Introductions Darryll Grubbs (Moderator) Jennifer Burnsynski (OCSE) Alisha Griffin (NJ) Ted White (TX)
Today s Outline I. RECENT EXPERIENCE OCSE, NJ, TX II. GOING FORWARD OCSE, NJ, TX
Part I RECENT EXPERIENCE
Recent Experience: OCSE
Recent Experience: New Jersey MEDICAL SUPPORT FACILITATOR PROJECT 1115 GRANT
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
Timework @ 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
Model Early Intervention Pre order establishment Facilitation and Outreach Collaborations : Child Support Medicaid Judiciary Non Dissolution Cases (new) 3 Counties: Ocean Hunterdon Camden
Operational Elements Intake: Health Information Outreach: Other party and Information Precourt Education/Establishment Recommendations to Court Orders Implemented
Outcomes Total Orders: 1,086 Order with HC: 939 = 86.51% Orders without HC: 147 = 13.51%
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 159 116 13 30 Enrolled in NCP's Insurance 174 2 152 20 Enrolled in Both CP and NCP's Insurances 20 5 3 12 Child's Pre-Order Enrollment Status Enrolled in Other Insurance 10 3 4 3 Enrolled in FamilyCare 62 18 19 25 Enrolled in Medicaid 428 49 183 196 Enrolled in Both Public and Private Options 27 4 13 10 Subtotal of Pre-Order Enrollments 880 197 387 296 Not Enrolled 59 7 25 27 Total 939 204 412 323
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
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
Recent Experience: Texas NiñosSanos Section 1115 Grant ChildLINK 2009 Legislative Initiative
Niños Sanos Section 1115 Grant 3 year grant (plus 4 th year no cost extension) Sept. 2007 through Aug. 2011 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)
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
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
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)
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.
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.
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.
ChildLINK 2009 Legislative Initiative Sections 154.1826 and 154.1827 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
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.
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.
ChildLINK 2009 Legislative Initiative Unfortunate timing: The RFP was released on March 15, 2010. The PPACA was signed on March 23, 2010. No bids for the health insurance component & no bids for the third party administrator component. Potential bidders cited uncertainty surrounding health care reform.
Part II GOING FORWARD
Going Forward: OCSE
Going Forward: New Jersey
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
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
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
Waiver Objectives Medicaid program reform and innovation Administrative flexibility Management efficiencies Prudent purchasing Competitive procurement Out of state DD contracts Improved health outcomes
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
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
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
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
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
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
Questions