OVERVIEW OF PRESENTATION

1
OVERVIEW OF PRESENTATION

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

2
THE STARS IN THEIR COURSES...

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

3
STAGE ONE PROGRAM DESIGN

• 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

4
STAGE ONE PROGRAM DESIGN (cont.)

• 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

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STAGE TWO CONCLUSIONS

• 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

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PHASE THREE BENEFIT DESIGN

• 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

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PHASE FOUR HUSKY PLUS

• 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

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PHASE FOUR HUSKY PLUS (cont.)

• Plan Established for Children With Special
  Physical Needs
• Two Title V centers of excellence selected as
  providers
• Connecticut Childrens 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

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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 Childs 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

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PHASE FIVE OUTREACH

• 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

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PHASE FIVE OUTREACH (cont.)

• 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
  others 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

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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

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PHASE SIX EVALUATION AND MONITORING

• 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
• Couldnt 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)

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PHASE SIX EVALUATION AND MONITORING (cont.)

• 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
• Were 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

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KEY DATES

• 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

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SIX PHASES OF EVERY PROJECT

• 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

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HUSKY ACTIVITYJUNE 1, 1998--AUGUST 9, 1998
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HUSKY B