Plan First Virginias Family Planning Waiver

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Plan FirstVirginias Family Planning Waiver

• Ashley Barton
• Maternal and Child Health Coordinator
• Department of Medical Assistance Services
• 804-371-7824
• PlanFirst_at_dmas.virginia.gov

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Virginia Waiver History

• 1999 General Assembly mandate
• Post partum family planning waiver
• Implemented on October 1, 2002
• Approved for 5 years
• Eligible population
• Women who received a pregnancy-related service
  paid for by Medicaid
• Income within 133 of the federal poverty level
  (FPL)

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Virginia Waiver History

• 2006 Virginia General Assembly Mandate
• Move to income based family planning waiver
• Expanded eligible population to include men
• Removed pregnancy requirement for women

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Virginia Waiver History

• Submitted Renewal application to Centers for
  Medicare and Medicaid Services (CMS) in March
  2007
• September 28, 2007 CMS approved renewal request
• 6 months to approve
• Regulation was effective January 1, 2008

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Virginia Waiver History

• 2007 General Assembly mandate to expand income
  level up to 200 FPL and remain budget neutral.
• Submitted amendment to CMS in March 2008
• Still awaiting approval
• Many budget revisions and CMS staff division
  changes

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Plan First Eligibility

• Effective January 1, 2008
• Eligible population includes both uninsured men
  and women who have income within 133 FPL and
  have not had a sterilization procedure.

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Plan First Eligibility

• Virginias income based waiver eliminated
• 24-month time limitation requirement
• Receipt of a Medicaid-paid pregnancy-related
  service by women requirement
• Upper age limit

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Plan First Eligibility

• New CMS requirements defined in Special Terms and
  Conditions
• No retroactive eligibility
• Eligibility begins the first day of the month of
  application
• No Ex Parte renewals
• Enrollment cannot be passive in nature

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Plan First Eligibility

• New CMS requirements defined in Special Terms and
  Conditions cont.
• Cannot choose family planning waiver enrollment
  if eligible for full-benefit Medicaid
• Not eligible if enrolled in other creditable
  health insurance
• Virginia opted for discontinuing auto-enrollment

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• Plan First - up to 133 FPL

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• Plan First - up to 200 FPL

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Virginias Experience

• What did not work so well?
• Set unrealistic goals
• Lack of operational oversight
• Entered during a time of policy development

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Virginias Experience

• Unclear Budget Neutrality guidelines
• Not notifying providers of approved codes and
  billing procedures
• Lack of initial outreach to providers and
  enrollees

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Virginias Experience

• What worked well?
• Access to subsidized family planning services
• Participation by private providers
• Continuity of care
• Cost savings
• Guttmacher Institute recently estimated that 1
  invested in public family planning services saves
  4

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Virginias Experience

• Research (other states and Guttmacher Institute)
• Connect with other state family planning waiver
  POCs
• Involving qualified staff to assist with budget,
  evaluation, eligibility and marketing team
  effort

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Virginias Experience

• Collaboration with community and state agencies
• Multiple provider and eligibility staff training
• Clarifying covered services and limitations with
  providers and enrollees
• Plan First Provider manual

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Virginia Experience

• Develop work plan
• What and when to submit to CMS
• System changes needed for claims and eligibility
  / Maintenance
• Regulatory action required
• Provider notification
• Marketing to individuals
• Training providers and eligibility staff

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Virginia Experience

• Marketing Task Force
• Focus groups for marketing materials
• Website link
• www.planfirst.org
• Email PlanFirst_at_dmas.virginia.gov

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Virginia Experience

• Discussion for future
• No Wrong Door application
• Coverage of follow up services?
• Confidentiality Issues
• Proof of income requirement
• Point of Service Enrollment
• Marketing and Outreach

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.org

• planfirst_at_dmas.virginia.gov