You wanted an analysis of the governor's Connecticut Community KidCare proposal for mental health care services for children. You were particularly interested in the types and numbers of children who would be covered and the costs of coverage.

SUMMARY

The KidCare proposal restructures the state's delivery of mental health services for children. It calls for increased community-based services; greater coordination among families, service agencies, and service providers; and flexible funding for services by merging currently categorical streams of federal and state monies. The departments of Children and Families (DCF) and Social Services (DSS) will jointly administer the new structure. They will hire a single administrative organization to manage funding, claims processing, data and contract management, and reporting; contract with five to 12 "lead service agencies" to manage services and coordinate care in designated geographic areas; and establish community collaboratives in these areas to develop individual service plans for each child who needs help from more than one state agency. The initiative will be phased in over the next 18 to 36 months.

Slightly more than 242,000 children would be eligible for KidCare today. As proposed by DCF and DSS, KidCare will cover (1) all children eligible for the state's HUSKY A and B plans and (2) children accepted in DCF's Voluntary Service Program. About 234,300 children are currently enrolled in HUSKY A, 7,700 in HUSKY B, and 360 in DCF voluntary services.

Twelve percent (12%) of the HUSKY children used one or more behavioral health services between April 1, 1998 and March 31, 1999 (the fiscal year DCF and DSS studied in preparing their study for the legislature that generated their KidCare proposal). Services for this population totaled $206.6 million during the 1998-99 study period. Using current enrollment data, about 29,000 children might use KidCare services.

The Governor's Budget calls for spending $44,850,000 million for DCF's portion of KidCare over the 2001-03 biennium: $18.1 million in FY 2001-02 and $26,750,000 million in FY 2002-03. Of this $38,650,000 is new money ($15 million in FY 2001-02 and $23,650,000 in FY 2002-03) and $6.2 million is redeployed from existing DCF funding. HUSKY spending is based on service use and is not included in this amount.

CONNECTICUT COMMUNITY KIDCARE PROPOSAL

The KidCare initiative calls for implementing changes in the way the state delivers and pays for children's mental health services. It is based on a plan developed by DCF and the DSS pursuant to Public Act 00-2, May Special Session.

The proposal builds on DCF's existing "systems of care" approach, which features regional collaboration among families, local agencies, and service providers to provide coordinated services to children with serious emotional disturbance who might otherwise need to be placed out of their homes or communities. The proposal seeks to (1) keep kids in or near their homes for treatment, (2) alleviate treatment bottlenecks in the care system thus better assuring the most appropriate treatments are available when needed, (3) provide nonmedical support services, and (4) replace categorical funding with flexible funding that addresses each child's (and family's) comprehensive mental health care needs.

Eligibility and Funding Sources

The proposal covers about 242,000 children who are enrolled in HUSKY A and B and in DCF voluntary services program. All HUSKY children will be enrolled in KidCare, regardless of whether they need behavioral health services (this is called a full carve-out). Medicaid, other federal funds for behavioral health care, state General Fund money, and third party insurance payments will be integrated into a single funding pool. DSS will be responsible for ensuring compliance with Medicaid and federal Children's Health Insurance Program rules. DCF will be responsible for contracting for services and contract management, grievance and administrative hearings, compliance with other federal rules, developing system performance measures, and quality improvement.

System Structure

The KidCare system structure as proposed in January involves:

· A single, statewide administrative service agency to manage funding, claims processing, data and contract management, and reporting;

· Five to 12 lead service agencies (LSAs) throughout the state that will manage services for enrolled children in a designated geographic area, develop local community resources, employ care coordinators to work with families whose children require services from more than one state agency, and assure service quality;

· One or more community collaboratives (a consortium of service providers, service agencies, and families) in each LSA catchment area that establishes teams to develop individual service plans for children needing services from multiple agencies, assess community services, and help oversee the LSAs; and

· Regional advisory councils to oversee LSAs, a statewide Family Support Network to encourage family involvement, and a state behavioral health advisory committee to DCF's existing Council on Children and Families.

Implementation Plan

The DCF/DSS plan as presented in January calls for implementing the proposal in the following stages. The agencies are still finetuning the schedule, so the following dates may be changing.

1. Between January to June 2001, DCF will begin (1) funding (at a cost of approximately $3.5 million) in-state specialized residential services and some community-based services like mobile emergency psychiatric services, short-term crisis stabilization, care coordination, and extended day treatment and (2) issuing requests for proposals for LSAs.

2. Between January and June 30, 2001, DSS will begin negotiating HUSKY contract extensions to take effect July 1, 2001. It will introduce arrangements to encourage managed care organizations to increase their reliance on community-based alternatives to institutional care and to coordinate with DCF caseworkers to create comprehensive care plans for children.

3. Between January 2001 and July 2002, DCF will hire an administrative service agency and select LSAs. It will work jointly with DSS on systems operation and financing issues, training, and performance measurement and evaluation.

4. Beginning July 2002, the system will be implemented in at least two LSAs. (Based on a recent provider inventory, DCF is currently leaning toward beginning in only one area.)

5. Beginning January 2003, phase in will start for other LSAs. Phase in will be conducted during the next 18 to 24 months.

KidCare Costs

Connecticut spent about $207 million in FY 1998-99 for behavioral health services for children enrolled in HUSKY. This is the total of state, federal, and local funds administered by five state and numerous local education agencies. DCF accounts for over half of the spending. Table 1 shows the spending by agency.

Table 1: State Spending for HUSKY Behavioral Health, FY 1998-99

Agency	Total Spent (millions)	% of Total
DCF	$119.79	58
SDE/Local Schools	46.77	22.6
DSS	29.72	14.4
DMR	5.75	2.8
DMHAS	4.60	2.2
TOTAL	$206.63	100%

Most (72%) of this funding, nearly $149 million, comes from the state. Federal Medicaid and Title IV-E (for DCF residential treatment) funds account for 20.4% or about $42 million, and local schools contribute the rest, about $15.3 million (7.4%).

About 12% of the HUSKY population used behavioral health services. Five percent of the children (5%) required psychiatric hospitalization costing $41.1 million, 13% required residential treatment costing $104.2 million, and 82% used home and community-based services costing $61.3 million.

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