty surrounding health care reform.
27 Part II GOING FORWARD
28 Going Forward: OCSE
29 Going Forward: New Jersey
30 State Level Implementation Key Players: Lead: Department of Banking & Insurance Principles: Department of Human Services Department of Health & Senior Services Department of Children & Families Coordination: Governors Council & Implementation Office
31 Key Components to Date on Children s Side Individual Health Care Coverage Program (IHC) High risk pools Comprehensive Medicaid wavier Integrated IT Planning Health Information Exchanges
32 Comprehensive Waiver Development Governor Christie calls for a Medicaid reform plan to preserve access to healthcare and advance innovation in light of overall Medicaid/NJ FamilyCare expenditure growth increasing 18% over the course of three years. Multi state agency and division collaboration to develop a flexible, value driven service delivery system Extensive process for public support Public Notice Comprehensive Waiver website Stakeholder comment mailbox Medical Assistance Advisory Council Meeting DHSS Medicaid LTC Funding Advisory Council Stakeholder and advocate meetings Legislative briefings and hearings
33 Waiver Objectives Medicaid program reform and innovation Administrative flexibility Management efficiencies Prudent purchasing Competitive procurement Out of state DD contracts Improved health outcomes
34 Streamlined and Efficient Operations Nearly all services and eligible populations served under a single operation authority Tiered decision making Contracts competitively bid Automate eligibility determination system
35 Benefits and Provider Payments Seeks flexibility to define covered services, adopt limits and cost sharing as necessary In lieu of $25 co pay, form a task force to create recommendations on reducing non emergency ER use Reform provider payments: Rebalance service delivery system Fairness for in and out of state providers MCOs and hospitals Evolution toward global/bundled payments
36 Delivery System Innovations Improved quality and outcomes Mandatory managed care enrollment: 92% clients enrolled Duals and Medicare Special Needs Plans (SNPs) Health Homes Accountable Care Organizations Team based care pharmacy pilot
37 Child Support Specific Activities Reinventing / Rebuilding / Enhancing interfaces Enterprise Portal Development Child Support Opens door to Services IVR / Customer Call Center Online Application Asset Management Facilitator Expansion Outreach Parent & Partner Education
38 Key Emerging Issues / Opportunities Establishing a voice at the table Interfaces: New & Expanding Authority to Share Enterprise solutions Sharing of Information Order establishment / modifications Connection with exchanges / navigators Decision Making Points Guidelines & MAGI Multiple families coverage Enforcement Policy and Practices
39 Going Forward: Texas What is Texas doing to prepare for Health Care Reform? Texas Department of Insurance & Texas Health and Human Services Commission are moving forward planning for an exchange. Seeking grants Seeking public comments
40 Questions
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