# Presentation: 056790

## OVERVIEW OF PRESENTATION

- Program Design Options
- Program Design Conclusions
- Benefit Package Design
- Husky Plus
- Outreach Efforts
- Evaluation and Monitoring

## THE STARS IN THEIR COURSES...

- William Shakespeare
- A State Budget Surplus
- An Enhanced Federal Match
- An Election Year
- A Clambake

## To Medicaid, or Not to Medicaid, That Is the Question?
Concern About the Creation of a New Entitlement
Prospects for continued federal funding beyond 2002
Concern about individual cause of action (litigation about notices, fair hearings, etc.)
Concern about the “T” in EPSDT:  Unlimited benefit package
Concern About Ability to Draw Down Full Federal Match If We Stick to the Limits on Expansion in the BBA
200% FPL
		    or
50 percentage points higher than current Medicaid eligibility

- Concern About the Creation of a New Entitlement
- Prospects for continued federal funding beyond 2002
- Concern about individual cause of action (litigation about notices, fair hearings, etc.)
- Concern about the “T” in EPSDT:  Unlimited benefit package
- Concern About Ability to Draw Down Full Federal Match If We Stick to the Limits on Expansion in the BBA
- 200% FPL
- 		    or
- 50 percentage points higher than current Medicaid eligibility

- STAGE ONE:  PROGRAM DESIGN

## Federal Allotment for Connecticut ($35 Million in FFY 1998) Was Based on the Number of Uninsured Children Below 200% FPL
As of April, 1997 Connecticut Already Covered Children Born After September 30, 1983 up to 185% FPL
Further Medicaid eligibility expansions to 185% FPL already enacted by the legislature
children born after July 1, 1981 effective July 1, 1997
children born after January 1, 1980 effective January 1, 1998
Wanted a Package for All Working Families
no Medicaid stigma
coordinated outreach to Medicaid and Non-Medicaid
accessible outreach to Medicaid eligible populations
did not want intake through the “welfare office”
wanted a buy-in option regardless of income

- As of April, 1997 Connecticut Already Covered Children Born After September 30, 1983 up to 185% FPL
- Further Medicaid eligibility expansions to 185% FPL already enacted by the legislature
- children born after July 1, 1981 effective July 1, 1997
- children born after January 1, 1980 effective January 1, 1998
- Wanted a Package for All Working Families
- no Medicaid stigma
- coordinated outreach to Medicaid and Non-Medicaid
- accessible outreach to Medicaid eligible populations
- did not want intake through the “welfare office”
- wanted a buy-in option regardless of income

- STAGE ONE:  PROGRAM DESIGN (cont.)

## Combination Approach
Capture enhanced Title XXI Match (65%) on previously enacted Medicaid expansions for children up through age 18 up to 185% FPL
Above 185% FPL, a non-Medicaid expansion
took advantage of the open-ended reference to income disregards to extend subsidized coverage to 300% FPL
full buy-in option available above 300% FPL

- Capture enhanced Title XXI Match (65%) on previously enacted Medicaid expansions for children up through age 18 up to 185% FPL
- Above 185% FPL, a non-Medicaid expansion
- took advantage of the open-ended reference to income disregards to extend subsidized coverage to 300% FPL
- full buy-in option available above 300% FPL

- STAGE TWO:  CONCLUSIONS

## Of the Three Non-Medicaid Options (FEHBP, Largest HMO, State Employees), State Employees Selected As Most Generous
Within State Employee Option, Three Benefit Packages Available
Blue Cross (discounted Fee For Service)
MD Health Plan (IPA model)
Kaiser Permanente (staff model)
Compared All Three Plans on Each Covered Service, Selected the Most Generous Option
Copayments Capped at $650 Per Family Per Year 	Premiums Capped at $600 Per Family Above 235% FPL    Total Annual Cost Sharing Maximum - $1,250

- Within State Employee Option, Three Benefit Packages Available
- Blue Cross (discounted Fee For Service)
- MD Health Plan (IPA model)
- Kaiser Permanente (staff model)
- Compared All Three Plans on Each Covered Service, Selected the Most Generous Option
- Copayments Capped at $650 Per Family Per Year 	Premiums Capped at $600 Per Family Above 235% FPL    Total Annual Cost Sharing Maximum - $1,250

- PHASE THREE:  BENEFIT DESIGN

## Even With a Generous Commercial Insurance Benefit Package, There Was a Concern That the Needs of Children With Special Health Care Needs Would Not Be Accommodated
Options Were:
Bring back Medicaid
Offer a risk adjusted rate for special needs kids, similar to what we do in Husky A (Medicaid Managed Care)
Provide a supplemental, wraparound package that would not count against the 10% cap on administrative costs
Selected the Supplemental Package
Children will be dual eligible, simultaneously receiving benefits from Husky B and Husky Plus
Husky Plus modeled on care coordination under existing Title V program 
Title V eligibility expanded to 300% FPL

- Options Were:
- Bring back Medicaid
- Offer a risk adjusted rate for special needs kids, similar to what we do in Husky A (Medicaid Managed Care)
- Provide a supplemental, wraparound package that would not count against the 10% cap on administrative costs
- Selected the Supplemental Package
- Children will be dual eligible, simultaneously receiving benefits from Husky B and Husky Plus
- Husky Plus modeled on care coordination under existing Title V program
- Title V eligibility expanded to 300% FPL

- PHASE FOUR:  HUSKY PLUS

## 
Plan Established for Children With Special Physical Needs
Two Title V centers of excellence selected as providers
Connecticut Children’s Medical Center
Yale Childrens Hospital
Title V steering committee becomes the steering committee for Husky Plus
A New Plan Established for Children With Special Behavioral Health Needs
Yale Child Study Center designated as plan coordinator
Community providers selected by RFP process
Both Plans Funded With $2.5 Million for SFY 1999

- Plan Established for Children With Special Physical Needs
- Two Title V centers of excellence selected as providers
- Connecticut Children’s Medical Center
- Yale Childrens Hospital
- Title V steering committee becomes the steering committee for Husky Plus
- A New Plan Established for Children With Special Behavioral Health Needs
- Yale Child Study Center designated as plan coordinator
- Community providers selected by RFP process
- Both Plans Funded With $2.5 Million for SFY 1999

- PHASE FOUR:  HUSKY PLUS (cont.)

## Children Determined to Be Medically Eligible for Both Plans Based on Designated Screening Tools to Measure Level of Impairment
In Each Plan, Care Coordinators Develop a Treatment Plan in Coordination With the Primary Care Provider and the Utilization Review Staff in the Child’s Husky B Plan
Each Plan Has Final Decision Over Payment Decisions for the Services in Their Benefit Package
The Goal Is Collaboration and Consensus
If the Husky B and the Husky Plus Plan Cannot Agree on Who Pays for a Service in the Treatment Plan, the Final Decision Goes to the Department

- In Each Plan, Care Coordinators Develop a Treatment Plan in Coordination With the Primary Care Provider and the Utilization Review Staff in the Child’s Husky B Plan
- Each Plan Has Final Decision Over Payment Decisions for the Services in Their Benefit Package
- The Goal Is Collaboration and Consensus
- If the Husky B and the Husky Plus Plan Cannot Agree on Who Pays for a Service in the Treatment Plan, the Final Decision Goes to the Department

- PHASE FOUR:  HUSKY PLUS (cont.)

## Medical Assistance for Children Has Now Become One New Program (Husky) With Three Distinct Parts:
Husky A (Medicaid)
Husky B (Title XXI expansion)
Husky Plus (special needs)
Coordinated Marketing and Outreach for All Three Programs
De-stigmatize Medicaid
Bring in the Medicaid eligible children
Take advantage of the new name for the program
A Four Page Application Developed for Husky A & B
Application process invisible to the client between the two programs

- Medical Assistance for Children Has Now Become One New Program (Husky) With Three Distinct Parts:
- Husky A (Medicaid)
- Husky B (Title XXI expansion)
- Husky Plus (special needs)
- Coordinated Marketing and Outreach for All Three Programs
- De-stigmatize Medicaid
- Bring in the Medicaid eligible children
- Take advantage of the new name for the program
- A Four Page Application Developed for Husky A & B
- Application process invisible to the client between the two programs

## A Single Point of Entry Servicer (SPES) Contracted to Screen and Process Applications for the Two Programs
Benova, the Medicaid managed care enrollment broker, selected as the SPES
Benova screens all applications for Medicaid eligibility. 
if Medicaid eligible, application referred to a DSS office
Benova and the DSS offices are linked electronically
Benova and DSS staff are co-located at each other’s offices
If the applicant is eligible for Husky B, Benova processes the eligibility in their own system
Benova processes managed care enrollments for both Husky A & Husky B

- Benova, the Medicaid managed care enrollment broker, selected as the SPES
- Benova screens all applications for Medicaid eligibility.
- if Medicaid eligible, application referred to a DSS office
- Benova and the DSS offices are linked electronically
- Benova and DSS staff are co-located at each other’s offices
- If the applicant is eligible for Husky B, Benova processes the eligibility in their own system
- Benova processes managed care enrollments for both Husky A & Husky B

- PHASE FIVE:  OUTREACH (cont.)

## Outreach Effort Is Coordinated With Funded Projects in Schools, School Based Health Centers, Community Health Centers, and Hospitals
Future Plans Include Presumptive Eligibility for Husky A (Medicaid) at WIC Sites, Healthy Start, and Child Care Providers
Outreach Is Critical, Not Only to Reach Uninsured Population, but to Negate the Impact of Adverse Selection

- Future Plans Include Presumptive Eligibility for Husky A (Medicaid) at WIC Sites, Healthy Start, and Child Care Providers
- Outreach Is Critical, Not Only to Reach Uninsured Population, but to Negate the Impact of Adverse Selection

- PHASE FIVE:  OUTREACH (cont.)

## In Husky A, There Is a Comprehensive Data Reporting Mechanism in Place With the Health Plans on a Range of Measures Including Encounter Data
Desire Was to Not Make Husky B Like Medicaid but to Follow a Commercial Model
In Connecticut, We Do Have Legislation That Requires HMOs to Submit Comprehensive HEDIS Data to the Department of Insurance
HEDIS data is for the entire plan book of business
Couldn’t Accept Not Having at Least HEDIS Data That Was Specific to Husky B Reported Annually
HEDIS will be supplemented by a report on well child visits (EPSDT-LIGHT)

- Desire Was to Not Make Husky B Like Medicaid but to Follow a Commercial Model
- In Connecticut, We Do Have Legislation That Requires HMOs to Submit Comprehensive HEDIS Data to the Department of Insurance
- HEDIS data is for the entire plan book of business
- Couldn’t Accept Not Having at Least HEDIS Data That Was Specific to Husky B Reported Annually
- HEDIS will be supplemented by a report on well child visits (EPSDT-LIGHT)

- PHASE SIX:  EVALUATION AND MONITORING

## No Encounter Data on Husky B Plans
For Husky Plus, We Felt the Data Set of Paid Services Would Be Small Enough That We Could Require Quarterly Encounter Data From Both Husky Plus Physical and Husky Plus Behavioral
We’re Going to Measure Our Success in Enrolling Uninsured Kids Against the Same Data the Interval Census (CPAS) Data
Remains to be seen whether the census provides an accurate baseline on the number of uninsured children

- For Husky Plus, We Felt the Data Set of Paid Services Would Be Small Enough That We Could Require Quarterly Encounter Data From Both Husky Plus Physical and Husky Plus Behavioral
- We’re Going to Measure Our Success in Enrolling Uninsured Kids Against the Same Data the Interval Census (CPAS) Data
- Remains to be seen whether the census provides an accurate baseline on the number of uninsured children

- PHASE SIX:  EVALUATION AND MONITORING (cont.)

## August, 1997	Balanced Budget Act Passes
October, 1997	Husky Legislation Enacted
January, 1998	State Plan Submitted
April, 1998		State Plan Approved
June, 1998		Enrollment Begins
July, 1998		Services Begin in Managed Care 			Plans and Husky Plus

- October, 1997	Husky Legislation Enacted
- January, 1998	State Plan Submitted
- April, 1998		State Plan Approved
- June, 1998		Enrollment Begins
- July, 1998		Services Begin in Managed Care 			Plans and Husky Plus

- KEY DATES

## Phase One:		Enthusiasm
Phase Two:		Disillusionment
Phase Three:		Panic
Phase Four:		The Assessment of Blame
Phase Five:		The Punishment of the Innocents
Phase Six:		Praise for the Non-Participants

- Phase Two:		Disillusionment
- Phase Three:		Panic
- Phase Four:		The Assessment of Blame
- Phase Five:		The Punishment of the Innocents
- Phase Six:		Praise for the Non-Participants

- SIX PHASES OF EVERY PROJECT

## HUSKY ACTIVITYJUNE 1, 1998--AUGUST 9, 1998

## HUSKY B