## Appendix E: State Plans for Follow-Up

*Accomplishments*

1.  What are the major accomplishments that your State has made to
    further program collaborations over the past year?

*Goals*

2.  What Medicaid/Child Welfare/Child Support Enforcement/SCHIP
    collaboration goals will you work on in the next year?

*Next Steps*

3.  What will be your next steps? Who will take the lead?

*Technical Assistance*

4.  What technical assistance or support do you need from others
    (Regional Offices, Central Office, TA contractors, etc.) in order to
    achieve your goals?

State and/or Tribe:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Participants in Break-Out Session:

Medicaid:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SCHIP:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Child Support:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Tribal Child Support:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Child Welfare:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Federal*:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*

**ALABAMA**

Participants: Zefferene Smith (Medicaid), Ava Rozelle/Turenza Smith
(SCHIP), Diana McCampbell (Child Support), Margaret Bonham (Child
Welfare), Chuck Kenher (Federal)

*Accomplishments*

-   Increased communication and collaboration

-   Increased education and knowledge about each others' programs

-   Child Support/Medicaid match and sharing of employment and insurance
    information

*Goals*

-   Increased enrollment of children served by child welfare and child
    support in the ALL Kids Plus Program

-   Increased medical support orders and provision of medical support
    for children receiving child support services

-   Pursuing development of ALL Kids Plus Program

*Next Steps*

> (DHR to take the lead)

-   Meet with agency representatives and county staff to develop an
    action plan to address systems issues, access and application issues
    and determine outreach methods

-   Educate judges

-   Complete process to join Arkansas consortium

-   Incorporate FPLS policy into revised child welfare legal check list

-   Educate child welfare staff about FPLS usage and protocol

-   ALL Kids provides training during our new staff training

-   Train ALL Kids staff about the child support program

-   Encourage child support staff to establish orders for medical
    support resulting from match with Medicaid

-   Explore using websites for further awareness and education around
    medical support/health insurance

*Technical Assistance*

-   OCSE is giving presentation to child support and child welfare staff
    about FPLS

-   Judicial training provided by OCSE staff

**ALASKA**

Participants: Michelle Lyons-Brown (Medicaid), Rick Romero (Child
Support), Nancy Burns (Child Welfare), Linda Gillett (Federal)

*Accomplishments*

-   Face-to-face

-   CSE established database of employers without health care plans

-   SACWIS/NSTAR interface

*Goals*

-   Information sharing and timeliness

-   Work on timeliness of Termination of Parental Rights (TPR) and
    guardianships

-   Process for receipt of court documentation

-   Enhanced collaboration between Medicaid and child welfare

-   Regular meetings -- Medicaid/Office of Children's
    Services/Department of Public Assistance/Child Support Services
    Division

*Next Steps*

-   Meeting between Office of Children's Services, Child Welfare, and
    Child Support Services Division

-   Determine what data is being shared that is appropriate and what
    data is not being shared that could/should be shared

-   Educate each other -- outreach and education

-   Develop strategy to expand medical support beyond custody kids --
    how to code cases

*Technical Assistance*

-   Buy-in by Department Commissioner

-   Review aging MOAs

-   Technical assistance in determining common data needs (in State)

-   Information on claiming administrative costs for Medicaid and IV-E

**ARIZONA**

Participants: Brenda Pearson (Medicaid & SCHIP), Beth Medici (Child
Support), Jakki Hillis & Mark Schwartz (Child Welfare)

*Accomplishments*

-   Medicaid contacts with PCG -- PCG validates TPS and looks for new
    leads -- info is shared with Health Plans, eligibility orgs, CSE

-   SCHIP and IV-D data sharing

-   IV-E and IV-D interface

-   Family Connections Unit -- Service Integration -- get families
    connected with TANF, Medicaid, CSE, vocational rehabilitation, etc.,
    to prevent children from entering foster care

*Goals*

-   Expedite permanency for children

-   Ensure that the needs of Tribal foster children are met

-   Implement DRA requirements for citizenship and identify verification
    in a manner that does not delay or deny Medicaid benefits to
    children in foster care

*Next Steps*

-   Enhance bi-directional data sharing between IV-E and IV-D agencies

-   Meet with Tribes to ensure that IV-E, Title XIX, and medical support
    services are available and provided to children in Tribal custody

-   Explore cash medical support opportunities

-   Enhance data sharing between CSE and SCHIP Title XIX

*Technical Assistance*

-   Sensible guidance from HHS on DRA requirements for child welfare
    population

**ARKANSAS**

Participants: Carolyn Payrick (Medicaid), Mary E. Smith (Child Support),
Steve Sorrows (Child Welfare), Ron Gardner (Federal)

*Accomplishments*

-   Collaboration Task Force

-   Included other agencies such as Workforce Development

-   Working on IV-E/IV-D interface

*Goals*

-   Enhance IV-E/IV-D information sharing; e.g., insurance information

-   Automated sanction notification to Medicaid

-   FPLS locate requests from child welfare as part of the interface

-   New Hire information to child welfare

*Next Steps*

-   Continue with Task Force

-   Interface meeting next week

-   Child support takes the lead

*Technical Assistance*

-   Continued clarifications from the regional office as Medical Support
    policies change

**CALIFORNIA**

Participants: Bill Walsh (Medicaid), Janette Lopez (SCHIP), Greta
Wallace, Karen Echeverria (Child Support), Sheila Dupuy (Child Welfare),
Dan Baker (Federal)

*Accomplishments*

-   Workgroup established between DSS (Welfare) and DCSS (Child Support)
    re: AIDCODES (resolved AIDCODE issues)

-   Workgroup continues to address broader policy and procedures issues

*Goals*

-   Bring child welfare (IV-E) into existing workgroup

-   Identify common objectives -- share strategic plans

-   Establish on-going collaboration of this group

*Next Steps*

-   DCSS will host a meeting of this group (agencies will bring
    additional representatives as appropriate) -- SCHIP presentation at
    the first meeting

-   Identify data sources among agencies; how to interface and
    restrictions

-   Establish cross-training. DCSS lead -- judicial stakeholders; Child
    Support Directors Association of California training conference

*Technical Assistance*

-   Support for data exchange

-   Assistance with data sources/statewide databases of insurers

-   Funding support for cross-training

**COLORADO**

Participants: Chad Edinger (Child Support), Ted Trujillo (Child
Welfare), Patsy Buida (Federal)

*Accomplishments*

-   Interface between child welfare and child support systems (ACSES &
    TRAILS). Scheduled completion date: December 2006

-   Trained State office level staff of Health Care Policy & Finance
    (HCPF) on child support and what we do

-   Better defined referrals between the agencies. We further developed
    our interface between HCPF and child support, culminating in the
    creation of the IM770 report that lists cases that are shared
    between the agencies in which child support identified the existence
    of private coverage and HCPF learned of through the
    partnership/interface.

*Goals*

-   Director and Office Manager Buy-In and Support -- Illustrate
    potential cost savings through the creation of an analysis similar
    to the Medicaid Cost Savings analysis presented by Massachusetts

-   FPLS categorized individual requests

-   We will collaborate to ensure that we minimize the possibility of
    lapses in coverage for children through formulating policies
    regarding Specific Amounts Medical and a Definition of Reasonable
    that converge with SCHIP/Medicaid eligibility criteria and estimated
    costs.

-   Identify means to improve our data collection abilities without
    duplication of Medicaid (HCPF) efforts

-   Frontline staff training on what to do with information and courts

*Next Steps*

-   Design a decision matrix similar to the one presented by New Jersey
    for use by front line staff

-   More effectively coordinate agency grant involvement. Child Welfare
    and Judicial Department are involved in a Court Improvement Project
    (CIP) grant and Child Support and Judicial Department are currently
    proposing collaboration on a Special Improvement Project (SIP)
    grant. If we more effectively coordinate these projects, we can
    increase our chances of being awarded the grants, increase the
    lessons learned from the grants, and increase and improve the
    outcomes of the grants.

*Technical Assistance*

-   Regional to examine and provide direction for improvement of
    Medicaid/HCP&F and child support relationship

-   NRC for Youth Development can assist child welfare

-   Georgetown Resource Center Grant to better learn how to do it -- Jan
    McCarthy.

**CONNECTICUT**

Participants: Diane Fray (Child Support), Barbara Claire (Child Welfare)

*Accomplishments*

**Child support and Medicaid:**

-   Improved communication between Husky (Healthcare for UninSured Kids
    and Youth) and child support enforcement to increase insurance
    coverage for children

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-   Either through private coverage or cash to cover HUSKY premiums

-   CSE/HUSKY workgroup to improve data gathering

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-   Identified data elements regarding NCPs in early 2005

-   Developed *Interface Helpful Hints,* identifying how to code
    paternity and relationship (Spring 2005)

-   Revised for W348A (Fall 2005) to gather NCP and dependent
    demographics; form was implemented in Spring 2006 along with the
    Medicaid Contact Letter

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-   Developed Medicaid Contact Letter (Fall 2005)

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-   Gathers demographic information about the NCP

-   All Eligibility and child support enforcement staff introduced to
    new form in May 2006 (letter has been implemented in EMS)

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-   Ongoing Best Practices sharing among Regional Offices

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-   One office has already had joint training

**Child welfare and child support:**

-   After Boston meeting, shared the new child support enforcement data
    sheets for obtaining information on NCPs that were developed for
    TANF and Medicaid with child welfare

-   Determined need for policy meetings to discuss referral process and
    information gathering

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-   Held post-Kansas City meeting (child support enforcement and child
    welfare managerial staff, including child welfare chief financial
    officer and child support director)

-   Improved data results in more accurate Federal reporting (e.g.,
    distribution and financial claiming)

*Goals*

**Child support and Medicaid:**

-   Discuss and determine if criteria for referrals to child support
    should be revised

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-   Child support enforcement review Draft ACF IM handed out at Kansas
    City meeting to develop some recommendations to be shared with
    Medicaid regarding appropriate referral criteria

-   Meetings with Family Services Director will be held to discuss such
    recommendations

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-   Streamline data gathering and revise interface

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-   Reduce the number of noncustodial parent screens (currently 12) on
    eligibility automated system (EMS) to improve and make data entry
    easier and more streamlined for eligibility workers' use

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-   Work request is #1 on the pending list of EMS enhancements

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-   On-going training/dialogue in offices with child support and
    Medicaid staff at all levels

**Child support and child welfare:**

-   Discuss and determine if criteria for appropriate referrals should
    be revised

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-   Shared Draft ACF IM regarding recommendations for appropriate
    referrals (locate as well as child support)

-   Seek a uniform approach for child welfare to send productive cases

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-   Develop improved child support enforcement/child welfare interface

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-   Incorporate automated IV-E application with SACWIS

-   More accurate financial claiming and improved distribution

-   Provide child welfare with direct access to child support
    enforcement system

-   August "kick-off" meeting for SACWIS

*Next Steps*

**Child support and Medicaid:**

-   Meeting with Family Services Director (July 2006)

-   Interface workgroup meeting (August 2006)

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-   Discuss the effectiveness of the Medicaid Client Contract Letter and
    348 gathering instrument which were introduced in May 2006

-   Determine if information forums between eligibility and child
    support staff will be needed if assessment determines progress was
    not as expected. Consider additional meetings that enhance
    cross-program understanding, leading to increased accuracy of
    referrals and number of medical support orders.

**Child support and child welfare:**

-   Child support/child welfare policy meeting (June 2006)

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-   Child welfare will make administrative decisions on new appropriate
    referral policies

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-   Child welfare meetings (2006 -- 2008)

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-   Tentative weekly meetings with vendor developing new system

-   Child support will be included in these meetings as appropriate

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-   Child support needs expected to be addressed mid-point in 2-year
    development cycle

*Technical Assistance*

-   Explore child welfare/child support enforcement referral policies
    used by other States

**DELAWARE**

Participants: Nicole Johnson (Medicaid), Troy McDaniel (SCHIP), Gertrude
Holland (Child Support), Carlyse Giddens (Child Welfare), Gary Koch
(Federal)

*Accomplishments*

-   Child support and child welfare system redesign has been initiated

-   Memorandum of understanding between child support and child welfare
    is in process

-   Preliminary meetings between child support and Medicaid to further
    improve data exchanges of TPL and Absent Parent. Additionally, HMS
    (fiscal agent contractor) has been alerted to possibility of new
    role in facilitating this process.

*Goals*

-   Define appropriate referral protocol between partner agencies

-   Child welfare to obtain access to FPLS

-   Develop list of common medical support goals for partner agencies

-   Explore possibility of creating new program to provide medical
    assistance for children transitioning out of foster care (ages
    18-21)

*Next Steps*

-   Coordinate series of meetings specific to information systems
    interface issues (Troy McDaniels)

-   Hold first quarterly collaboration meeting prior to 9/1/06 (Carlyse
    Giddens)

-   Formally involve DSS in collaboration initiative (Carlyse Giddens)

-   Develop cross-training program to share agency specific functions
    with partner agencies (Nicole Johnson)

-   Explore SIP grant application (Gertrude Holland)

*Technical Assistance*

-   SIP grant technical assistance

-   Invite Federal regional staff to attend quarterly meeting

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-   Continued guidance from CMS on best practices and interfaces

-   Involve National Resource Center for Organizational Improvement (at
    University of Maine) to help facilitate first quarterly meeting

**DISTRICT OF COLUMBIA**

Participants: Bette Wolf (Medicaid), Pamela Campbell (SCHIP), Phyllis
McKeiver (Child Support), Ronnie Charles (Child Welfare)

*Accomplishments*

-   Continue to make progress with our initial goals and strategies

-   Continue with cross functional collaborations with Intake and
    Establishment units to increase IV-E cases with regard to medical 

*Goals*

-   Develop training to enhance collaboration before/between Child
    Support/Medical Support/SCHIP/Child Welfare

-   Develop and document process via flow charts to determine linkage

*Next Steps*

-   Schedule and enhance regular scheduled meetings; perhaps quarterly
    (Target first meeting in month of June)

-   Identify other key players/stakeholders who are essential to    
    collaborations

-   Determine Data Elements (each entity and sharing opportunities) 

 *Technical Assistance*

-   Executive level participation and facilitation of quarterly meetings

-   Continued Regional Office technical assistance

-   Explore Best Practices from more advanced States

 

**FLORIDA**

Participants: Hal Bankirer (Child Support), Elizabeth Wynn (Child
Welfare), Carola Pike (Federal)

*Accomplishments*

-   Established Department of Children and Families (DCF)/Child Support
    Enforcement work group

-   Child support agency representative presented an overview of the
    child support enforcement program in a statewide meeting for child
    welfare staff

-   Meeting with significant partners, including Agency for Health Care
    Administration (AHCA) (Florida's Medicaid agency)

*Goals*

-   Continue to invite and encourage AHCA to participate in
    collaborative meetings/workgroups

-   Continue ongoing workgroup collaborations between the child welfare
    and child support enforcement agencies

-   Expand workgroups to include child welfare legal services, Medicaid
    agency, system integration staff (SACWIS and other State legacy
    systems)

-   Examine "inappropriate referrals"

-   Integrate systems as they are developed through the Florida
    Management Team (FMT)

*Next Steps*

-   Reconvene workgroups that have already been established with
    Department of Children and Families (child welfare agency) and
    Department of Revenue (child support enforcement agency). CSE has
    the lead.

-   Integrate systems

-   Develop "appropriate" referrals protocols

-   Clarify who can have access to the Federal Parent Locator System,
    State Parent Locator System; specifically, whether community based
    care providers can use these systems

-   Expand use of the Federal Parent Locator System and State Parent
    Locator System, as appropriate

-   Child Support Enforcement/DCF continue working on Foster Care
    initiative

*Technical Assistance*

-   Follow up in four months

-   Other assistance to be determined in the future

**GEORGIA**

**          **

Participants:  Roxanne Jefferson (Child Welfare), Diedria Bolden and
Nancy Durden (Medicaid), Rebecca Kellenberg (SCHIP)

*Accomplishments*

-   National Medical Support Notice enforcement project -- a
    collaborative effort among Medicaid, SCHIP and Office of Child
    Support Services

*Goals*

-   Foster care pilot project to streamline the referral process, obtain
    more orders for support, and have paternal families become
    custodians

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-   Medical support -- cash payment

-   Identify fathers and their families who could be caregivers through
    common data systems

-   Referral process for child welfare

*Next Steps*

-   Continue with workgroups, pilots and medical enforcement

    -   Contact: Cindy Moss

    -   Set up meetings: Anita, Marianne, Yvonne

*Technical Assistance*

-   Need to change Medicaid regulations to require pursuit of child
    support if receiving Medicaid

**GUAM**

Participants: Sheree Blas (Medicaid), Pauline R. Chaco (Child Support),
Linda Rodriguez (Child Welfare), Wendy Gray (Federal)

*Accomplishments*

-   Met with stakeholders to jump start our collaboration effort

-   Established contacts within the programs

*Goals*

-   Goals have not changed since last year

*Next Steps*

-   Implement the goals

-   Set monthly meetings

*Technical Assistance*

-   Help from regional offices

-   Training assistance from the different programs

**HAWAII**

Participants: Pearl Tsuji (SCHIP), Amy Tsark (Child Welfare), Elizabeth
Trias (Federal)

*Accomplishments*

-   Child Welfare Services Branch (CWSB) executed a Memorandum of
    Agreement with Child Support Enforcement Agency (CSEA) regarding
    CWSB's access to the FPLS

*Goals*

-   Begin collaboration meetings to identify mutual projects

*Next Steps*

-   Convene a meeting with Medicaid, Child Welfare Services (CWSB), and
    CSEA directors to report back on the Salt Lake City Collaboration
    Meeting

-   Continue to pursue cash medical support, which was a goal from last
    year

*Technical Assistance*

-   Child support regional office

**IDAHO**

Participants: Peggy Cook (Medicaid), Kathleen Clark (Child Support), Wes
Engel (Child Welfare), Katie Donley (Federal)

*Accomplishments*

-   When to pursue Birth Costs and amounts

-   Formation of cross-program workgroups

-   Children and Family Services accessing Child Support Services
    genetic testing contract

-   Child Support Services present at Children and Family Services
    Division Meeting

-   Locate unit -- Diligent Search

*Goals*

-   Appropriate referrals defined -- policy/standards meet program needs

-   Coordinate Third Party Recovery Unit with child support medical
    support

-   Explore cash medical support options

*Next Steps*

-   Convene work group -- restructure membership

-   Third Party Recovery to managers

-   Cash Medical Support to managers

-   Med Support group -- Medicaid representative

*Technical Assistance*

-   Not sure yet -- possibly run our concepts past Federal
    representatives to make sure we're on the right path (all programs)

**ILLINOIS**

Participants: Barb McDermott (Child Support), Erwin McEwen (Child
Welfare), Mike Vicars (Federal)

*Accomplishments*

-   Fatherhood initiative -- downward modifications to Illinois
    Department of Corrections noncustodial parents

-   Department of Human Services, Department of Children and Family
    Services, Department of Healthcare and Family Services dealing with
    employment/training providers and child welfare issues

-   Meeting with Medicaid to review our referral process

*Goals*

-   After ALL Kids is implemented, further review of referrals

-   Further child welfare links

-   Set up measurements in performance

-   Program direct service

*Next Steps*

-   Summit with providers handling specific services for males (Dept. of
    Children and Family Services taking lead)

-   Finish how to better utilize the shared data

-   Continue meeting with Medicaid to take proactive approach to
    reimbursement

-   Division of Child Support Enforcement work with Third Party
    Liability unit to gain better understanding of reimbursement

-   Rewrite DCFS diligent search policy

*Technical Assistance*

-   DCSE needs definitive "reasonable cost" regs

-   DCFS front-end configuration for diligent search effort (tech
    support)

-   Need further technical support on getting child welfare department
    the information from the Federal Parent Locator Service/State Parent
    Locator Service (FPLS/SPLS)

**INDIANA -- did not attend**

**IOWA**

Participants: Mike Baldwin (SCHIP), Carol Eaton (Child Support), Mary
McKee (Federal)

*Accomplishments*

-   SCHIP, Medicaid and child support now [all]{.underline} have
    legislation to obtain health insurance information from insurance
    carriers

-   Good collaboration has occurred between child support, Medicaid and
    SCHIP

-   Many meetings have been held between child support and Medicaid
    regarding data matches, quality of data, streamlining of forms, etc.

Goals

-   Coordinate exchange of health insurance information among Medicaid,
    SCHIP and child support

*Next Steps*

-   Child support has established a workgroup with Medicaid to discuss
    exchange of information from insurance carriers

-   Discuss whether additional groups should be brought to the table

*Technical Assistance*

-   Medical support regulation

**KANSAS**

Participants: Scott Brunner (Medicaid and SCHIP), Monica Remillard
(Child Support), Cathy Hubbard (Child Welfare)

*Accomplishments*

-   Progress on child support enforcement medical support guidance to
    aid staff in working medical cases

*Goals*

-   Identify how the Kansas eligibility system receives updates on TPL
    and other insurance. Medicaid currently has a vendor actively
    searching for private medical insurance on Medicaid recipients. How
    can this info be shared?

-   How to transfer funds received by child support enforcement from
    cash medical support orders to the Medicaid agency?

*Next Steps*

-   Describe the referral process between Social and Rehabilitation
    Services and the Health Policy Authority for cases to child support

-   Investigate Arkansas Health Insurance Data Match Consortium

-   Identify how automated system (KAECSES) differs between Medicaid and
    Healthwave (Federal SCHIP).

*Technical Assistance*

-   CMS guidance on the maximum amount for a Medicaid or SCHIP
    collection on a cash medical support order

**KENTUCKY**

Participants: Nici Gaines (Medicaid and SCHIP), Monte Gross (Child
Support), Peggy Arvin (Child Welfare)

*Accomplishments*

-   DRA -- Strengthened HIPP program

-   On 5/3/06, KY obtained a State Plan amendment (SPA) for its Medicaid
    program, becoming one of the first States to utilize new options
    available through the DRA. Under the plan, the State will enroll
    most of its current Medicaid population into four targeted benefit
    plans and utilize new options to increase cost sharing and expand
    access to community-based long term care services. However, the
    State still needs waiver approval for some changes proposed in the
    plan. Through these changes, the State is seeking to "improve health
    status; ensure people receive the right care, in the right setting,
    at the right time; ensure the solvency of KY Medicaid, and transform
    KY Medicaid into a 21^st^ Century Health Care System." The State
    expects these changes to generate \$1 billion in savings over the
    next seven years. These changes could have significant implications
    for beneficiaries and providers and provide an early example of how
    States can use the new benefit, cost sharing and home and
    community-based services options in the DRA.

-   Opt in to private insurance

-   Meeting among three major agencies in the Fall -- have established
    automated process to give TPL data to Medicaid from DCS

*Goals*

-   Communication among the agencies

-   Educating each other about individual programs

-   Sharing information between agencies through systems

-   Get OIG involved to conduct audits and investigate abuse of Cabinet
    programs

*Next Steps*

-   All point persons here will go back and educate themselves about
    each area

-   Make this a priority

-   Set up meeting among all agencies

*Technical Assistance*

-   Not sure yet

**LOUISIANA**

Participants: Rhett Decoteau (Medicaid), Robynn Schifano (SCHIP), Lisa
Andry (Child Support), John McInturf (Child Welfare), Andrew Hagan
(Federal)

*Accomplishments*

-   Medicaid/Child Support online inquiry access to Medicaid

-   Automated Interface Meeting to discuss interface

-   L'CHIP -- Screen for eligibility part of new Sept. (Public can do
    this.)

-   Arkansas Consortium

-   Screen for need with client

-   Central Registry in IV-D state office for foster care referral

-   Legislative Mandate -- "No Wrong Door"

-   Substance Abuse person in child welfare office

*Goals*

-   Collaborative meetings

-   Refine referral process with both Medicaid and foster care

-   Actually implement locate collaboration with foster care agency

-   Training staff in each agency about other programs

-   Shreveport model for IV-E and IV-D

-   Use Medicaid funds to help IV-E with Mental Health children

-   Health Insurance for Medicaid clients -- Premium Assistance Program

*Next Steps*

-   Get meeting scheduled - Lisa

-   Include referral issue in Medicaid Process Improvement
    Collaboration - Robynn

*Technical Assistance*

-   FPLS -- already foster care technical assistance

**MAINE**

Participants: Rosalie Masur (Medicaid), Barbara Van Burgel (Child
Support), Matthew Ruel (Child Welfare)

*Accomplishments*

-   Maine has made headway in merging the information and technology
    systems for child support enforcement, Medicaid, SCHIP, child
    welfare, and TANF

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-   Established the Office of Information Technology (OIT)

-   OIT has merged systems for all programs

-   CSE interfaces with Automated Client Eligibility System (ACES) for
    TPL information obtained by a vendor

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-   CSE/CW initiative to establish a child support order in every case
    referred by child welfare

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-   Collaborate to establish appropriate referral criteria

*Goals*

-   Join Arkansas Consortium for health insurance match data

-   Obtain Federal guidance on acceptable documentation to verify
    citizenship

-   Schedule regular monthly meetings to ensure appropriate business
    rules are applied to the OIT process

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-   Ensure the system addresses issues vital to all programs

-   Write rules/policies in accordance with each program's business flow
    chart

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-   Staff training and policy implementation

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-   Follow through on IT changes -- moving from mainframe-based system
    to Oracle environment

-   Ensure programs can interface in new environment

*Next Steps*

-   Federal guidance on acceptable documentation for verification of
    citizenship

-   Delay implementation of citizen verification requirements for one
    year

-   Waive work participation audit findings for one year from the date
    Federal guidance is provided to States

-   Amend the rule to accept self-declaration

**MARYLAND**

Participants: Barbara Washington (Medicaid), Alanzo Robinson (SCHIP),
Dianna McCulloh (Child Support), Carnitra White (Child Welfare)

*Accomplishments*

-   Ongoing collaboration with Mental Hygiene Administration, Governor's
    Office for Children, and Mental Health Providers around mental
    health needs for children in child welfare system

-   Ongoing collaboration meeting among Medicaid, SCHIP, and child
    support enforcement

*Goals*

-   To ensure health coverage/medical support to as many Maryland
    children as possible

*Next Steps*

-   Clarify legal/confidentiality issues when exchanging information
    among Medicaid, child support and child welfare agencies (child
    support lead)

-   Educate child support and child welfare about automated systems to
    locate NCP and other relatives (child support/child welfare lead)

-   Educate Medicaid, child welfare, child support regarding needs and
    gaps and explore "Medicaiding" mental health services for children
    (child welfare)

-   Explore extending Medicaid to former foster care children over the
    age of 18 who don't attend college -- similar to Arizona (child
    welfare)

-   Explore information sharing of Medicaid's third party liability
    insurance information with child support (child support)

*Technical Assistance*

-   Technical assistance required regarding Federal requirements for
    extending Medicaid to former foster care children over the age of 18
    who don't attend college (Arizona accomplished this.)

**MASSACHUSETTS**

Participants: Colleen Murphy (Medicaid), Melissa Cummings (Child
Support), Chuck Kenher (Federal)

*Accomplishments*

-   The State child support and Medicaid agencies have collaborated on
    medical cost savings strategies through regular, high-level staff
    meetings since 1996

-   Cash medical support legislation

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-   Legislation drafted by the IV-D agency requiring NCPs without
    available health insurance to reimburse Medicaid costs was filed in
    May 2006.

-   Legislative public hearings began on June 13

*Goals*

-   Appropriate Medicaid referrals

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-   Child support and Medicaid to develop meaningful criteria designed
    to refer productive and meaningful cases

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-   Implement cash medical support, if enacted

-   Child support/ Department of Social Services (DSS) collaboration

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-   Develop criteria for appropriate referrals

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-   Develop interface between child support enforcement and child
    welfare systems that gives DSS the ability to process locate
    inquiries electronically

*Next Steps*

-   Invite DSS to future child support enforcement/Medicaid
    collaboration meetings

-   Appropriate reporting of child welfare locate requests

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-   Review child support enforcement data reporting procedures to ensure
    accurate reporting of child welfare locate requests

*Technical Assistance*

-   Technical assistance regarding electronic medical support notice and
    electronic referrals from Medicaid to child support

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-   Technical assistance from Vermont re: electronic NMSN

**MICHIGAN**

Participants: Jane Alexander (Medicaid), Marilyn Stephen (Child
Support), Jim Hennessey (Child Welfare), Linda Lawrence (Federal)

*Accomplishments*

-   Department of Community Health SIP grant

-   Expansion of NMSN process to additional counties

-   Foster care/mental health purchasing agreement

*Goals*

-   Cost savings presentation to "sell" collaboration

-   Flexibility in child support use for foster care kids

-   Medicaid for kids aging out of foster care

-   FPLS and SPLS and foster care cases

*Next Steps*

-   Additional meeting in Michigan -- Jim Hennessey

-   Cost savings presentation -- Jane Alexander

-   Bring flexibility in child support use to existing committee --
    Marilyn Stephen

-   Medicaid liaison -- Marilyn Stephen

*Technical Assistance*

-   Coordination of Medicaid caps and reasonable cost for IV-D

-   May need waiver on child support and kids aging out of foster care

-   Can the Federal office provide data about insurance match, use of
    FPLS for foster care, collection of birthing expenses?

**MINNESOTA**

Participants: Kathy Henry (Medicaid), Wayland Campbell (Child Support),
Pam Carson (Federal)

*Accomplishments*

-   Had negotiations over a medical matching policy

-   Upgraded Minnesota medical support statutes in collaborative effort
    with Medical Assistance staff

*Goals*

-   Organize health care administration to analyze savings through
    collaborative efforts (Kathy)

-   Touch base with Arkansas matching program (Wayland)

-   Dedicate resources from all three areas

*Next Steps*

-   Talk to Chuck Johnson (WC)

-   Follow up with Arkansas (WC)

-   Set up meeting with senior management team (Kathy)

*Technical Assistance*

-   Put eligibility on Technical Assistance Group agenda to clarify
    referral policies (Kathy)

-   Investigate whether there are any outstanding issues with health
    care (Wayland)

**MISSISSIPPI**

Participants: Betty Williams (Medicaid & SCHIP), Sherry Taylor (Child
Support), Rosalyn Wilson (Federal)

*Accomplishments*

-   Face-to-face meetings have been scheduled to work on interfacing the
    Medicaid and Child Support Enforcement systems

-   Testing will begin between December 2006 and January 2007

*Goals*

-   Tentative implementation of the interfacing of the systems for
    February 1, 2007

-   Gather information regarding the Medical Support Consortium

*Next Steps*

-   Provide training and education for each agency

-   Develop memorandum of understanding with sister agencies

*Technical Assistance*

-   Guidance regarding what information can be released to other
    agencies

**MISSOURI**

Participants: Chris Reeter and Charles Bentley (Medicaid and SCHIP),
Laura O'Mara (Child Support), Paula Neese (Child Welfare)

*Accomplishments*

-   Improved access to dental care for children in child welfare system
    (as presented in conference)

-   Had medical support vendors in for presentation on services
    available

-   Talked with other States to obtain cost estimates for privatized
    medical support enforcement services

-   Started sampling to determine potential cost savings for the
    Medicaid program related to medical support enforcement activities

-   Started discussions between child support and child welfare on
    electronic sharing of locate information

-   Child support staff assisted child welfare with locate tools for
    diligent search efforts

*Goals*

-   Continue efforts for improving access to dental services

-   Prepare budget item for next year's budget for contracted services
    for health insurance data matching and medical support enforcement

-   As child welfare brings up SACWIS, finalize plans for the sharing of
    locate data between child support and child welfare agencies through
    electronic means

-   Improve existing interface that shares health insurance information
    between child support and Medicaid agencies

-   Review the health insurance questionnaire that accompanies the
    National Medical Support Notice to see if requesting additional data
    would be helpful to the Division of Medical Services

-   When children cannot be enrolled in employer-sponsored health
    insurance because of withholding limitations under the Federal
    Consumer Credit Protection Act, refer such cases for possible
    participation in the Health Insurance Premium Payment (HIPP) program
    to see if cost-effective for State to pay the premium

-   Refer cases to the HIPP program when the custodial party is ordered
    to provide insurance, appears to have it available through
    employment and the children are on Medicaid

-   Start discussions/research on possibility of establishing cash
    medical support orders

*Next Steps*

-   Continue work in progress on improving access to dental care for
    children in child welfare system -- leads/Division of Medical
    Services and Children's Division

-   Determine potential cost savings to Medicaid program for enhanced
    medical support services -- leads/Division of Medical Services and
    Child Support

-   Decide upon privatized medical support enforcement services the
    State will seek and prepare budget item for next year's budget --
    leads/Child Support and Division of Medical Services

-   Work on enhancements to existing Medicaid/Child support interface
    for exchanging health insurance data-- leads/Child Support and
    Division of Medical Services

-   Establish process for referring cases from Child Support to the HIPP
    program -- leads/Child Support and Division of Medical Services

-   Initiate research on possibility of establishing cash medical
    support orders -- lead/Child Support

*Technical Assistance*

-   Would like to see health insurance data match at the Federal level

**MONTANA**

Participants: Kathe Quittenton (Medicaid), Katherine Buckley-Patton
(SCHIP), April Armstrong (Child Support), Bruce Deitle (Child Welfare)

*Accomplishments*

-   Legal Summit in July '06 -- endorsed by Justice Karla Gray and
    focused on district court judges, attorneys, guardians ad litem, and
    child welfare workers to focus on protection of children.

-   Expanded MA resource limit to \$15,000 after 7/1/06. Open more slots
    in CHIP.

-   Expanded SCHIP with additional mental health services for children
    with serious emotional disturbance.

-   Also discovered consequences: effectiveness of CSED medical support
    orders causes dis-enrollment from SCHIP and alternate insurances do
    not offer coverage equal to SCHIP

-   Unintended consequence is proliferation of substandard insurance
    carriers who provide child-only policies with unacceptably high
    deductibles and few covered items but affordable monthly premiums.

*Goals*

-   Ongoing networking -- verifying alternate information re: programs
    on each website

-   Quarterly meetings and invite our partners to all conferences

*Technical Assistance*

-   Would like to have collaboration meetings held every year

**NEBRASKA**

Participants: Pat Darnell (Medicaid), Deb Scherer (SCHIP), Daryl Wusk
(Child Support), Barbara Cotterman & David Aerts (Federal)

*Accomplishments*

-   Initiated a contract with PCG to initiate match to local health
    policies

-   Successful at posting cash support to Medicaid

-   Collaboration in procurement of MMIS -- includes child support
    enforcement staff

-   Applied for 1115 grant for cross-training child welfare staff on
    medical support

*Goals*

-   Improve disconnect between CHARTS-NFOCUS-MMIS (Medicaid)

-   Implement PCG contract

-   Cross-train child welfare workers via 1115 grant to include medical
    support

*Next Steps*

-   CSE -- terminate order administratively if the child goes home

-   PCG -- determine data exchange and benefit to Medicaid

-   If obtain 1115 grant -- develop and implement training

*Technical Assistance*

-   Collaborate with courts for child support enforcement orders

-   Review systems for data exchange

-   Regional office will provide technical assistance for questions and
    assist to find other States that have been successful

-   Technical assistance funds through child support enforcement
    technical Federal contractors

**NEVADA**

Participants: Elizabeth (Betsy) Aiello (SCHIP), Leslee Arnold (Child
Support), Theresa Anderson (Child Welfare), Beverly Binkier (Federal)

*Accomplishments*

-   Developed collaborative diligent search policy -- includes
    communication with child support but need input from child support

*Goals*

-   Review use of SCHIP for families of children re-unified from child
    welfare

-   Support marketing campaign HIFA waiver

-   Improve collaboration among child support, SCHIP, and child welfare

*Next Steps*

-   Create steering committee -- blessing from Administrators --
    Kick-off meeting

-   Bring Child Support Policy revision work group for diligent search

-   Revisit Medicaid referrals

-   Review State Administrative Office of the Court-- Court Improvement
    Project to expand to address court orders -- develop guide

-   Referrals to child support

-   Child support custodian referrals in which NCP will pay the premium

-   Medicaid review child welfare's efforts to increase medical/dental
    services

-   Look at duplicative effort

-   Cross-training -- SCHIP & Medicaid 101; Medicaid and Child Support
    101; Develop curriculum for social workers

-   Look at CPS support orders, appropriate CSE referrals, exchanging of
    information, cross-training, and how to use Nevada Check-up for our
    NCP's with no available insurance for their children.

*Technical Assistance*

-   Beverly Binkier (region) to provide technical assistance

-   More of the national meetings

**NEW HAMPSHIRE**

Participants: Sarah Kourian (Child Support), Debra Pelissier (Child
Welfare), Wendy Lynn Gray (Federal)

*Accomplishments*

-   ACF/CMS Medical Support Conferences

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-   Meetings in Boston and Kansas City helped initiate collaboration
    among child support, child welfare and SCHIP staff

-   Child support enforcement and child welfare do not meet regularly

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-   Developed process for child welfare access to FPLS

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-   To overcome restrictions on use of child support enforcement data,
    enacted State legislation to permit sharing of child support
    enforcement information with the child welfare agency

-   Completed programming to create child welfare/child support
    enforcement interface to process locate requests

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-   Medicaid/SCHIP referrals

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-   Child support enforcement began meeting with TANF agency (determines
    Medicaid eligibility) to develop protocols for appropriate referrals

-   Child support enforcement also began meeting with SCHIP agency to
    develop/refine simplified referral process

*Goals*

-   Complete implementation of child welfare/child support enforcement
    electronic interface for FPLS data

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-   Develop appropriate use protocols

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-   Identify SCHIP-eligible kids for child support enforcement

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-   TANF to identify SCHIP eligibility

-   More accurate child support enforcement case coding

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-   Develop appropriate child welfare and Medicaid case referral
    protocols

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-   Primary goal of child support enforcement/TANF/child welfare
    collaboration meetings

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-   Submit modified confidentiality legislation to provide greater
    inter-agency data sharing leading to more appropriate and timely
    referrals

-   Automate NMSN process using interfaces

*Next Steps*

-   Continue child support/child welfare meetings

-   Continue child support enforcement and TANF (Medicaid eligibility)
    meetings

-   Continue SCHIP meetings

*Technical Assistance*

-   Legislators

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-   Sponsorship of legislation to enhance authority for information
    sharing among child support enforcement, child welfare, and Medicaid

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-   Federal support

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-   Continue Medical Support Collaboration Meetings, either at Regional
    or wider levels

-   More lenient Case Closure criteria for Medicaid-only cases

-   Database of employers carrying insurance

-   OCSE Medical Insurance data match program

-   Written compendium of best practices/lessons learned from other
    States

-   OCSE definition of "reasonable cost"

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-   System interface

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-   Technical assistance to enhance interfaces with the other divisions
    within DHHS that have cross-child support enforcement issues

**NEW JERSEY**

Participants: Elena Josephick (Medicaid), Heidi Smith (SCHIP), Alisha
Griffin (Child Support), Karen Baldoni (Child Welfare)

*Accomplishments*

-   Instituted more regular communication and developed a proactive
    partnership with Medicaid

-   Increased information sharing between child support and Medicaid to
    ensure more accurate and current information on systems

-   Provided information on family care to clients through NMSN

-   Implemented Medicaid/ ACSES matching enhancements

-   Identified areas requiring follow-up to ensure privacy safeguards
    with Medicaid are implemented

-   Identified action items for Insurer Medical Provider Tables (IMPT)
    in NMSN

-   Maintained regular communication between child support and child
    welfare; expanded stakeholder base

-   Participated in SIP grant with the Center for Policy Research (CPR)
    for enhanced child welfare collaboration

-   Attended two day child support /child welfare conference

-   Created child support /child welfare action plan to operationalize
    outcomes from conference

*Goals*

-   Continue regular meetings with Medicaid to ensure progress is
    maintained and partnership remains strong

-   Monitor Medicaid matching enhancements for sustained efficiency

-   Develop procedures for privacy safeguards cases with Medicaid

-   Develop a process for collection and distribution for Medicaid and
    Family Care

-   Improve insurer medical provider tables

-   Continue regular meetings with child welfare to ensure progress is
    maintained and partnership remains strong

-   Participate in IV-D / IV-E collaborative pilot in Camden County

-   Implement training for Camden County and State staff

-   Develop a IV-D / IV-E referral structure

-   Monitor timeline for implementing action plan from grantee
    conference

-   Update DFD/Medicaid cooperative agreement

-   Develop procedures for privacy safeguards cases with Medicaid

-   Develop a process for collection and distribution for Medicaid and
    Family

Care

-   Create a three-county pilot Medical Support Facilitator Project with
    Medicaid

-   Fully implement the child support/child welfare action plan

-   Assist in creation of child support / child welfare module in New
    Jersey

Child Support Institute training

*Next Steps*

-   DFD, OCSS/Medicaid meeting to track progress and proceed with action
    items scheduled early 2007

-   DFD, OCSS/child welfare meeting to review training presentations and
    action plan scheduled for early 2007

-   DFD/OCSS lead is setting up meetings with Medicaid to update the
    DFD/Medicaid Memorandum of Understanding

*Technical Assistance*

-   Development of a federal reporting database of insurers for matching
    purposes against (similar to New Hires for employers)

-   Federal policy to prevent insurance companies from sending NCPs
    explanation of benefits statements when privacy safeguards are in
    effect

-   Directions for collecting cash medical support to reimburse
    Medicaid/ Family Care

-   Collaboration with SIP grant recipient (The Center for Policy
    Research) for training material

**NEW MEXICO**

Participants: David Tafoya (Child Support), Teresa Larson (Child
Welfare)

*Accomplishments*

-   Preliminary meetings with all parties have taken place

*Goals*

-   Continue to work with the judicial system

-   Continue IV-D and IV-E quarterly work group meetings

-   Improve coordination/communication among local staff (IV-D, IV-E,
    Medicaid)

-   Identify and fund systems changes

*Next Steps*

-   Finalize MOUs

-   Continue work groups

*Technical Assistance*

-   Continue national meetings and information sharing

**NEW YORK**

Participants: Donna Mazzeo (Medicaid), Cheryl Morris (Child Support),
Dianne Ewashko (Child Welfare), Tom Miller (Federal)

*Accomplishments*

-   Collaboration between Medicaid and child support successful in
    obtaining health insurance information. Data matching health
    insurance information for IV-D kids and sharing health insurance
    information for Medicaid-eligible children referred to child
    support.

-   Analyzed medical support process to improve response rates for those
    employers who failed to respond to NMSN or provide an update for a
    waiting period indicator. Primary focus of responses involved
    understanding the NMSN and related requirements.

-   Collaboration between child support and child welfare successful in
    sharing information through FPLS. Implemented process to obtain FPLS
    location information for child welfare.

-   Collaboration between SCHIP and child support initiated. A data
    match with SCHIP resulted in 16,000 matches.

*Goals*

-   Improving NMSN

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-   Working on updating internal notices which accompany NMSN to address
    concerns raised in analysis

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-   Analyzing non-compliance for medical support

-   Continuing collaboration between child support and SCHIP to obtain
    health insurance information

-   Finalize collaboration between child welfare and child support in
    further sharing of location information through State Parent Locator
    Service

-   CONNECTIONS interface which will provide an automated exchange of
    information among child support, child welfare, and Medicaid

-   Review the issue of cash medical support for Medicaid cases

-   Finalize the new child support application to meet current needs for
    the various programs

*Next Steps*

-   Review referral process to determine appropriate referrals in
    association with the Connections system interface

-   Child support to further collaborative efforts with SCHIP by
    establishing a meeting with SCHIP

*Technical Assistance*

-   Long-range translation of forms/applications

-   Possible assistance with the appropriateness of referrals

-   More Federal support for children 18-21 leaving foster care

-   NMSN -- suggested revisions to clarify "waiting periods" and
    "terminations"

**NORTH CAROLINA**

Participants: Cinnamon Narron (SCHIP), Barry Miller (Child Support),
Keith Davis (Child Welfare)

*Accomplishments*

-   January '06 collaboration meeting (child support, Medicaid, and
    child welfare). Included field staff, program staff, and managers of
    programs

*Goals*

-   Schedule two meetings

-   Establish statewide criteria for referrals to child support

-   Establishing process/criteria for parent location only referrals; in
    addition, a process for locating relatives

-   Modify CSE automated system to accommodate the interface changes
    needed

*Next Steps*

-   Scheduling next collaboration meeting -- child support takes lead

-   Setting meeting agenda

-   Expanding information on noncustodial parent for SCHIP health
    insurance

*Technical Assistance*

-   Being available as needed (resource) when there is an issue

Note: Biggest thing -- not a one size fits all approach (e.g.,
appropriate/ inappropriate referrals)

**NORTH DAKOTA**

Participants: Camille Eisenman (SCHIP), Mike Schwindt (Child Support),
Betty Strecker (Federal)

*Accomplishments*

-   Developed workgroup based on Lewin Project, expanding group and
    adapting to North Dakota

-   Tying all of this work into OCSE and Department of Human Services
    Strategic Plan

-   Medicaid, Foster Care, Child Support -- changes to certain processes

*Goals*

-   Implementing Lewin curriculum statewide to meet North Dakota's needs

-   Continue efforts with Parental Employment Pilot Project (JOBS, child
    support enforcement and courts)

-   Enhance collaboration among all programs

*Next Steps*

-   Child support as lead with:

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-   Executive Director -- DHS of N.D. -- lending support

-   Program Division Directors -- providing direct support

-   Program Staff -- actual work

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-   Need to develop formalized work group

*Technical Assistance*

-   Questions answered re: Medicaid flexibility, etc., from Federal
    programs

-   What flexibility is there in child support for case closure?

-   Updates of other States' progress

**OHIO**

Participants: Tracy Williams (Medicaid), Joe Pilat (Child Support),
Jessie Tower (Child Welfare), Carolyn Wilson-Hurey (Federal)

*Accomplishments*

-   Various interdepartmental workgroups discussing mutual issues of
    concern

-   Not all programs were present for 2005 meeting

*Goals*

-   Agreed to meet at the deputy level on a bi-monthly basis to examine
    issues, review rules and regulations, look seriously at a cash
    medical contribution, data sharing

-   Discuss with legal; look at appropriate referrals

*Next Steps*

-   Medicaid and child welfare to meet and determine appropriate
    definitions for case referrals to the Office of Child Support --
    Lead: child welfare and Medicaid director

-   Examine potential for a budget initiative on cash medical -- Lead:
    OCS and Medicaid director

-   Prepare a draft agenda for first meeting to occur in 45 days --
    Lead: OCS/Medicaid/child welfare

*Technical Assistance*

-   Request information from States within Region V regarding their
    definition of reasonable referral to OCS entails. Could include
    "good cause" definitions

-   Request direction from Region V re: flexibility of definitions

**OKLAHOMA -- CHICKASAW NATION**

Participants: Charles Brodt (Medicaid), Dorinda Morris (Child Support),
Jerry Sweet (Tribal Child Support), H.C. Franklin (Child Welfare), Clark
Seabaugh (Federal)

*Accomplishments*

-   Efforts are continuing to reestablish the interface between the
    Oklahoma Health Care Authority (OHCA) and the Child Support
    Enforcement Division (CSED)

-   Efforts have improved to make sure that child support issues are
    addressed: standard child welfare forms for Individualized Service
    Plans (Treatment Plans) for parents

-   OHCA is providing Child Welfare (CW), the OKDHS Division of Children
    and Family Services with medical history of children placed in
    shelters. This has never been done previously.

-   Child welfare meets with Tribes quarterly, are involved in Child and
    Family Services Reviews (CFSRs) with Tribes and courts

-   Child welfare has reports for local Oklahoma Department of Human
    Services (OKDHS) offices to identify children that need to be
    included on Oklahoma SCHIPS program, SoonerCare

-   Communication has improved among child welfare and OHCA and child
    support enforcement. E-KIDS is an electronic interface that allows
    child support enforcement staff to view some components of the child
    welfare case.

-   Tribes meet regularly with their counterparts in OHCA and OKDHS on
    medical support issues

*Goals*

-   More collaborative training among child support, OHCA, Tribes

-   Get newborns added to Medicaid case as soon as possible for Medicaid
    eligible mothers who received prenatal care. Oklahoma needs to
    continue efforts to improve the process of getting these children
    added. We should explore the possibility of combining the Paternity
    Acknowledgment process with the SoonerCare application process. This
    may already be a project in progress.

-   Invite child welfare and OHCA participation in the OCSEA conference
    on the panel with CSED on medical support issues

-   Fix OHCA/OKDHS interface

-   Develop electronic methods of providing medical histories by OHCA to
    be available to providers, especially for child welfare children

-   Involve stakeholders and other systems with which OKDHS must
    interface (IV-D and TANF Tribal programs, OHCA) in developing
    Enterprise and OCEAN systems

-   Improve education and policy about inquiries from child welfare for
    locating parents in child support enforcement cases and parents that
    are not in the CSE caseload

-   Need to coordinate efforts of child welfare Diligent Searchers and
    child support enforcement staff doing locate work

-   Identify future needs for exchange of information among CSE, Tribes,
    and CW

-   Child support enforcement needs to establish a decision-making
    matrix for deciding how medical support is to be addressed. Could be
    by legislation or policy. Needs to include as a consideration the
    medical needs of the child. Child welfare has a particular need to
    include mental health coverage in any insurance being provided, if
    the child has those needs.

-   CSED needs to be able to better identify cash medical assistance for
    the OCSE-157 report

*Next Steps*

-   Invite Charles Brodt from OHCA and HC "Skip" Franklin from OKDHS/CW
    to the Oklahoma Child Support Enforcement Association conference to
    join the panel addressing medical support. Dorinda Morris will
    e-mail them with the specific date of the presentation.

-   Invite Tribes (39) to CW training for CW supervisors at regional
    meetings.

-   OHCA does not have any annual conference with its staff. OHCA has an
    annual board retreat. Other agencies are invited to attend retreat.
    OHCA has a monthly committee (high level) management meeting between
    OKDHS & OHCA that identifies tasks.

-   Have Skip Franklin approach Farilyn Ballard to allow OHCA, CW, CSE
    to present at one of the HSC meetings (monthly) with a proposal that
    the same presentation be given at Regional HSC meetings to share the
    goals and steps taken to implement them. Skip suggests no more than
    45 minutes. Lead: Skip Franklin for OKDHS. Charles Brodt for OHCA.
    Could also involve CSED in this effort.

-   Dorinda Morris will send memo to Raymond Haddock re: the problems
    with the OHCA/OKDHS Interface so the high-level workgroup can
    monitor progress of restoration of the interface

-   Make/continue efforts to improve application process for
    Medicaid-eligible newborns and explore combining this process with
    Paternity Acknowledgment process.

-   Enterprise system: should consider the need of stakeholders outside
    OKDHS to interface with OKDHS

-   Have Diligent Searchers be on a locate panel with CSE locate staff
    at the OCSEA training conference so the groups can learn from one
    another. Lead: Dorinda Morris will suggest this to Barbara Perkins.

-   Have a session at OCSEA conference with a panel with folks from OHCA
    & CW to exchange information on how EKIDs is working. Lead: Dorinda
    Morris

-   Relate the collaboration issues to the Family First office in
    Oklahoma City. This is the preventative part of the services. This
    is a potential testing ground for identifying collaboration issues.

*Technical Assistance*

-   Need to identify what is appropriate referral

-   More of the national meetings

**OREGON**

Participants: Nancy Horn (Medicaid & SCHIP), Bob David (Child Support),
Nancy Keeling (Child Welfare)

*Accomplishments*

-   Formed a Medical Support Workgroup with expanded participation with
    the State Insurance Group

-   Identified support link issues among Child Support -- Medicaid and
    Children, Adults & Families

-   Identified training needs

*Goals*

-   Continue collaboration to manage budget changes within State and
    agencies

-   Reimbursements through child support orders

-   Review use of FPLS by child welfare

*Next Steps*

-   Develop collaboration paper to ensure support from agency directors
    for legislative support

-   Meetings will be scheduled as soon as possible

*Technical Assistance*

-   N/A at this time

**PENNSYLVANIA**

Participants: William Shaffer (SCHIP), James Fee (Child Support), Teri
Taschner (Child Welfare), Juanita DeVine (Federal)

*Accomplishments*

-   A SCHIP presentation occurred at the State child support directors'
    conference

-   Philadelphia Court Project -- two workers in family court process
    Medicaid applications for families in need before leaving courtroom

*Goals*

-   Determine utilization of FPLS for State's child welfare program

-   Determine State's policy on 72 hour placement rule (relating to
    appropriate referral issue) for the State's child welfare program.

-   To have SCHIP information system link to State's Medicaid
    information system

-   To have SCHIP information system link to State's child support
    enforcement information system

*Next Steps*

-   Based on pending release of HHS IM, this will help all systems
    determine what an "appropriate referral" is

-   Examine how DRA will affect business -- self-declaration of
    citizenship versus DRA's new rules of providing documentation to
    verify citizenship

*Technical Assistance*

-   No technical assistance requested at this time

**PUERTO RICO**

Participants: Jamilla Canario (Child Support), Joanne Krudys (Federal)

*Accomplishments*

-   Child support director and child welfare director developed a
    cooperative agreement to direct the procedure and elements that had
    to be considered to identify and make an appropriate case referral

-   The Medicaid agency and the child support enforcement agency started
    the conversation seeking to improve the development of strategies to
    comply with the Federal and State regulation

-   Child support agency shared the material and ideas from the last
    meeting

-   Child support enforcement of Puerto Rico is reviewing the
    information request to employer so it includes all the information
    concerning medical insurance

-   The new guidelines for establishment and modification of child
    support orders incorporated the medical support disposition of
    Organic Law of Administration of Child Support of Puerto Rico.

-   The technical experts in the system area of the child support
    enforcement area are sharing all the technical aspects to ensure a
    more efficient sharing of information

-   Each agency identified a person to work on coordination of medical
    support matters

-   The child support agency identified the necessity of legislation to
    establish the responsibility of paying cash medical support

*Goals*

-   Complete the interface with the agencies

-   Encourage collaboration among child support, Medicaid, and child
    welfare

*Next Steps*

-   Develop the required legislation to allow the collection of cash
    medical support

-   Review the possibility of creating a medical support guideline

-   Do a comparative study of other jurisdictions' definitions of
    reasonable cost and evaluate the necessity of amending the Puerto
    Rican statute's definition

-   Review the State law to comply with the DRA in medical support
    matters

-   Continue the collaboration of all concerned agencies to improve ways
    of sharing information in order to obtain the best health insurance
    and health treatment available for all children

*Technical Assistance*

-   Arrange a regional meeting with Medicaid staff

**RHODE ISLAND**

Participants: Lissa DiMauro (Medicaid), Kevin Savage (Child Welfare)

*Accomplishments*

-   The Rhode Island Child Welfare and Child Support Enforcement
    agencies are updating the way FPLS data are provided to child
    welfare.

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-   The manual/paper process currently in use will be replaced by one
    that gives child welfare automated access to FPLS data

-   The IV-D and child welfare agencies are developing a memorandum of
    understanding and interface procedures to permit the download of
    FPLS data into appropriate databases

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-   Both agencies are in the process of meeting and developing a plan
    for sharing FPLS data that is currently accessible only to child
    support

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-   Policy officers, attorneys, fiscal staff, and key MIS staff from
    each agency participate in the process to ensure that all necessary
    aspects of implementation are addressed

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-   Since May 2003, Rhode Island has collected cash medical support from
    NCPs who do not have health insurance

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-   In three years, over \$3.4 million in cash medical support has been
    collected by the IV-D agency

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-   Reorganization of child support enforcement from the Taxation
    Division to the Human Services Agency

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-   The reorganization last year moved the IV-D program into the
    Executive Office of Health and Human Services, making collaboration
    easier because now IV-D, Medicaid, and child welfare are in the
    Executive Office

-   IV-D and Medicaid attend weekly senior staff meetings

-   Plans are underway to share results from IV-D's medical insurance
    match (vendor:PCG) with Medicaid

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-   Data matches administered by the Medicaid fiscal intermediary with
    the cooperation of child support enforcement to identify TPL access
    in absent parent cases have proven to be a significant benefit to
    Rhode Island in maximizing usage of private medical coverage for
    Medicaid recipients.

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-   When TPL access is identified in absent parent cases, children who
    receive Medicaid HMO coverage are moved into the RiteShare plan when
    possible, giving them private coverage in the NCP's private health
    care plan, with wrap-around Medicaid coverage

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-   Child support enforcement and the Department of Children, Youth and
    Families use the DHS eligibility system to enter suspected TPL
    cases, which get verified by DHS.

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-   If confirmed, the process occurs as described above

-   If the TPL no longer exists, there is currently no mechanism for
    informing the sending agencies that TPL access has been terminated

-   DHS is developing the electronic means to communicate the
    verification results back to the other State agencies

*Goals*

-   Continue with FPLS interface development

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-   Maintain joint efforts to automate child welfare access to FPLS data

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-   Continue streamlining the child welfare to child support enforcement
    referral process

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-   Resolve systems interface problems that have negatively impacted the
    number of child welfare cases referred to IV-D

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-   This issue has bogged down the process

-   Resolution requires the cooperation of child welfare, child support
    enforcement, and the Department of Human Services

-   The *InRhodes* system (the DHS eligibility system) requires
    reprogramming in order to facilitate easier transmission of cases
    from DCYF

-   Many of the data fields that require entry for transmission require
    mandatory data that is unavailable to DCYS staff

-   DHS programmers have met with DCYF and child support to obtain the
    necessary information to resolve the systems issues

-   Changes are in the programming queue

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-   Resolve legal impediments in some paternity establishment cases when
    the mother is not the moving party

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-   Work with courts to increase cooperation on child support

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-   DCYF has assigned an attorney to follow up with the court on child
    support cases

-   Affidavits have been developed, at the request of the Family Court,
    and are completed by DCYF staff confirming court removal order and
    placement dates

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-   This avoids calling DCYF case work staff into court to testify in
    child support cases and provides the court with the information it
    needs from DCYF

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-   Enhance eligibility system to collect updated TPL data

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-   Currently, the system collects and stores TPL data

-   System does not have the capacity to override the stored data if a
    family loses its TPL coverage or if that coverage changes

-   In cases in which coverage changes, another provider is added to the
    system. A manual process is required to remove a TPL provider once
    it has been added to the system. This creates access problems for
    Medicaid recipients who formerly had access to TPL but no longer do:
    The system continues to block their access to Medicaid as their
    primary insurer until the non-existent TPL coverage is manually
    removed from the MMIS system.

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-   Partner with all agencies to increase efforts to identify paternal
    relatives for foster children's connection for permanency

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-   DCYF, in its efforts to increase permanency options for children in
    the foster care system, needs to use all resources available

-   Both the child support enforcement and Medicaid agencies collect
    information on absent fathers that is potentially vital in
    connecting children to paternal families

-   DCYF must work more closely with both agencies to use that
    information for the purpose of permanency planning

-   Child welfare, Family Service and Legal staff to address this
    process internally

*Next Steps*

-   Child welfare to child support enforcement referrals

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-   Correct programming errors in the case management system that
    incorrectly indicate certain child welfare cases have been referred
    to IV-D

-   Jointly develop an affidavit form for mothers that meets Rhode
    Island's legal requirements for paternity establishment when the
    mother is not the moving party in a paternity action

-   Rhode Island's participants at the Medical Support Meeting will take
    the lead in these efforts

*Technical Assistance*

-   Clear Federal guidance or, if necessary, legislation regarding
    sharing of commercial insurance data

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-   An Action Transmittal or similar policy document to clarify to
    insurance companies that complying with a IV-D agency request for
    information regarding whether or not an individual has insurance
    coverage is [not]{.underline} a HIPPA violation

-   If a clear policy directive on HIPPA cannot be obtained, seek
    corrective Federal legislation

**SOUTH CAROLINA**

Participants: Carolyn Roach (Medicaid), Gordon Moseley (Child Support),
Mary Williams (Child Welfare), Ruth Walker- Simpson(Federal)

*Accomplishments*

-   Conducted three meetings since Charleston '05 regional meeting

-   Identified major areas of concern and began discussion

-   Created a training video that gives overview of child support
    enforcement, CMS, and child welfare

*Goals*

-   Provide access to IV-D system to child welfare workers statewide

-   Clarify with Medicaid which cases will/will not be referred to child
    support enforcement

-   Child welfare quarterly meetings will be attended by Medicaid
    representatives to maintain dialogue

*Next Steps*

-   Medicaid will clarify cases to be referred and contact child support
    enforcement to provide dissemination to staff

-   Provide periodic updates on collaborative efforts to Federal office
    in Atlanta

*Technical Assistance*

-   None at this time

**SOUTH DAKOTA**

Participants: Terry Walter (Child Support), Betty Strecker (Federal)

*Accomplishments*

-   Department-wide cross-program training -- so there is "No Wrong
    Door" for customers

-   Established liaison contacts for Economic Assistance (EA) programs,
    Child Protection Services (CPS), Child Support Enforcement (CSE),
    and Medicaid & Third Party Liability (TPL)

-   Identified interfaces/access to other programs' automated systems

-   Conducted bi-weekly Division Directors meetings and Department
    Strategic Planning

-   Became a member of the Arkansas Consortium for health insurance
    matches

-   Department-wide Customer Service Workgroup with representatives of
    all divisions on improving delivery of all departmental services, as
    well as coordination among divisions

-   Established a "ROAR" Workgroup -- Recruitment, Orientation and
    Retention Workgroup. Recruit qualified staff. Provided orientation,
    which includes cross-program training of new staff. Retention of key
    staff in the department (continuing through Fall 2006).

*Goals*

-   Develop "appropriate" case referral policy for CPS cases; also,
    generate automated system alerts to Child Support Enforcement when
    CPS case is initiated.

-   Analyze the feasibility of automating access to SPLS/FPLS for CPS
    cases

*Next Steps*

-   Collectively formulate CPS policies related to "appropriate" case
    referrals to Child Support Enforcement. Lead -- Kim Malsam-Rydson,
    Department Deputy Secretary, Directors for CPS and Child Support
    Enforcement and Third Party Liability

-   Research the possibility of automating SPLS/FPLS functions with CPS
    -- Nichole MaComb (CSE) and Kim Thomas (CPS)

*Technical Assistance*

-   Provide guidance on "appropriate" case referrals for CPS cases.

**TENNESSEE**

Participants: Bill Duffey (Child Support), Judy Cole (Child Welfare)

*Accomplishments*

-   Meeting with Department of Children's Services and TennCare Medicaid

-   Identified barriers/issues hampering child support services to
    foster care children

-   Established workgroup to address issues/barriers

*Goals*

-   Develop child welfare status reports for foster care children for
    child support

-   Gather information on Arkansas consortium

-   Child welfare access to FPLS

-   Continue meetings

-   Child welfare to expand referral time for workers to allow more time
    to gather essential data for child support

-   Highlight and prioritize needed information to be gathered by child
    welfare

-   Define appropriate Medicaid and child welfare referrals to child
    support

*Next Steps*

-   Develop protocols for appropriate data exchanges

-   Child support/child welfare workgroup reported on progress
    concerning issues and barriers to larger committee August 2006
    concerning developing status reports; prioritizing information for
    child support; expanding the time frame for CW workers to gather
    information for child support referrals from one day to five days

-   Child support to finish tasks necessary to allow child welfare
    access to FPLS data

-   Child support will contact Arkansas regarding insurance consortium

-   Workgroup to focus on defining appropriate referrals from Medicaid
    and child welfare

-   Work with TennCare -- Medicaid regarding new State initiatives --
    "CoverTN" and CoverKids

*Technical Assistance*

-   Guidance and policy resource

**TEXAS**

Participants: Kay Ghahremani (Medicaid/SCHIP), Joe Sierra (IV-A TANF),
Cecile Young (Child Support), Katherine Keenan (Child Welfare), Lily
Matheson(Federal)

*Accomplishments*

-   Reinstated Child Support and Medicaid quarterly meetings (OAG/HHSC
    Interagency Quarterly Meeting) to address concerns and issues in
    administering our programs

-   Creating a new Medicaid-Foster Care Health Care Delivery model

-   Created an Office of Medical Support Initiatives which is charged
    with increasing collaboration with the Medicaid and CHIP

*Goals*

-   Will research options to implement a program similar to the one
    described by the Medicaid representatives from Missouri. Missouri's
    program allows parents to enter into temporary shared custody
    arrangements with the State's Child Protective Services agency for
    parents who would otherwise relinquish custody of their children in
    order to obtain behavioral health services

-   Will operationalize the Office of Medicaid Support

-   Will need to figure out citizenship requirements of DRA as they
    relate to foster care/transitional Medicaid, including the redesign
    of the questionnaire and script

-   Explore increasing referrals from Medicaid for medical support

-   Will be looking at getting more access to health care for children
    in the child support system

*Next Steps*

-   Cecile -- ramping up Office of Medical Support Initiatives

-   Kay and Kathy -- Missouri model

-   Joe and Cecile -- Medicaid referrals

-   Kathy -- Citizenship issues

*Technical Assistance*

-   Clarification or guidance on the case closure flexibility discussed
    at the meeting?

-   Are there any new grant opportunities as a result of the DRA?

-   Can States agree upon some formula that reflects the Medicaid
    savings that result from medical support orders? (Massachusetts has
    a formula.)

**UTAH**

Participants: Blaine Goff (Medicaid), Gayleen Henderson (SCHIP), Tracy
Graham (Child Support), Cosette Mills (Child Welfare), Diane Degenhart
(Federal)

*Accomplishments*

-   Awareness

-   New people brought into the discussion

-   Ongoing collaboration between some of the agencies (not all
    together)

*Goals*

-   Health care coverage for clients known to all of our agencies

-   Cross agency education

-   Improvement of processes that cross agencies

-   Broaden collaboration for medical support to other applicable
    agencies (such as disabilities, TANF, juvenile justice)

*Next Steps*

-   Identify appropriate persons in our agency and sister agencies to
    participate (June) (each)

-   Initial meeting of larger group to present concept/goals and invite
    into process/set agenda -- by July (Tracy)

-   Cross-agency education to follow as initial tasks of group

*Technical Assistance*

-   None identified yet

**VERMONT**

Participants: Robin Arnell (Child Support), Sara Boardman (Child
Welfare), Mike Ginns (Federal)

*Accomplishments*

-   Twice a month, Vermont IV-D, Medicaid, and TANF management-level
    staff meet to review common case management issues. Results include:

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-   Child welfare caseworker attends all child support court hearings
    involving IV-E child(ren)

-   IV-D and child welfare workers attend annual legal refresher
    training

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-   Implementation of OCSE Section 1115 Grant

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-   Compiling 3-phase child support-Medicaid agreement, including a
    final Memorandum of Understanding -- the final agreement will be
    complete at the conclusion of the 1115 grant

-   Revised Medicaid assignment of rights form

-   Currently on Phase II

    -   Centralized the medical support functions in the child support
        agency (referred to as Employer Services Unit)

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-   Responsibility given to Employer Services Unit (ESU)

-   ESU gathering employer health insurance information

-   ESU responding to employer questions on NMSN and other issues

-   A database of health insurance information has been established for
    child support enforcement and child welfare

    -   Created electronic NMSN

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-   Registered employers receive NMSN by e-mail

    -   Creating insurance data bank

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-   Match to receive insurance information from the Vermont insurance
    regulatory agency

    -   Child welfare is now copied on all general Office of Child
        Support e-mail communications

    -   Revised court order to make it standardized for IV-D and non
        IV-D cases throughout the State. Compels people to address all
        issues in a case.

    -   An 11-year partnership between child support and child welfare

*Goals*

-   Automating communication between agencies and enforcement functions

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-   Section 1115 grant to provide improved communications among child
    support, Medicaid, and TANF agencies

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-   Reliable measurements of cost savings and cost avoidance

-   Create interface between State banking and insurance regulatory
    agency and the child support and Medicaid agencies

-   Continue joint child support/child welfare staff training

*Next Steps*

-   Review the definition of "appropriate Medicaid referrals"

-   Create a design document for the programmers to implement redefined
    appropriate referrals

-   Child support will take the lead (CSE has an 1115 grant for Medical
    Support Collaboration)

*Technical Assistance*

-   Obtain written Federal policy clarifications

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-   Are States permitted to retrieve employer/insurance info. for
    custodial parties?

-   What are case closure criteria for "child-only" Medicaid cases when
    CP does not cooperate?

**VIRGIN ISLANDS**

Participants: Jane Laws (Medicaid and SCHIP), Joanne Krudys (Federal)

*Goals*

-   Increase the number of children who are covered by medical insurance

-   Replace Medicaid with noncustodial or custodial parent private
    insurance as primary insurer of children wherever possible

Next Steps

-   Establish collaborative relationship among the Bureau of Health
    Insurance and Medical Assistance (DoH) and the Paternity and Child
    Support Division (PCSD-DoJ)

-   Establish a Medicaid-to-PCSD referral process that is limited to
    Medicaid applicants who are willing child support establishment
    participants and who meet minimum noncustodial parent locate data
    requirements (name and at least SSN, DOB, and/or address)

-   Identify Lead Medical Support Collaboration Contact in each
    respective agency

-   Identify Federal and territorial law relevant to medical support
    issues including but not limited to 45 CFR 303.30 to 303.32 and OCSE
    PIQ 02-03

-   Identify cost savings -- with respect to potential Medicaid savings
    and potential incentive payments related to proposed medical support
    performance indicators (possibly consider developing a cost savings
    analysis similar to the one developed in Massachusetts)

-   Determine how SCHIP funds (Title XXI) interact with Medicaid funds
    (Title XIX) and determine impact upon medical support collaboration

-   Identify all required data elements on both the child support and
    Medicaid side, and determine to what extent data could be exchanged
    electronically

-   Determine to what extent New Hire Reporting can be enhanced/modified
    in order to identify availability of private insurance

-   Determine if interface can be accomplished centrally or if this
    needs to be a dual St. Thomas/St. Croix interface

-   Develop pilot interface process and policy

-   Develop final interface process and policy based on pilot results

*Technical Assistance*

-   Training needed with child support, child welfare, and Medicaid,
    especially in the areas of referrals.

-   Child support director to provide technical assistance in setting up
    the conferences between Puerto Rico and the Virgin Islands and the
    Regional Offices.

**VIRGINIA**

Participants: Cindy Olsen (Medicaid), Linda Nablo (SCHIP), Connie White
(Child Support), Lynette Isbell (Child Welfare), Juanita Devine
(Federal)

*Accomplishments*

-   Examined numbers through matching Medicaid and SCHIP recipients
    against child support cases

-   Began to identify clean-up issues for health insurance information
    in the child support system

-   Build base for future collaboration

*Goals*

-   Develop/enhance automated interfaces among all programs

-   Collaborate on appropriate referrals among programs

-   Clarify how third party liability (TPL) information is shared and
    handled

-   Explore providing Medicaid coverage for children aging out of foster
    care

*Next Steps*

-   Develop a work plan to define interfaces

-   Convene work groups as needed

-   Collect data to develop cost analysis for Medicaid coverage for
    children aging out of foster care

*Technical Assistance*

-   Contact other States/use regional office

-   OCSE -- explore automated data match for child welfare

-   Use child welfare national resource center for research -- best
    practices

-   ACF should explore using locate services for relatives (not CP and
    NCP) for children in foster care

**WASHINGTON - LUMMI NATION - PORT GAMBLE S'KALLAM**

Participants: Heidi Robbins-Brown (Medicaid & SCHIP), David Stillman &
David Johnson (Child Support), Tenesha Carpenter & Gina Beckwith (Tribal
Child Support), Diane Inman (Child Welfare)

*Accomplishments*

-   Collaboration activities with Tribal IV-D programs

-   Five workgroups (including a Tribal workgroup)

    -   Systems

    -   Co-sponsor cash assistance legislation

    -   TPL and foster care

    -   Referrals improvement

    -   Tribes' foster care

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-   Strengthen medical support efforts through draft legislation for
    cash assistance

-   Improved Data Access and Sharing:

    -   Catalog existing data sharing activities and identify additional
        opportunities for improved/increased data sharing

    -   Use data sharing to protect staff

    -   Review current use of FPL system for more efficient use of the
        resource

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-   Improved referral process between IV-E and IV-D

-   Pursue Third Party Liability improvements

-   CA review of HRSA Managed Care contracts as they come up for renewal

*Goals*

-   Provider One -- a new comprehensive medical payment system

-   Also will be able to track when and where Tribal services are
    offered

-   Continue sub-workgroup meetings to address goals

*Next Steps*

-   Massachusetts -- legislative medical cash assistance

-   Matrix -- examples of legislative efforts from other States

**WEST VIRGINIA**

Participants: Sharon Carte (SCHIP), Susan Perry (Child Support), Jane
McCallister (Child Welfare), Ann Burds (Federal)

*Accomplishments*

-   Child support paid for a speaker for a Family Court Judge conference
    on medical support issues

-   Following the medical support meeting in 2005, the West Virginia
    participants met and discussed the necessary policy changes

*Goals*

-   Training for lawyers, social workers, and judges in October '06 on
    medical support issues/options

-   SCHIP will distribute child support information

-   Child support will distribute SCHIP information to hospitals

-   Encourage increased use of on-line application for SCHIP/Medicaid

-   Discuss referral process between child support and Medicaid

*Next Steps*

-   Refine procedures on IV-E referrals -- Susan and Jane

-   Refine procedures on Medicaid -- Susan, Nancy, and Sue Buster

-   Automate request for birthing expenses from child support to
    Medicaid

*Technical Assistance*

-   Clarify draft IM on child support referrals from IV-E

-   Work on legislation to establish insurance reporting

-   Get "reasonable cost" regulation out

**WISCONSIN -- LAC DU FLAMBEAU -- MENOMINEE -- POTOWATOMI**

Participants: Carol Chellew (Child Support), Terry Holt, Jacquelyn
Pische, Rosemund Hoffman (Tribal Child Support), David Timmerman (Child
Welfare), Dennis Barton, Pamela Carson (Federal)

*Accomplishments*

-   Some improvements in data exchange

-   Proper closing of Medicaid cases in child welfare

-   Additional KIDS access for child welfare staff

*Goals*

-   Birthing expenses for fathers (should not be charged to Tribes)

-   Duplicate referrals being sent to child support

-   Foster home licensing issues with Tribes and counties

-   More access to KIDS and Wisconsin Statewide Automated Child Welfare
    Information System (WiSACWIS) systems

-   Need data sharing agreement between Medicaid and child support

*Next Steps*

-   Need to set up meetings among all agencies to discuss issues

-   Collaboration of specific child support issues between child support
    and Tribes

-   Identify training issues to ensure proper data entry

-   Look at increasing system access

-   Reduction of system user fees

*Technical Assistance*

-   Need system programmers to discuss interface

-   Need central offices (State) to become bigger players

-   Foster home licensing specialists to discuss licensing

-   Issues between State, counties, and Tribes

-   CMS/ACF staff for guidance and approval

**WYOMING**

Participants: Dana Pepmeier (Medicaid), Brenda Lyttle (Child Support),
Zaffer Sharif (Child Welfare), Rosanne Robinson & Kimberly Patton
(Federal)

*Accomplishments*

-   Improve automated systems coordination between child support
    enforcement and Title XIX, i.e., Medicaid eligibility (ME)-- 2
    collaboration meetings held

-   Improve cross-program understanding by having ME and Kid Care
    (State's SCHIP program) staff speak at a child support enforcement
    district managers' meeting

-   Regular Department of Family Services Child Welfare/Child Support
    Enforcement field staff meetings are held on an on-going basis
    regarding foster care cases

-   Cross-program participation in a statewide Foster Care summit

-   Child Support presentation at the National Eligibility Workers (NEW)
    Conference in Omaha in August 2006

*Goals*

-   Collaboratively work on an "appropriate" case referral policy of
    foster care cases to child support enforcement

-   Increase the Child Welfare Program's use of the SPLS/FPLS to locate
    fathers

-   Improve program delivery by having joint meetings with managers from
    the Title XIX, child support enforcement and child protection
    services programs

*Next Steps*

-   On-going meetings between Medicaid and SCHIP, and DFS' (child
    protection services and child support enforcement) programs to
    collaborate on program policy matters. Lead -- Brenda Lyttle and
    program managers on an on-going basis

-   Collaboratively formulate CPS's policies related to "appropriate"
    case referrals to child support enforcement. Leads -- Brenda Lyttle
    and Mike Beaver, Summer of FY 06

-   Increase child welfare program use of the SPLS/FPLS to locate
    fathers. Leads -- Brenda Lyttle and Mike Beaver, on-going

-   Coordinate, as necessary, implementation of medical support program
    provisions of the Deficit Reduction Act of 2005 between child
    support enforcement and Medicaid programs. Lead -- Brenda Lyttle, FY
    2006 and 2007

*Technical Assistance*

-   Provide Federal guidance on "appropriate" foster care case referrals
    to child support enforcement