Meeting Summary: October 20, 2006
Next meeting: Friday November 17, 2006 @ 9:30 AM in LOB RM 1D

Attendees: Sen. Toni Harp (Chair), Rep. Vicki Nardello, Rep. David McCluskey, Ellen Andrews, Dr. Alex Geertsma, Mary Alice Lee, Rose Ciarcia & Kevin Loveland (DSS), Thomas Deasy (Comptroller Office), William Diamond (ACS), Janice Perkins (Health Net), Sylvia Kelly (CHNCT), Gail DiGoia (Anthem), Robert Diaz (WellCare), Dr. Larry Loeb (DSS Dental Comm.), Deb Poerio( SBHC), Joanne Goldblum (New Haven Diaper Bank), (M. McCourt, staff).

Department of Social Services
The Council Chair requested DSS provide information on the following items:

• Impact of federal citizenship law on the HUSKY program: Kevin Loveland reported on the impact as evidenced by increased pending application and re-determinations:

o All program end-of-month pending applications have increased in Sept 06 compared to July 05 pendings by 3264 (>28%). Historically the total number of end-of-month pending applications for all programs averages about 11-12,000. Currently there are about 3000 more pendings, two-thirds of which are Medicaid HUSKY.
o FMA category (HUSKY A) pending Medicaid applications had the greatest increase from June 06 to Sept 06, with 1482 (>60%) more pending apps in September than in June compared to other Medicaid programs. The Aged, Blind Disabled pendings increased 18% from June to Sept. 2006 and LTC pendings increased 13%. The latter two groups are generally exempt from the federal citizenship law, as these individuals have already provided citizenship and identity documentation when enrolled in these Medicaid programs.

• Some good news in the midst of implementing this policy:

o DPH & DSS have worked out a vital statistics matching arrangement and DSS will shortly send a test file to DPH as part of the match process development. Vital stats prior to 1988 are on micro film; DPH has only one micro film reader. DPH is looking into state equipment supplies for additional readers to facilitate the vital stats match process.

o CMS will allow CT to designate out posted eligibility staff such as Qualified Entities, Healthy Start programs, HSI staff, and others to document that they have seen the original birth, passport or other identity documents, copies of which can then accompany applications. Contract amendments or new contracts will have to be developed and training provided before this can be implemented.
o As of Oct. 1, 2006, 6892 (45%) of previously enrolled HUSKY A clients have re-enrolled. These enrollees represent those that lost eligibility June 30, 2006 with the Transitional Medical Assistance (TMA) program change in the enrollment period of 12 months, down from 24 months. Rep. Nardello stated that outreach to these families that lost Medicaid is critical, as once the family receives the termination notice, they often assume they (or their children) cannot re-apply.

o DSS is now able to fill vacancies more quickly; on average it took about 6 months to fill all positions affected by one vacancy. Dept of Administrative services (DAS) allows a pool of eligibility workers to fill vacant eligibility positions. In 2003 DSS lost more staff than other agencies through lay-offs and early retirement; the burden of unfilled position on the eligibility system was exacerbated with the implementation of the federal citizenship law that resulted in more pending applications in the system for new and renewal clients. According to CMS rules, new applicants cannot be enrolled (other than those children in presumptive eligibility, DCF committed) until citizen documentation is supplied; clients renewing coverage can still receive services while completing the renewal process with appropriate documentation.

o DSS is moving forward with the on-line application program development, issuing a RFI for interested vendors to demonstrate their web-based programs in November.

• Some pending applicants may be eligible for SAGA that would allow them access to health care services during the pending delays; however eligibility in SAGA requires an asset determination and the income eligibility level is much lower than HUSKY. It is important to let applicants know about SAGA. DSS also pursues emergency Medicaid eligibility for those applicants for whom it is critical they receive health care immediately.

• Five new hospitals responded to DSS invitation to become Qualified Entities, bringing the total to 8 as of October 19th. Since John Dempsey Hospital, the only CT public hospital, is concerned about funding, as are other hospitals, Rep. McCluskey hoped hospitals would be pro-active in the children's presumptive eligibility (PE) process. Sen. Harp noted it would be in the interest of every hospital to participate in the PE program as a Qualified Entity to connect “hidden” uninsured children to health coverage and at the same time ensure Medicaid reimbursement for services provided.

Other DSS Updates
• DSS has released the RFP for the competitive Community-based portion of the HUSKY outreach program funded through the Governor's release of $1 million dollars and extended the letter of intent due date by one week. DSS is working with the State Dept. of Education on the school-based outreach program portion funded at $500,000.

• Upcoming reports:

o The DSS/Office of Health Care Access (OHCA) survey of those TMA & other HUSKY members that have lost coverage 13 months prior to June 2005 will be reported to the Council in January 2007.
o The MCO quarterly Prior Authorization approval/denial first report is due to DSS in early December 2006.
o The MCO report on provider network turnover, requested by the Council in late spring 2006, will be available in early 2007; the MCOs still need to determine uniform reporting parameters.

• Rose Ciarcia described the Centers for Health Care Strategy (CHCS) “pay-for-performance” (P4P) technical assistance grant awarded to CT. These programs would follow the CMS P4P definition of using payments/incentives for patient-focused, high value care areas. This approach ensures engagement of families and practitioners in changing health care delivery. Critical to the success of any P4P initiative is the input of key stakeholders and a process by which to monitor the payments and improvement measures. Sen. Harp expressed her view that given the lack of Medicaid reimbursement adjustments over the past 20 years, P4P financial incentives should not be considered in lieu of Medicaid rate increases.
• Rep. McCluskey requested DSS and CHNCT describe the implementation of the SFY 07 budget items for SAGA non-emergency transportation and vision services at a future Council meeting. DSS plans to review revised CHNCT proposals and will then report to the Council.

HUSKY Enrollment October 2006
Enrollment has been steadily increasing after the July 2006 major membership loss. Summary:

• HUSKY B applications denied/closed for incomplete documentation has steadily decreased since June. Self-declaration of income was reinstated in July 2006.
• HUSKY B pending new applications remain higher than one year ago, but lower than July 2006. Federal citizenship documentation regulations do not apply to HUSKY B, which is not a Medicaid program.

Special Report: Joanne Goldblum, President, New Haven Diaper Bank

Program (see above documents for presentation)

The New Haven Diaper Bank (NHDB) provides diapers for many very low-income families. No federal or state program covers the costs of diapers or personal hygiene products. The NHDB depends on donations to purchase diapers that are distributed monthly through existing social service agencies. Approximately 50,000 diapers are distributed monthly.

Why this is a necessary service
An adequate supply of diapers for one infant can cost over $100/month. Inadequate diaper supplies can lead to:

ü Infant/toddler health problems such as skin disease,
ü Barriers to childcare center attendance, since parents are required to supply disposable diapers at the center, or the child cannot attend the center
ü Risk for abuse related to infant discomfort/crying from an unchanged diaper.
ü Delays in developing parental self sufficiency – when the child cannot attend child care center because the family cannot afford diapers, the parent cannot consistently remain involved in schooling or job training activities that would lead to self sufficiency.
ü School readiness is linked to unaffordable basic hygiene products, including diapers.

Ms. Goldblum identified a basic need in her community that often is overlooked in the health/social system and has done an exemplary job in creatively meeting the needs of very low income families in New Haven solely through donations and community collaboration. Sen. Harp thanked Ms. Goldblum for her tireless efforts in addressing a basic need that is both a public health as well as service access issue.

Other
Ellen Andrews suggested inviting the CT Health Foundation to a future Council meeting to discuss their access to linguistic services study and the E-HealthCT program that is focused on electronic medical records, sharing such records within the multiple layers of the medical system.

Council Subcommittee Activities

Consumer Access Report:

Quality Assurance Report

Both subcommittees will meet November 16 to discuss alternatives to ED use for non-emergent care.