Texas Medicaid and CHIP

1
Texas Medicaid and CHIP

• Protecting Childrens Health in Lean Times
• Presented by Jason Cooke
• Associate Commissioner/State Medicaid-CHIP
  Director
• Texas Health and Human Services Commission at the
  3rd Annual TACHC/CHAT/CKF Outreach Conference
• January 20, 2004

2
Recap of Key Policy Changes

• CHIP
• Assets test 3/04
• Cost-sharing increases 11/03
• Benefit changes 9/03
• Gross income 11/03
• 6 months continuous eligibility 1/04
• 90-day waiting period 10/03
• Provider reimbursement reduction 9/03
• Behavioral health

3
Recap of Key Policy Changes

• Childrens Medicaid
• Data broker at renewal
• Provider reimbursement reduction

4
Enrollment and Retention

• CHIP What does the budget assume?
• Average monthly enrollment
• 380,603 SFY04
• 346,818 SFY05
• Average monthly enrollment to date
• 461,716

5
Enrollment and Retention

• CHIP What do the numbers say?
• 416,302 enrolled as of January
• Disenrollment 8.8
• Renewal 72.4
• Failure to renew 17,323
• Enrollment decline among lower income populations

6
Enrollment and Retention

• CHIP What do the numbers mean?
• Declining new enrollment
• Non-renewals
• Completed renewal ineligible
• Adverse risk-retention?

7
Enrollment and Retention

• What are the impacts beyond the numbers?
• Cost, enrollment and outcome measures
• Examples of possible Medicaid outcome measures
• NICU use relative to enrollment trends for
  pregnant women
• Access and quality related to adult mental health
  counseling and psychology services
• Examples of possible CHIP outcome measures
• Access impact on disenrolled children
• Utilization of services in the population
  remaining in CHIP
• Access impact on children subject to increased
  cost-sharing
• Medical outcomes of diagnoses with dental
  comorbidity

8
Enrollment and Retention

• What is the role of CBOs today?
• Enrollment
• Community resource
• Impact multiplier
• Renewal
• Community partnerships
• Renewal application completion assistance
• Consumer education Medicaid data broker role
• Utilization
• Consumer education

9
Enrollment and Retention

• Some retention best practices
• Community partnerships CBOs, health plans and
  providers
• Reaffirmation CHIP is still the best health
  insurance bargain in town
• Consistency Renewal scripts under development by
  Sherry Matthews
• Medical home practical reality for families

10
Medicaid and CHIP Renewal

• Pre-9/03
• E-Z Renewal v. Renewal
• Post-9/03
• E-Z Renewal and Renewal forms combined
• Mirrors initial application
• CHIP form pre-populated, changes must be
  documented
• Medicaid form not pre-populated, verification
  consistent with initial application

11
Next Up CHIP Assets Test

• Self-declaration at application, renewal
• Make, model, year of all vehicles owned
• Vehicle value determined using Hearst
  Corporation/NAR Division Black Book
• Exempt uses form to ineligible families
• No documentation

12
HHS Consolidation

• Creation and structure of new agencies
• Public meetings
• Public comment
• Agency Advisory Councils
• Medicaid/CHIP Administration

13
Medicaid/CHIP Consolidation

• Transformation Project
• Involves staff at all levels
• Collaboration with Deloitte Consulting
• Assessment
• Business processes
• Performance measures
• Organizational structure
• Staff allocation
• Reengineering

14
Medicaid/CHIP Consolidation

• Transformation Project (contd)
• Transformed Administration
• Integrated business processes
• Organizational structure
• Staff reallocated based on risk
• Integrated performance measurement
• Performance-oriented culture

15
Medicaid/CHIP Consolidation

• Transformation Project (contd)
• Performance-oriented culture
• Customer service
• Stakeholder communication
• Clear roles and responsibilities
• Accountability at group and individual levels
• Commitment to measurement of performance

16
Medicaid/CHIP Consolidation

• Transformation outcomes
• Appropriate staffing
• Clearer, more consistent, more timely
  communication with stakeholders
• Clarity of roles staff and contractors
• Focus on a few key functions
• Greater efficiency in managing change
• Medicaid LTC, MedTrans policy centralized

17
Medicaid/CHIP Consolidation

• Medicaid/CHIP Administration
• Medicaid/CHIP Division
• Policy, operations, contract management, CMS
  relationship
• Financial Services Division
• Rate-setting, budget, forecasting
• OIG
• Waste, fraud and abuse investigations,
  enforcement

18
Medicaid/CHIP Consolidation

• Medicaid/CHIP Administration (contd)
• Office of Eligibility Services
• Eligibility operations
• Office of Family Services
• Eligibility policy
• Office of the Ombudsman
• Consumer and provider inquiry intake

19
Conclusion

• Did you ever wonder what someone was thinking
  when they invented the bumper sticker?
• Not much time to read
• Not much space for the message
• Target superficial level of consciousness
• Example CHIP HAPPENS

20
Conclusion

• Do all the good you can,
• By all the means you can,
• In all the ways you can,
• In all the places you can,
• At all the times you can,
• To all the people you can,
• As long as ever you can.
• -- John Wesley, English theologian
  (1703-1791)
• by way of CPPP