# Presentation: 712849

## ASSURING ACCESS THROUGH SERVICE DELIVERY ARRANGEMENTS

- Overview of Michigan's CHIP
- Medicaid Expansion versus Private Insurance
- Service Delivery Capacity
- Historic Medicaid Providers
- Mental Health and Substance Abuse Carve Out
- Children's Special Health Care Services Coordination
- Performance Monitoring

## Overview of Michigan CHIPState Characteristics

- Overview of Michigan CHIP*State Characteristics*

## Overview of Michigan’s CHIP

***53,200 estimated eligibles***
**Kids must:**
**- Be under 19**
**- Live in a family with approximate ****	****monthly income under:**
**	****	****$1,357 for a family of 2**
**	****	****$1,707 for a family of 3**
**	****	****$2,057 for a family of 4**
**	****	****$2,407 for a family of 5**
**-****	****MAY have other health insurance**
**You will have 30 days to choose a health plan after you are notified that the child qualifies.**
**No premium is required.**

**MIChild Private Insurance Plan**
***112,500 estimated eligibles***
**The child must:**
**- Be under 19**
**- Live in a family with approximate ****	****monthly income under:**
**	****	****$1,809 for a family of 2**
**	****	****$2,275 for a family of 3**
**	****	****$2,742 for a family of 4**
**	****	****$3,209 for a family of 5**
**-****	****NOT have other health insurance**
**You must choose a health plan at the time you apply.**
**You pay a monthly premium of only $5.  Even if you have more than one child you pay only $5 a month.**

## OVERVIEW OF MICHIGAN'S CHIPCOMPARISON OF FEATURES

## MEDICAID EXPANSION VERSUS PRIVATE INSURANCEMedicaid Advantages

- Service Delivery Network established and in place, no need for new contracts
- Large number of beneficiaries give state bargaining strength with providers, i.e., development of new health plans
- Can use non-licensed, Medicaid defined HMOs
- Historical providers familiar with needs of Medicaid population

## MEDICAID EXPANSION VERSUS PRIVATE INSURANCE Private Insurance Model Advantages

- Flexibility to change design features to promote access
- Provider rates can be higher than Medicaid and still affordable to state
- No Medicaid "stigma," seen as mainstream health insurance program
- HMOs can use either their Medicaid provider network or their commercial network

## TOTAL NUMBER OF  COMMERCIAL HMOS (IN EACH COUNTY)

- 21 counties have 0 plans
- 18 counties have 1 plan
- 34 counties have 2-5 plans
- 8 counties have 6-10 plans

## SERVICES DELIVERY CAPACITYPRE AND POST RFP

- 38 counties have 0 Medicaid plans
- 24 counties have 1 Medicaid plan
- 6 counties have 2 Medicaid plans
- 7 counties have 3 Medicaid plans
- 8 counties have 4 or more Medicaid plans

- 1 county has 3 Medicaid plans
- 20 counties have 4 Medicaid plan
- 23 counties have 5 Medicaid plans
- 13 counties have 6 Medicaid plans
- 26 counties have 7 or more Medicaid plans

**PRE**

**POST**

## SERVICES DELIVERY CAPACITY1977 Total Licensed Dentists in Michigan = 6,346

- 1977 Enrolled = 3,382
- 1996 Participation = 2,056
- 1996 Billing more than $1,000 = 1,628

- 1998 Total Dentists Participating = $4,188
- Must adhere to access standard:
- Take new patients
- provide appointment within 3 weeks
- emergency appointment within 24 hours.

**Medicaid**** ****Dental**** ****Coverage**

**MIChild Dental Coverage**

## SERVICE DELIVERY CAPACITY

## SERVICE DELIVERY CAPACITYMIChild Physician and Health Plan Incentives

- 20% Adverse Risk Supplement for First 7 Months - $12.70
- Physician Rates Based on Medicare, 95% Above Medicaid Almost Doubles Rates
- Maternity Case Rate  $4,000
- Vaccines Supplied by State

## SERVICE DELIVERY CAPACITYHospital Issues

- Monopoly hospitals refusing to negotiate hospital contracts with health plans
- Department position, health plans are agents of Medicaid and can not be charged higher prices them Medicaid DRG in absence of a contract

## HISTORIC MEDICAID PROVIDERSComparison Chart

## HISTORIC MEDICAID PROVIDERSComparison Chart

## MENTAL HEALTH AND SUBSTANCEAbuse Carve Out Access

- Public Community Mental Health and Substance Abuse Network are the traditional providers for the uninsured and Medicaid population
- Access to service for "non-severe" problems may be an issue

## MENTAL HEALTH AND SUBSTANCE Abuse Carve Out

- Boundary Issues for Medicaid
- Psychotropics
- 20 visit coverage by plans
- Fewer boundary issues anticipated for MIChild

## CHILDREN’S SPECIAL HEALTH CARE SERVICES COORDINATIONChildren’s Managed Care Plan

- Two CSHCS managed care plans tailored to high medical needs children with statewide coverage phased in over next 2-3 years
- MIChild eligible children qualifying for CSHCS can:
- join a MIChild plan
- join a CSHCS managed care plan
- get CSHCS specialty services on a fee-for-service basis

## PERFORMANCE MONITORING

- Member Satisfaction
- Quality and Access Study
- HEDIS
- Encounter Data
- Appeal Reporting