Reaching All Kids:Opportunities & Strategies for Collaboration between Title V, Medicaid and CHIP Programs

Iowa’s Title V – Medicaid/CHIP Partnership

Iowa EPSDT Key Contacts

Jane Borst, Iowa Title V Director– Iowa Department of Public Health – Chief, Bureau of Family Health – E-mail: jborst@idph.state.ia.us – Phone: 515 281-3826

Sally Nadolsky, Medicaid Policy Specialist– Iowa Medicaid Enterprise– Maternal Health Centers and Screening Centers– E-mail: snadols@dhs.state.ia.us – Phone: 515 725-1142

ObjectivesDescribe the foundation for the relationship

between Iowa’s Title V MCH program and Medicaid

Describe the scope of the relationships between Iowa’s Title V MCH program and Medicaid & CHIP

Describe plans for the future for Iowa’s Title V MCH program as it relates to Medicaid services

Iowa’s Title V – Medicaid/CHIP Partnerships

Agreements are established between Iowa Medicaid and the Iowa Department of Public Health to: – Assure cooperation between state agencies– Facilitate outreach through toll free number (Healthy

Families Line) & Grassroots (hawk-i) Outreach network

– Administer community-based Informing, Care Coordination, & Oral Health and Enhanced Prenatal Services through local Title V agencies

– Assure/Provide Preventive Direct Health Care Services– Monitor quality – Medicaid Birth Certificate match

Community Agencies

Coordinated Community-based Systems of Care

Community Development

Family Centered Services

Child Health Service Areas

Iowa’s Title V –hawk-i (CHIP) Partnership

Grassroots Outreach• Builds on Covering Kids & Families Statewide Coalition• Based on local Title V agency Community Needs Assessments• Outreach Coordinators• Local agencies develop community-based outreach Action Plans

– Plan strategies must include:• school-based, health care professionals, faith based, & others (i.e.,

business, child care)– hawk-i Administrator approves plans– Quarterly meetings to coordinate community-statewide strategies

• Low Cost/Highly Effective Outreach Title V administered paid by CHIP

Iowa’s Title V – Medicaid Partnership

• EPSDT– Outreach– Informing & Care Coordination– Direct Care

• I-Smile • Prenatal- Enhanced Services &

Presumptive Eligibility• Medicaid Birth Certificate Match

Healthy FamiliesStatewide Resource

1-800

Linking Families with

Maternal & Child Health &

Family Planning Agencies

Prenatal Care Hotline

Healthy Child Care “warm line”

Information & Referral 1-800 369-2229

Where we’ve been….. OBRA ’89: Intent was to assure access to

health care and establish comprehensive coverage for children eligible for Medicaid.

EPSDT was expanded to include:– Informing recipients of coverage benefits –Care coordination services and–All other medically necessary services

Where we’ve been in Iowa….. Initially, the program was operated entirely by local

Department of Human Services offices.

In the late 1980s, Iowa had an EPSDT participation rate of less than 10%.

In 1988, the Iowa General Assembly recommended a comprehensive system change to implement national recommendations.

Where we’ve been in Iowa…..

In 1991, a pilot project with three local Title V agencies was implemented to provide

• EPSDT program information upon determination of Medicaid eligibility (Informing services)

• Care coordination services

In 1995, Iowa expanded the system change statewide

Care coordination for children with special health care needs is available through Child Health Specialty Clinics (Title V CHSCN)

Organization Connections

Iowa Dept. of Human Services

Iowa Dept. of Public Health

Community-based Title V Child Health Agencies

Interagency Agreement

Subcontracts

Other Local Providers

RFP & Contract

Federal Department of Health and Human Services

Title VTitle XIX

Provider Number Contract

Child Health Specialty Clinics

Outcomes

EPSDT participation rates increased annually.

System performance successfully met the 80% participation rate.

FFY 1991-2004 EPSDT Participation Rates

0%

20%

40%

60%

80%

100%

120%

140%

1991 1992 1993 1994 1995 1996 1997 1998* 1999 2000 2001 2002 2003 2004

Year

Pilot Period

Times are changing . . . .

“Change is inevitable - except from a vending machine.”

Robert C. Gallagher

CMS - Interim Final Regulations

2005 Deficit Reduction Act

CMS Interim Final Regulation on Targeted Case Management– Clarifies definition of Targeted Case Management– Requires comprehensive assessment, case plan, referrals,

monitoring, and follow-up– Requires single case manager across programs– Effective March 3, 2008 - moratorium extended deadline

Iowa Medicaid and the Iowa Department of Public Health agreed that . . . .

– The Interim Regulation was written to address populations of chronically ill or disabled individuals.

– Title V promotes regular preventive care for all children and pregnant women.

– Iowa’s Informing and Care Coordination system is successful and should continue.

Informing & Care CoordinationPreviously classified as Targeted Case Management

services

Iowa’s Medicaid State Plan – State Plan Amendment implemented Feb 1, 2009. New agreement established for state fiscal year 2009

Local Title V agencies bill IDPH for Informing, Care Coordination, and Medicaid for “direct care” services.

Iowa Medicaid EnterpriseInforming and care coordination services no

longer classified as Targeted Case Management in Iowa’s State Medicaid Plan

Medicaid Administrative Services

Contract with IDPH serves as the payer of these services provided by local Title V maternal and child health agencies

Medicaid Administrative Services

Child Health Services• Informing • Care coordination

The Iowa Department of Public Health reimburses local contractors. IME reimburses IDPH

Child Health Center Direct Care

Child Health EPSDT Screening Services • Well Child • Lab • Developmental Screens• Immunization • Transportation

The Iowa Medicaid Enterprise reimburses local Title V Child Health Screening Centers directly

I-Smile

I-Smile☼ Objectives

1. Improve the dental support system for families

2. Improve the dental Medicaid program

3. Implement recruitment and retention strategies for underserved areas

4. Integrate dental services into rural and critical access hospitals

I-Smile & Child Health Centers☼Each agency must have a dental hygienist to serve as

the local I-Smile Coordinator (Title V Contract).

☼Each agency creates an I-Smile Action Plan with the objective of improving EPSDT dental services rates.

☼Coordinators are responsible for assuring the I-Smile strategies are met.

Oral Health Next Steps

☼Continue to improve the dental Medicaid program

☼Increase recruitment and retention efforts, particularly in rural Iowa

☼Investigate expansion of oral health workforce

☼Health care reform– 25% of Iowa children have no payment source for dental care– Assure that dental insurance is included within the state’s reform

efforts

Prenatal – Postpartum Care

Maternal Health Service Areas

Medicaid Administrative Services

Maternal Health Services• Presumptive Eligibility - Outreach• Care Coordination

The Iowa Department of Public Health reimburses local contractors. IME Reimburses IDPH

Direct Care for Maternal Health Centers

Maternal Health Services• Risk Assessment• Prenatal Exam• Prenatal Education• Counseling (Nutrition, Psycho-social)• Transportation• Home Visits

The Iowa Medicaid Enterprise reimburses local contractors directly (Screening Center Providers)

Outreach – Early Prenatal Care & Plans for Delivery

Presumptive Eligibility

Linkage with Medical Homes

Vital records and Medicaid Claims Data Match

Data become information on birth outcomes

Information on birth outcomes is being reviewed by the medical directors, epidemiologists and key stakeholders

Regular meetings to review the analysis and investigate solutions

Next Steps

Continue data analysis to identify areas for potential intervention.

Develop an intervention strategy to improve birth outcomes.

Title V local agencies will be a partner in this effort.

Collaborative Partnership

“Action and reaction, ebb and flow,

trial and error, change ---

This is the rhythm of living.

Out of our over-confidence, fear;

out of our fear, clearer vision, fresh hope.

And out of hope, progress.” Bruce Barton

Questions?