# Presentation: 283512

## Medicaid Funds for HCAP Grantees

- Sustaining your programs by partnering with Medicaid

## Medicaid: a Federal, State Partnership

- Feds, states share cost of operating Medicaid
- Feds pay from 50% - 75%
- Administrative costs are shared at the same rates in all states: usually 50/50
- Feds permit the state’s share of Medicaid to come from other public entities
- Counties, cities, school districts, hospital districts, health districts, fire districts...
- Public entities’ revenues can come from fees, grants, taxes

## Why You Need Medicaid 

- Medicaid is where the money is
- Medicaid serves your clients
- Medicaid needs your help to carry out its mission
- Medicaid is available over the long-term
- System change: look up stream!

## Why Medicaid Needs You

- Help enrolling under-served populations
- Ability to expand provider network and create new health resources
- Ability to manage high cost clients, conditions
- Create data the state needs
- Pilot innovations

## Bold Medicaid Moves 

- Extend Medicaid eligibility to cover higher incomes, to cover special populations, to cover non-categorical (single, childless) adults
- Extend SCHIP eligibility to cover parents, higher incomes ( may be possible by county)
- Use DSH ( disproportionate share hospital) payments for indigent care
- Upper payment limit “schemes;” devote the money

## More Bold Moves

- Use DSH ( disproportionate share hospital) payments for indigent care
- Upper payment limit “schemes;” devote the money to Medicaid, SCHIP
- Contract with the State to operate Medicaid at a county or regional level: (COHS in CA)

## Leveraging Existing Funds

- CMS permits the state’s share of Medicaid SCHIP funds to come from other taxing entities
- IF you are spending unleveraged public funds ( state, county, city, school, hospital)....
- Redefine Medicaid to include your services, your costs and use existing funds as the match ( this will require a government partner)

## Tools for Accessing Medicaid for HCAP revenue

- Medicaid Administrative Claiming (MAA)
- Targeted Case Management (TCM)
- Federally Qualified Health Centers (FQHC)
-  State Qualified Health Centers

## Medicaid Administrative ActivitiesMAA

- Medicaid Administrative Costs shared 50/50 between the state (local), federal government
- No cap on administrative costs that can be claimed for Medicaid (10% limit on SCHIP)
- State can contract with others to help  administer Medicaid, others can sub-contract

## MAA: What is claimable?

- OUTREACH
- Outreach for Medicaid or SCHIP coverage
- Assistance with enrolling
- Outreach for health care services
- Assistance with accessing care
- Making appointments
- Arranging or providing transportation
- Interpreting
- Coordinating care

## MAA: What is claimable?

- PROGRAM PLANNING AND DEVELOPMENT
- Planning for new or expanded health care services specifically  or incidentally for Medicaid beneficiaries
- Planning for better coordination between systems
- Developing data for planning health care services

## How does MAA work?

- The State enters into a contract with an entity to provide administrative services
- The contract specifies the basis for payment
- Fee-for-service
- Cost (based on time study
- State Medicaid pays the contract and claims 50% of its cost from CMS. May require you to pay or certify the state share of the cost

## What MAA is Not

- It is not client based. Activities do not have to be done for a specific Medicaid client
- It is not a Medicaid health service: usually provided by staff who aren’t billing for medical services
- It does not offer full reimbursement for allowable activities. Some are discounted by the % of Medicaid in the population served

## Examples of MAA

- Staff at WIC, Schools, Family Resource Centers, HCAP ask families about health care coverage and help them apply for Medicaid or SCHIP
- HCAP, county health department staff, school or other staff help clients to understand and navigate the health care system
- HCAP Coalitions work to create new dental services, improve coordination for  mentally ill, design disease management programs

## Targeted Case Management or TCM

-  Helping Medicaid clients access a wide range of health and social services
- This is a Medicaid service (not admin). Therefore federal match is state specific
- Face to face encounters
- 			with
- Enrolled clients
-                     by
- Qualified providers
-                    who
- Document the service at the client level

## TCM: What is Billable? 

- Assessment of needs
- Development of a  service plan
- Information and referral to resources (health, housing, education, social, emotional, etc.)
- Coordination with providers, family
- Monitor outcomes from services and the plan
- Crisis planning

## How TCM Works

- Participation depends on having an approved TCM benefit in the State Medicaid Plan
- The State Plan specifies the TCM target populations, provider requirements
- Services can be limited to a geographic area: requirement for “statewide-ness” does not apply
- Providers bill on an encounter basis
- Reimbursement usually related to actual  costs: ranges from $7 to $1,000

## What TCM is not

- Not the provision of a direct medical care service
- Not billable if it is part of a medical care service that is already being reimbursed by Medicaid
- Not usually a one time contact
- Not usually included in managed care capitation rates

## TCM Examples

- Nurse home visiting to high risk women and children
- Mental Health Case Management
- Probation and Parole services to non-inmates
- Case Management for homeless persons
- Services to help the frail elderly stay at home
- Managing services for a client with TB or HIV

## Federally Qualified Health Centers: FQHCs

- States now pay FQHCs based on costs of Medicaid visits in previous years
- States have criteria for “rebasing”
- If your FQHC takes on new services (e.g. case management) or new cost for MIS, the state could raise the FQHC’s rate
- New FQHCs being created with new 330 grants

## State Qualified Health Centers

- FQHCs are federally created via the 330 or look alike process
- States can create their own special class of clinic  provider and pay them cost-based rate too

## How FQHCs Work

- Change the scope of the County Clinic FQHC  to include psychiatry visits and pharmacy costs for County MH Clients (Santa Cruz CA)
- Have the FQHC provide Maternity Case Management or School Based Health and bill at FQHC rates (Multnomah Co. OR)
- DC Qualified Health Centers meet Medicaid’s requirements and get higher billing rates

## How to get Started with Medicaid

- Identify your contacts, your champions (Legislator, governor, hospital, association)
- Find out if Medicaid is currently paying for MAA or TCM: precedent is helpful
- State MCH, PH or other health program managers
- The state Medicaid plan
- County health departments
- Consultants, web sites, other providers
- Approach Medicaid: can they, will they help?

## Possible Benefits to Medicaid

- You can help to control costs
- You can help to improve outcomes
-  You can help them “win friends” by being good partners with you
- You can pilot innovative approaches before they go statewide
- It doesn’t have to cost them anything!

## Words to the Wise

- State staff may need to be taught and coached
-  If there is no precedent and state staff is not knowledgeable, get help!
- It takes time to develop this option, time for cash to flow. Start soon!
- There are staff costs to bill TCM or claim MAA, but they vary based on state model

## Are you already performing activities potentially reimbursable by Medicaid? 
What are you spending on those activities?
Are you serving Medicaid clients? (does not matter for outreach)
Administrative burden depends on your state program design and your infrastructure
It’s always valuable to understand Medicaid make state level contacts, advocate for services that matter!

- What are you spending on those activities?
- Are you serving Medicaid clients? (does not matter for outreach)
- Administrative burden depends on your state program design and your infrastructure
- It’s always valuable to understand Medicaid make state level contacts, advocate for services that matter!

_**How much can we earn? Is it worth it?**_

## Is it worth it?

- Knowledge is power: learn about Medicaid
- Contacts are power: connect with the State
- It’s always worth advocating to improve services, improve access, connect Medicaid to the communities

## Partner with Medicaid:You can do it!

-    Elinor Hall, MPH
- 	Health Policy and Management Consulting
- 	503-292-3240
- 	Ellihall@comcast.net