**COMPLETED GRANTS**

**ARIZONA**

**GRANT DESCRIPTION:** Through a private agency, the State sought to
match medical insurance coverage and medical support orders, using the
new National Medical Support Notice (NMSN).

**GRANT NUMBER**: 90FD0040 -- Section 1115

**SUMMARY**: Initially, Arizona planned to develop and implement a
project that\
would compile information from its automated statewide system (ATLAS)
that identified those cases in which the noncustodial parent (NCP) had
medical insurance available that could provide medical coverage for his
or her children as ordered.  The information from ATLAS was to be used
by a private consulting firm to find medical insurance information for
these NCPs which would allow the Division of Child Support Enforcement
(DCSE) to issue the NMSN and obtain medical coverage, if available, for
those children included in the court order. However, only 7 percent of
cases matched so the project was changed and the State began to work
directly with parents and employers.

**PROJECT FINDINGS**: Beginning in September 2002, ATLAS issued notices
to all 66,937 parents ordered to provide medical insurance, both
custodial parents (CPs) and NCPs. (Arizona child support guidelines
allow the responsibility for medical insurance coverage to be required
from either parent. Therefore, medical support enforcement may be taken
against the CP or the NCP.) The notice gave the responsible parent an
opportunity to provide medical insurance coverage information to DCSE
before the issuance of the NMSN to the parent's employer. (Some cases
contained court orders that required that both parents provide medical
support.) Responses from CPs and NCPs were received with medical
insurance information for 8,909 cases (13 percent) and the insurance
information was entered on ATLAS. The State then sent 31,248 NMSNs to
employers of CPs and NCPs and obtained the following results:

-   2,315 (7 percent) of employers did not have insurance available;

-   2,304 (7 percent) of employers had insurance but the court-ordered
    parties were not eligible;

-   5,931 (19 percent) of employers responded that the children were
    covered by insurance; and

-   11,090 (35 percent) of employers reported that the parties were no
    longer employed at the company.

As a result of sending the NMSNs to employers, 3,285 court ordered
parties (11 percent) requested an administrative review of the State's
enforcement actions.

The unanticipated response to the medical support mailings resulted in
DCSE's establishing a centralized unit to process and respond to the
thousands of responses from court ordered parties and their employers.
These staff received specialized training and were responsible for
updating employment and medical insurance information received as a
result of the mailings.

Arizona learned of several medical support issues during the course of
this project. First, many employers were not familiar with the NMSN
process. Some employers requested that the NMSN be sent to the
employee's union, apparently unaware that it is the responsibility of
the employer to forward the NMSN to the employee's union if appropriate.
In some cases, wage assignments and insurance enrollments are handled by
different entities and, thus, need to be sent to different addresses.
The issuance of NMSNs to employers results in an increase in requests
for administrative reviews. Also, there were many issues with interstate
cases. For example, when the NCP is responsible for medical support and
lives in another State and has medical coverage that does not include
the locale in which the CP and/or children reside, the State is forcing
the NCP to pay for medical insurance that will never benefit the
children.

**CURRENT UPDATE (April 2007):**

 

The results of the grant showed that the private vendor did not have
sufficient information to make these matches a viable part of Arizona's
medical support enforcement.  Instead, the grant showed that the State
had much more success taking its own actions.  So, Arizona is not doing
any data matches at this time.

 

Currently, the State is building a web site for employers to receive and
respond to Income Withholding Orders and NMSNs.  It anticipates that
this project will be completed at the end of 2007.  It is hoping to
connect this web site to the site where employers are allowed to submit
their New Hire data. 

 

**CONTACT:**

Annmarie Mena

<amena@azdes.gov>

602.274.7646

# COLORADO

**GRANT DESCRIPTION:** Colorado proposed to develop an innovative
coordinated approach to increase the number of children in IV-D cases
with healthcare coverage. The project tried to expand on the
recommendations of the Medical Child Support Working Group and to use a
medical support facilitator (MSF) and new automated processes.

**GRANT NUMBER:** 90FD0069 -- Section 1115

**SUMMARY:** The goals of the demonstration project were to analyze the
child support caseload to better understand the current obstacles and
impediments to providing healthcare coverage; develop and pilot new and
innovative processes, collaborations, and automated linkages for medical
child support, Medicaid and SCHIP; increase healthcare coverage for
children within the project area; and analyze the potential for Medicaid
savings by identifying private healthcare coverage options.
Additionally, a data match between the child support caseload and a
master list of insurance eligibility files developed from insurance
carriers was also explored.

Two Colorado counties -- Denver and Mesa -- served as the project
demonstration sites. The primary intervention tested in those sites was
the use of MSFs to: determine whether healthcare coverage was actually
being provided and was consistent with what was recorded on the DCSE
automated system, ACSES; assess which type of healthcare coverage was
available and appropriate for the children -- private, Medicaid or SCHIP
-- if healthcare coverage was not currently being provided; ensure the
children were enrolled in the appropriate coverage type; compare
available private plans and make recommendations for establishing a
medical support order; and monitor the enrollment period to ensure
seamless and continuous coverage.

**PROJECT FINDINGS:** The MSF intervention resulted in a significant
increase in healthcare coverage among enforcement cases. There were no
substantial gains in healthcare coverage among establishment cases
mainly because most of them were already enrolled in Medicaid. Despite
gains in coverage, not all children in experimental cases were insured
at the end of the project. There were a number of reasons for this,
ranging from the parents not being interested in obtaining assistance to
children being ineligible for public coverage to employers not returning
the NMSN.

The data match did increase the number of cases with medical support by
6 percent in the treatment group.  However, much of the information
gained through the match was already known to the child support office.
It is possible that the automated match might have been more useful if
Colorado had not already been getting a lot of information about health
care coverage by using the MSFs to find medical support through more
conventional means such as directly contacting the parents or employers.

There were substantial offsets to Medicaid costs as a result of the MSFs
and the child support enforcement process. The study found that 9
percent of the Medicaid cases worked by the MSFs became privately
insured during the course of the project. If this result could be
replicated statewide, Colorado estimated it could save \$7.6 million in
Medicaid costs per year.

**CURRENT UPDATE (April 2007):**

Improvements to Colorado\'s automated system resulted from the grant. 
These include a periodic letter to the custodial party of the cases not
showing coverage on the system to inquire if medical insurance has been
obtained and an improved system process regarding the receipt of
information from employers after the NMSN was sent.

The State did not continue to use MSFs as specialized workers, but did
incorporate the practices of the MSF into the work of technicians in
each county CSE unit. These practices include contacting both parties
periodically, giving full explanations to them of medical support
available to families such as Medicaid, SCHIP, low cost medical and the
like, and taking steps to ensure that they know how to follow through to
obtain the coverage. Colorado felt that the project provided a good way
to obtain best practices but that the structure of its program did not
lend itself to sustaining specialists to handle medical support.

A medical support workgroup was formed that continues to look at ways to
improve the establishment and enforcement of medical support and to keep
pace with the national trends in this area.

**CONTACT**:

Dan Welch

<Dan.Welch@state.co.us>

303.866.4452

# GEORGIA

**GRANT DESCRIPTION:** Georgia proposed to develop and implement a model
to expand private health insurance coverage through use of volume
purchasing arrangements with private health plans. This would be the
court-ordered option if neither the CP nor the NCP has
employer-sponsored insurance. This approach is a State-specific
modification to a recommendation of the Medical Child Support Working
Group.

**GRANT NUMBER:** 90FD0101 -- Section 1115

**SUMMARY:** Georgia wanted to use its grant to develop an innovative
approach to increase the number of children in IV-D cases with
non-government health care coverage. It contracted with a vendor to
determine the feasibility of creating a healthcare purchasing pool. The
vendor was tasked with analyzing data on income, employment, and health
insurance from both parents to determine the feasibility of creating a
healthcare purchasing pool as well as reviewing Georgia's statutes,
rules and regulations to determine if there were any legal obstacles to
creating such a pool. The vendor also worked with the State to meet with
stakeholders to ascertain the extent of interest in such a pool.

**PROJECT FINDINGS:** The data analysis suggests that a large number of
children in the child support caseload (i.e., 35,000 -- 68,000 children)
are uninsured and would possibly represent the "critical mass" required
to consider the formation of a purchasing pool. However, the analysis
also indicates that a purchasing pool may not be the panacea for all of
the uninsured children in the caseload for several reasons. Some of the
CPs and children live outside the State, so a Georgia health plan could
be considered "out of service area." If the State adopted the model it
studied (based on work done in Sacramento, CA), staff estimate that only
7,500 cases would be eligible for the pool and concluded that it is not
a feasible option at this time. Furthermore, no current mechanism exists
for the Office of Child Support Services to create and implement a
purchasing pool for the purposes of offering private insurance for IV-D
children. So, new legislation is necessary to create such a pool.

**CURRENT UPDATE (April 2007):**

Georgia has an agreement with the GA Dept of Community Health (DCH) to
increase medical insurance for children with Medicaid and
SCHIP (Peachcare). It has a contract with a vendor to enforce medical
insurance and DCH pays the State share for this work.

 

**CONTACT**:

Cindy R. Moss, Director\
Office of Child Support Services\
<crmoss1@dhr.state.ga.us>\
404.657.3851

# MINNESOTA

**GRANT DESCRIPTION:** Minnesota sought to demonstrate a process for
gathering input from stakeholders in the child support process to
improve medical support for children. The purpose of the project was
development of an implementation plan and proposed legislation to
improve the support.

**GRANT NUMBER:** 90FD0048 -- Section 1115

**SUMMARY:** Minnesota's project had several goals. The State contracted
with a vendor to:

-   Identify the extent to which children in the child support caseload
    had medical coverage ordered;

-   Examine efforts the child support program could undertake to assist
    families in identifying and securing coverage for children;

-   Analyze the communication and coordination between the child support
    program and health care assistance programs and make recommendations
    for improvement; and

-   Analyze funding options that might be available to implement program
    models.

The study's recommendations are aimed at maximizing the number of
children in the child support system covered by private health care
(when appropriate to the parent's circumstances) and, where that is not
possible, identifying new methods to increase enrollment in public
programs by creating a seamless system so that children maintain
continuous health coverage.

**PROJECT FINDINGS:** The study made numerous recommendations to the
State to assist its efforts in providing health care for children,
including adopting new guideline provisions for medical support similar
to those developed for the Shared Responsibility model for child support
guidelines. (The Shared Responsibility model was developed as part of
Minnesota's quadrennial review of its child support guidelines and under
this model the responsibility for each component of child support --
basic support, child care support, and medical support -- is shared by
the parents based on their proportionate share of total adjusted gross
income.)

It also recommended legislation that would make enrollment in
MinnesotaCare an option for coordinating health care coverage under
medical support orders and suggested the State develop model language
for medical support orders. It suggested the State should expand efforts
to order and collect cash medical support and examine the feasibility of
creating an insurance pool for children in IV-D cases lacking
appropriate employer-sponsored coverage.

Additional recommendations contained in the report focus on monitoring
and enforcing medical support orders through the life of the child
support case to ensure seamless coverage and maximizing the use of
automated systems to increase efficiencies and support this seamless
coverage. It also recommended increased cooperation and communication
among other Department of Human Services agencies that handle health
care eligibility programs, such as MinnesotaCare and Medical Assistance.

**CURRENT UPDATE (April 2007):**

In 2005, Minnesota's legislature passed Guidelines legislation to
implement an income shares model of support calculations, which uses the
parents' combined gross income to calculate child support. This
significantly changed the way medical support is established and
enforced for actions filed on or after 1/1/2007. These changes include:
medical and dental insurance are included in the term health care
coverage; the custodial parent can be an obligor for purposes of medical
support; and the \$50 medical support obligation provision is no longer
in the statute.

As of 1/1/2007, if health care coverage is ordered the following needs
to be done:

-   Request information from the parents, employers, health plan
    administrators and other sources regarding financial and health care
    coverage information;

-   Determine whether either parent has appropriate coverage available,
    and if so, recommend which parent should be ordered to provide the
    coverage for the joint child based on the requirements of Minnesota
    law; and

-   Calculate worksheets to determine a contribution toward public
    coverage if appropriate health care coverage is not available.

Minnesota law defines medical support to include the following: carrying
health care coverage for a child; contributing to the cost of health
care coverage; contributing to the cost of public coverage; and/or
contributing to the cost of unreimbursed and/or uninsured medical
expenses.

If appropriate health care coverage is available, the order must state
all of the following:

-   Which parent is ordered to provide or maintain the health care
    coverage for the child(ren);

-   The cost of premiums and how the cost is divided between the
    parents;

-   How unreimbursed and/or uninsured expenses will be divided and
    collected by the parents; and

-   The circumstances, if any, under which the obligation to provide
    health care coverage will shift from one parent to the other.

To determine if health care coverage is appropriate, the Child Support
Officer or the court must evaluate the accessibility, comprehensiveness,
and affordability of health care coverage as well as the child's special
medical needs. If appropriate health care coverage is not available, the
order must state whether a contribution for medical support is required.

The order may specify that CPs should apply for public coverage for the
child. However, the Child Support Enforcement Division has no authority
to enforce this provision. In addition, public coverage does not meet
the definition of health care coverage for purposes of medical support
establishment and enforcement.

For more information about the Minnesota child support program and
Shared Responsibility guidelines, go to:
<http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=id_000160#quicklinks>

**CONTACT:**

Lee Krzyzaniak

<Lee.Krzyzaniak@state.mn.us>

651.431.4553

# MONTANA

**GRANT DESCRIPTION:** Montana planned to develop and implement
procedures to initiate enforcement of CP medical support obligations in
appropriate cases to increase the number of children in IV-D cases with
medical coverage.

**GRANT NUMBER:** 90FI0049 -- Special Improvement Project

**GRANT SUMMARY:** Prior to receiving this grant, the Montana Child
Support Enforcement Division (CSED) only enforced medical support
obligations against NCPs, leaving a gap in children's coverage for cases
in which insurance was not available to those NCPs. While Montana laws
allowed for the enforcement of medical support obligations against the
CP as well as the NCP, the CSED had not previously implemented the CP
side of this enforcement authority. The project focused on system
enhancements and procedural changes needed to implement CP medical
enforcement.

The system design built on the existing NCP-only design, creating new
elements as needed to support project field requirements. To accomplish
the technical aspects of the project, the CSED contracted with a vendor
to perform all system design and development tasks.

**PROJECT FINDINGS:** Montana established six evaluation measures for
the project. Of the total number of cases with medical support ordered,
the percentage of those cases in which health insurance coverage is
currently in effect increased from 27 percent to 30 percent. The State
also looked at whether the parent with health insurance credit in the
guidelines is the parent who provides coverage under the NMSN. This
percentage increased slightly, from 72 percent to 74 percent and is seen
to indicate the beginning of a shift toward fairer medical enforcement,
where the parent who obtained a more favorable support amount based on
payment of premiums is the parent whose obligation is enforced.

The third measure looked at the percentage of cases in which the parent
with existing coverage is the parent who provides coverage under the
NMSN. Under this measure, there was an insignificant improvement from 96
percent to 97 percent. The fourth measure looked at the percentage of
cases where NMSN results in coverage. This number rose quite
significantly in the first six months of implementation, from 6 percent
to 28 percent.

The project also looked at the number of cases closed by the CP as a
result of medical enforcement against the CP. While only 9 cases were
closed by CPs during the six months of the study, approximately 200
medical support enforcement actions against CPs were initiated each
month. So the number of case closures was relatively small.

Finally, the CSED estimates the total Medicaid savings for the period of
January through July 2004 to be \$1,743,858. Based on earlier figures,
the CSED estimates that Montana realized an additional \$93,273 per
month in Medicaid cost avoidance since the beginning of the effort to
enforce CP medical support.

**CURRENT UPDATE (April 2007):**

Montana has stayed committed to the policies and procedures developed as
part of this grant, and continues its integrated approach to medical
support enforcement activities, which includes enforcement against
custodial parents in appropriate cases.  Since the conclusion of the
grant, the CSED has offered periodic training to staff on the medical
support enforcement procedures and developed flow charts and Frequently
Asked Questions to assist workers.

 

The CSED\'s ultimate goal with this project was to increase the number
of children with health insurance coverage.  In January 2004, prior to
the start of this grant, the CSED only had 9,008 children documented in
its automated system as having health insurance coverage available.  At
the end of FY 2006, the CSED\'s system reflected that 14,583 children
had health insurance coverage available.   During FY 2006 alone, the
CSED increased the number of children covered by insurance by almost 3.5
percent.  In addition, as reported on the CSED\'s OCSE-157 Report for FY
2006, 47 percent of the CSED\'s cases in which medical support was
ordered had health insurance provided.  While the NCP is still the
primary provider of health insurance coverage, since implementation of
enforcement against CPs, coverage provided by CPs now accounts
for almost 30 percent of the health insurance policies.  Finally, as a
result of the CSED\'s efforts in the medical enforcement area, the CSED
believes that the Montana Medicaid program may realize annual savings
between \$2 and \$3 million.   

**CONTACT:**

Barbara Delaney

<bdelaney@mt.gov>

406.444.1957

# NEW JERSEY 

**GRANT DESCRIPTION:** The project was to conduct a feasibility study of
model review and adjustment procedures for medical support obligations
with an emphasis on collaboration with the New Jersey FamilyCare
Program. (FamilyCare provides free or low-cost health insurance for
uninsured parents with income up to 200 percent of the Federal poverty
level.)

**GRANT NUMBER:** 90FI0028 -- Special Improvement Project

**GRANT SUMMARY:** The study explored the efficacy of using a Medical
Support Facilitator during the review and modification process to
determine the most appropriate healthcare coverage (private or public)
for a child. The study used a test environment to examine the potential
impact of ordering the NCP to meet his or her obligation to provide the
Medical Support Facilitator-determined health coverage through the
payment of cash medical support to the State Disbursement Unit. A cash
medical support guideline was also developed as part of the study. The
study examined the feasibility of automating the collection of the
medical support obligation through income withholding and distributing
the premium payments to either the private provider or to FamilyCare,
the State's public health insurance program. New Jersey wanted to
automate the process as much as possible so that the system established
requires the NCP to make all payments through the State Disbursement
Unit and any missed payments be collected through automated collections
remedies.

**PROJECT FINDINGS:** The study concluded that performance in medical
support and establishment can be enhanced through improved review and
adjustment of support order processes. The enhanced performance is
obtained through automated process efficiencies. Implementation of the
proposed medical support guideline developed during the study and of the
proposed review and modification procedures would garner the following
key benefits:

-   Increased medical support establishment on review and adjustment
    cases;

-   Streamlined processes for establishing medical support orders;

-   Increased percentage of cases with medical support orders;

-   Increased proportion of cases complying with medical support orders;

-   Automated enforcement of medical support orders;

-   Enhanced communication and cooperation between the IV-D agency and
    FamilyCare; and

-   Increased enrollment in FamilyCare.

The study indicates that cash medical support orders ease enforcement
burdens significantly because they allow for greater consistency in
enforcement through automated means.

**CURRENT UPDATE (April 2007):**

See NJ's Section 1115 grant description below

**CONTACTS:**

**State Contact:**

Alisha Griffin

<Alisha.griffin@dhs.state.nj.us>

609-584-5093

Francine Vitagliano

<Fran.vitagliano@dhs.state.nj.us>

609-631-2788

For complete Final Report, please see DCL-03-10, April 23, 2003.

**GRANT DESCRIPTION:** The project sought to increase the number of
child support orders in which medical support was established and
enforced by using intense outreach, a uniform data collection form for
employers and an in-court facilitator to coordinate the Children's
Health Insurance Program (CHIP) application process with the IV-D
agency. The demonstration was to be conducted in Middlesex County.

**GRANT NUMBER**: 90FD0038 -- Section 1115

**GRANT SUMMARY:** The In-Court Facilitator Project was operational in
Ocean County from 10/1/2002 through 8/31/2003. Over the course of 11
months, the Ocean County Family Court and Board of Social Services
worked together to disseminate FamilyCare information to the public.
During this time, the Family Division staff provided a medical insurance
questionnaire/referral form and brochure on FamilyCare to individuals
coming to the Family Division to file a motion. Family Division staff
forwarded completed referrals to the Board of Social Services, where
staff followed up with those clients requesting additional information
and/or services.

**PROJECT FINDINGS:** While the public was able to receive assistance
and information regarding New Jersey Family Care as well as other
programs offered through the Ocean County Board of Supervisors, a
significant number (33 percent) of individuals already had medical
coverage for their children and were not interested in information about
New Jersey FamilyCare.

Of those individuals who were interested in FamilyCare and were sent an
application, over 40 percent did not complete the application. In
addition, almost 20 percent of those who expressed an interest already
had some type of medical coverage. Only three of the 528 people who were
interested actually applied and were granted coverage by FamilyCare.

New Jersey concluded that though the In-Court Facilitator Project did
not produce a statistically significant increase in the number of family
care participants, it proved to be an effective avenue for distributing
FamilyCare information as well as information about other State programs
such as food stamps and the child support enforcement program.

**CURRENT UPDATE (April 2007):**

New Jersey plans to conduct a pilot in three counties using its new
medical support guidelines and In-Court facilitators. However, it is
having difficulty automating the collection and distribution of medical
support payments.

**CONTACTS:**

**State Contact:**

Alisha Griffin

<Alisha.griffin@dhs.state.nj.us>

609-584-5093

Francine Vitagliano

<Fran.vitagliano@dhs.state.nj.us>

609-631-2788

# 

# VERMONT

**GRANT DESCRIPTION:** This SIP grant sought to improve and enhance
systems for assuring affordable health care coverage for children served
by the Vermont Office of Child Support (OCS) by increasing the frequency
of medical support provisions in child support orders; increasing
compliance with those provisions; and increasing enrollment of children
in child support cases in health insurance plans available through the
employers of NCPs.

**GRANT NUMBER**: 90FI0062 -- Special Improvement Project

**GRANT SUMMARY:** Vermont aimed to streamline court and employer
processes by ensuring that medical support is addressed at the time a
child support order is formulated and rendered, thus attempting to
preclude court reappearances by CPs, NCPs, and the OCS staff. The State
tried to produce realistic court orders based on the actual cost of
insurance rather than on estimates. They also sought to minimize
employer contacts and use of resources by accessing health coverage data
via an OCS employer web site. They wanted to reduce Medicaid costs, move
as many children as appropriate off public assistance and onto private
insurance and to preclude third-party Medicaid billing to insurance
companies that have stopped providing coverage.

Vermont's strategies for achieving these objectives included improving
available health insurance data collected by and available to OCS and
Medicaid staff, improving data exchanges between programs, and providing
automated support by enhancing the OCS employer web site with up-to-date
information on employer insurance coverage. The State followed up with
employers required to report on available dependent coverage and tracked
and enforced compliance with medical support orders. It also provided
information to CPs regarding available coverage.

A distinctive feature of the project was the collaboration between the
child support and Medicaid staffs. OCS also partnered with employers to
compile information about private insurance plans that companies offer.

**PROJECT FINDINGS/ CURRENT UPDATE (April 2007):** Vermont is in the
process of gathering information from its data warehouse on the
evaluation measures specified in this project. Since September 2005, the
State registered 479 employers on the website, for a total of 533
registered employers as of March 22, 2007.

**CONTACT:**

Robin Arnell

<Arnell@ahs.state.vt.us>

802.241.2236

# WASHINGTON

**GRANT DESCRIPTION:** Washington proposed to implement two competing
centralized efforts to establish and collect medical support. The
medical support enforcement process was extremely difficult,
particularly in light of changes in employment of the NCP and changes in
insurance providers by employers. At the start of the grant, medical
support was a lower priority than collections of child support payments
for State enforcement caseworkers.

**GRANT NUMBER:** 90FD0079-- Section 1115

**GRANT SUMMARY:** Washington's project had two goals: enrolling more
children in private medical insurance plans and ensuring that private
insurers are covering healthcare costs, wherever appropriate, for
medical support-eligible children in order to reduce claims on the
State's Medicaid program. Washington explored the costs and benefits of
two centralization efforts:

-   Creating a Headquarters Medical Unit (HMU) using existing staff of
    the IV-D division. This approach subscribed to the general
    hypothesis that a centralized approach to medical support
    enforcement would be more effective and efficient than the previous
    process, which left enforcement in the hands of 800 individual
    caseworkers across the State.

-   Contracting with private vendors to conduct matches of child support
    and health insurance records. Through this intervention, the State
    shared child support records with two competing vendors. The vendors
    searched their own proprietary databases to determine whether they
    could find active, or recently terminated, health insurance policies
    held by the NCPs. After verifying matches between the child support
    records and their databases, the vendors returned a list of
    potentially enforceable insurance policies.

**PROJECT FINDINGS:**

The project's findings argued against the implementation of a statewide
HMU in the form it took during the demonstration. The unit's very broad
scope, which addressed all cases with orders for cash support, was not
cost-effective. A more targeted approach which might, for example,
review cases in which the NCP had an order in excess of \$300 per month,
might increase the likelihood of discovering third-party coverage.
However, if Medicaid savings remained the more important goal, then the
HMU could target current and former TANF cases, which are more likely to
involve a child who is, or has been, eligible for Medicaid.

The second part of the project involved matching data with private
companies that maintain large, national databases on health insurance
coverage for individuals. As with the HMU, the goal of the data match
was to find NCPs who either have enrolled or could enroll
Medicaid-eligible children in third-party insurance plans. Each vendor
received 4,000 cases drawn randomly from the statewide caseload of cases
with orders for cash support. This was compared to a control group of
4,000 cases that received standard medical support enforcement. While
one of the vendors showed some success with increasing third-party
coverage, the overall vendor experiment did not result in measurable
Medicaid savings, a reduction in Medicaid claims, or a substantial
increase in third party coverage. However, during the course of the
projects important lessons were learned which could make future matches
more beneficial. Still, it is rare to find NCPs with both access to
health insurance and Medicaid-eligible dependents, so even if these
children were enrolled in private insurance, because there are so few of
them, the potential savings would not be great.

**CURRENT UPDATE (April 2007):**

In November 2005, DCS commissioned an internal workgroup not only to
analyze some of the data results from the grant report, but primarily to
look at the statewide DCS workload needs across medical support
enforcement.  In June 2006, the workgroup presented the DCS Management
Team with a report outlining a variety of issues and barriers.   In
September 2006, the DCS Management Team met with the grant evaluator for
his input on the workgroup\'s report and its connection to the grant
findings.  From all this information, Washington has taken the following
incremental steps to build on the findings and begin removing some of
the barriers:

-   An additional non-permanent position was added to work the \"Third
    Party Liability\" reports received from Medicaid\'s Coordination of
    Benefits (COB) unit;

-   A data extract of 2500+ cases with higher potential for Medicaid
    recovery was provided to the HQ Medical Unit for further review and
    testing.   These cases were ones where the child was on active
    Medicaid and the NCP parent has a support obligation of \$400/month
    or higher and 90 percent of the support due in the past three months
    had been paid;

-   Staff tested the hypothesis (with a case review) that DCS may have
    some gaps in medical coverage caused by incorrect premium limitation
    data on the Support Enforcement Management System, where
    out-of-state orders control medical premium limits.   They found a
    need for data clean-up in this area; and

-   Staff began efforts to enhance the telephone KIDS system and the
    on-line child support payment system so clients can self-report
    updated medical insurance information.

Washington continues to encounter barriers that are gradually being
addressed because of systems changes at the State Medicaid agency,
uncertain medical coverage performance measure data requirements, and
the need for new legislation to allow for the collection of cash medical
support.

 

To view the entire report on this project, go to the following link:
[**http://www1.dshs.wa.gov/pdf/esa/dcs/reports/WA-MSEreport2-28-06.pdf**](http://www1.dshs.wa.gov/pdf/esa/dcs/reports/WA-MSEreport2-28-06.pdf)

**CONTACTS:**

Carol Welch, Ph. D.

<cwelch@dshs.wa.gov>

360.664.5082

Gaye McQueen

360.664.5086

<gmcqueen@dshs.wa.gov>

# WYOMING

**GRANT DESCRIPTION:** Data Warehousing, Data Mining and Capacity
Building: Using data warehousing to improve children's medical coverage
and management effectiveness in Wyoming's IV-D program.

**GRANT NUMBER**: 90FD0061-- Section 1115

**GRANT SUMMARY:** Wyoming had two goals for this project. First, the
State sought to develop and implement a data warehouse containing child
support data derived from the child support automated computer system
known as Parental Obligation System for Support Enforcement (POSSE) to
be used for management reporting purposes. Second, Wyoming wanted to
expand the quality and quantity of medical support data available in
POSSE by enhancing current functionality of the system to include
additional medical support information and upgrading existing interfaces
with the Medicaid agency.

**PROJECT FINDINGS:** By developing and implementing a data warehouse,
Wyoming now has the ability to take a better look at child support data
and implement new strategies on how to use the data to improve Wyoming's
child support performance measures and improve child support service
delivery to children and families. Wyoming has also improved the way the
automated system stores medical support information, allowing case
workers to make better informed decisions on how to establish and
enforce medical support orders.

**LESSONS LEARNED:**

-   When building a data warehouse, the vendor should be located on site
    and dedicated to the project.

-   If enhancing a system to include additional medical support
    information, include the Medicaid Agency and all interested parties
    in all meetings and conversations.

-   Make sure open communication exists across all levels including
    other agencies.

-   Allow for dedicated staff during development and implementation and
    ensure adequate training is conducted.

-   Allow for dedicated staff to maintain a data warehouse after its
    completion.

**CURRENT UPDATE (April 2007):**

On Goal 1, the data warehouse developed by Wyoming's Child Support
Enforcement Unit (through the use of a vendor) currently includes 10
"canned" reports and the functionality to produce various ad hoc reports
using the Esperant query and reporting tool and Excel spreadsheets.  The
Wyoming Judicial District Child Support Offices and the State Office use
these canned reports and functionality to create ad hoc reports as a
management tool to identify specific participant-related reports and
case-related reports to improve casework activity and increase
performance standards.  The District child support offices also use the
data warehouse reports as a means to improve the self-assessment audit
process by creating internal quality control programs to monitor and
audit their own casework based on self-assessment audit criteria.  The
results of this are evident as Wyoming passed all self-assessment audit
criteria with an above 90 percent average across all categories.  \
\
As to Goal 2, the Child Support Enforcement Unit\'s automated system
currently stores medical support order and medical support policy
information in excess of Federal performance requirements.  The system
allows users to record medical support order information such as: who is
ordered to provide medical support; children medical support is ordered
for; and various ordered coverage types.  The system also allows users
to create medical support policy holder information such as: medical
insurance company name; policy number, premium costs, policy type,
policy begin and end dates; recipients of medical support; and various
provided coverage types.  The system allows users to track medical
support ordered and coverages ordered, medical support policy
information and coverages provided and also allows the user to view
medical support orders by child.  Wyoming enhanced the interface between
POSSE and the Medicaid automated system to provide and receive more
efficient medical support information.  

Wyoming has just completed the data reliability audit of data submitted
on the FFY2007 Federal OCSE 157 annual report.  All of the data reported
on Lines 21 and 21a, regarding medical support percentage, was clearly
identified and contained on these new medical support order and medical
support policy screens.  Wyoming Child Support Enforcement believes that
it is ahead of the mark in storing and reporting medical support
information.     

**CONTACTS:**

Jay Mullendore

<JMULLE1@state.wy.us>

307-777-5653

# GRANTS IN PROGRESS

# Michigan

**GRANT DESCRIPTION:** This two-year SIP grant responds to 2005 Priority
Area 4: Health Care Coverage in Child Support Cases. This project is
designed to reduce the number of uninsured children in Michigan.

**Grant Number:** 90FI0075 -- SIP

**SUMMARY:** The project goal will be achieved by automating the process
of identifying child support orders that include healthcare coverage of
the child and collecting data to enable State workers to assess the
options available. Pertinent information (vital records, Medicaid
eligibility, child support enforcement) that resides as unconnected data
in the data warehouse will be cleansed and integrated. The grantee will
also assist in securing the best option for healthcare coverage for the
children. Once the at-risk children are identified, child support orders
will be cross-checked with other state agency information to provide a
complete health insurance profile of the family. This process will
assist local enforcement agencies in targeting the non-custodial parents
to provide the health care coverage required by court order. The grantee
will utilize current technology and existing data as a foundation on
which it could build a file-sharing system that makes use of state
computing equipment and systems that are already in place. Utilizing
data systems currently in place to enhance effectiveness and
communication between agencies could be replicated in other States. The
evaluation plan will focus on how many children gain healthcare coverage
or improve their coverage as a direct result of the new process. The
grantee will work with the Michigan Office of Child Support.

**CONTACT:**

Dana Ashley Green

<GreenDana@michigan.gov>

517.335.8989

# National Council of Juvenile and Family Court Judges

**GRANT DESCRIPTION:** This two-year grant, \"Judicial Tools to Improve
Court Practice in Child Support,\" responds to 2005 Priority Area 2:
Improving Judicial/Administrative Child Support Enforcement Processes.
The National Council of Juvenile and Family Court Judges (NCJFCJ) will
create innovative resources to assist with achieving the goals of the
National Child Support Enforcement Strategic Plan for FY 2005 - 2009
strategic plan that all children have parentage established, have
support orders established, have medical coverage and reliably receive
financial support from parents as ordered.

**Grant Number:** 90F10082 -- SIP

**GRANT SUMMARY:** State court judges are an integral part of the
success of the child support system. The achievement of the Strategic
Plan\'s objectives relies upon judges who are fully informed and
actively involved in ensuring appropriate process service, reducing the
number of default orders, setting appropriate quantum of child support
orders, awarding retroactive support only for appropriate and reasonable
periods, crafting support orders that adequately provide for the medical
support needs of children, and taking a problem-solving approach to
ensure that child support is a reliable source of income for families.

The proposed project will develop three tools: a bench card to improve
court practice in service of process, default orders and retroactive
support; a medical support monograph for judges; and a publication
containing recommendations on improving court practice in integrating
problem-solving court principles into the child support docket. The
project will then pilot the tools, evaluate their usefulness, and revise
them. The finished products will be unveiled at two NCJFCJ-sponsored
national judicial education programs and disseminated nationwide.

**CONTACT:**

Cheryl Lyngar

<clyngar@ncjfcj.org>

775.784.6225

# VERMONT

**GRANT DESCRIPTION:** This seventeen-month project, \"Project UNIMED: A
Unified Approach to Medical Support through Intra-Agency
Collaboration/Data Exchange,\" responds to Priority Area 4: Use of
Specific Collaboration Protocols with Other Agencies, and involves the
development of cooperative protocols among Vermont\'s Child Support,
Medicaid, and Temporary Assistance for Needy Families agencies to
increase and expedite medical support order establishment and
enforcement.

**Grant Number:** 90FD0106 -- Section 1115

**SUMMARY:** The goal of this demonstration is to develop and
demonstrate best practices for the most efficient and effective means of
establishing and enforcing medical support, generating data reports to
answer national questions related to medical support impacts, and
fulfilling OCSE-157 data reporting requirements. Data will be collected
and analyzed on project effectiveness.

**CONTACT:**

Robin Arnell

<Arnell@ahs.state.vt.us>

802.241.2236