family cost participation in georgia’s part c system
DESCRIPTION
Family Cost Participation in Georgia’s Part C System. Why FCP in Georgia?. Precedent Initial Planning Stakeholder Involvement. GA Part C Demographics. Part C serving over 11,000 children per year Narrow eligibility criteria (Revised Fall 2005) 60.5% Medicaid eligible - PowerPoint PPT PresentationTRANSCRIPT
Family Cost Participation
in Georgia’s Part C System
Why FCP in Georgia?
Precedent
Initial Planning
Stakeholder Involvement
GA Part C Demographics
• Part C serving over 11,000 children per year
• Narrow eligibility criteria (Revised Fall 2005)
• 60.5% Medicaid eligible• 36.5% Private Insurance• 3.8% PeachCare (S-CHIP)
Georgia Demographics
• Median Income of families with children (2004) = $46,400 ($50,800 nationally)
• Percentage of Children Living in Poverty(100%): 21% (18% nationally)
• Percentage of Children in Extreme Poverty (below 50% Poverty level) = 10% (8% nationally)
Source: GA Kids Count
Determining Family Costs
• Children with Special Needs Financial Analysis for Family Cost Participation includes review of the following:– Available funding sources (Medicaid, SCHIP,
Title V, Private Insurance, etc.)– Number of family members– Gross household income– Unearned income– Out of pocket extraordinary expenses
related to the child’s disability (used for "spend down”)
Please check () all programs child is currently enrolled in:
Medicaid #: ______________________Indicate CMO, if applicable:
________________________ PeachCare for Kids #: ______________
Indicate CMO, if applicable: ______________________ Babies Can't Wait Children’s Medical Services High Risk Infant Follow-Up Health Insurance Coverage
Primary Family Health/Insurance Plan
(% covered for specific services, if known)
Secondary Family Health/Insurance Plan
(% covered for specific services, if known)
Carrier/Address
Policy/Program Number
Enrolled Family Member/Employee
Phone #
1. Number of people in family:
2. Household (Gross) Earned Monthly or Yearly Income (see Appendix C, page 7-8): $ (Circle monthly or yearly)
Unearned Income Amount
Sources of Unearned Income (see Appendix C, page 7-8)
(State specific source and if monthly, annual, one-time)
3. $
4. $
5. $
6. $
7. Total Monthly or Yearly Income: Add lines # 2 through 6 $ (Circle monthly or yearly)
List below the average monthly or yearly "out of pocket" extraordinary expenses that are related specifically to the child's disability: (Identify specific purchases, expenses, modifications, and alterations that family members have made within the previous month or year to accommodate the extended/additional needs of the child’s disability. Extraordinary expenses cannot include anticipated or future costs or family’s anticipated out-of-pocket cost participation expenses.) (See Appendix C, page 9)
Expense Cost Description of Costs
8. Child Care Special Costs (Difference)
$
9. Materials, Supplies
10. Equipment
11. Medical/Health
12. Medications
13. Special Food Supplements
14. Transportation/Parking
15. Other - list specifics:
16. Add lines # 8 - 15 for total Monthly or Yearly Extraordinary Expenses: $ (Circle monthly or yearly)
17. Subtract line # 16 from line # 7: $ = Adjusted Family Income (Circle monthly or yearly)
18. Babies Can’t Wait:Using Adjusted Family Income from line #17 and # of family Members from line # 1, determine % of family cost participation using the Cost Participation Scale (see Appendix C, pages 4-5). Family Cost Participation = %
19. Children's Medical Services:To determine family cost participation, use the following formula:If line #17 is monthly, multiply Adjusted Family (monthly) Income x 12 = Adjusted Family Income (Adjusted Family Income – Baseline) x .10 = Annual Cost ParticipationNote: CMS Baseline is 150% of Federal Poverty Level. (See Appendix C, page 6) Family Cost Participation = $
Income 1 2 3 4 5 6 7 8 9
AnnualMonthlyWeekly
67,2005,6001,292
35 30 25 20 15 10 5 0 0
AnnualMonthlyWeekly
74,0006,1671,423
40 35 30 25 20 15 10 5 0
AnnualMonthlyWeekly
80,8006,7331,554
45 40 35 30 25 20 15 10 5
AnnualMonthlyWeekly
87,6007,3001,685
50 45 40 35 30 25 20 15 10
Family Size 07/01/06
VERIFICATION: (Only one form of verification is required.) CSN Staff or designee (i.e., service coordinator, care coordinator) must visually verify one of the three documents below for each parent. The document(s) verified must be those that illustrate the most accurate estimate of the family’s total gross income. Total gross income must be written in the box below.
2 Most Recent Payroll Slips
OR Income Tax Return From
Previous Year
OR W2 Form from Previous Year
$ $ $
I verify that all information above is true and correct. ___/____/____Printed Name of Parent Signature of Parent Date
___/____/____Printed Name of CSN Staff/Designee Signature of CSN Staff/Designee Date
Determining Family Costs
• Children with Special Needs Financial Analysis for Family Cost Participation:– Also used for Title V/CSHCN program
cost participation– Includes standard definitions of earned
income, unearned income, and resources not to be included as earned or unearned income
– Includes descriptions of allowable extraordinary expenses
Determining Family Costs
• Children with Special Needs Financial Analysis for Family Cost Participation includes:– Consent/Decline Access to Private
Insurance form– Decline to Complete Financial
Analysis for Cost Participation form
Determining Family Costs
• Children with Special Needs Financial Analysis for Family Cost Participation:– Completed after eligibility
determination, prior to IFSP development
– Updated at least annually or more often if family financial status changes
Determining Family Costs
• Children with Special Needs Financial Analysis for Family Cost Participation:– Completion of scale yields a
percentage (0% - 100%) – Families are responsible for their
percentage of the total cost for each unit/session of early intervention support/service
• Family cost participation only applies to IFSP services that are not covered by third party fund sources (e.g. Medicaid, PeachCare for Kids, Children’s Medical Services, private insurance, etc.).
• If families consent to access private insurance AND private insurance pays for any portion of a service, no additional cost is assessed to the family. The family’s contribution or cost share is fulfilled by the payment received from their private insurance.
Why does FCP Work for Georgia?
• Consistent policies & procedures
• Same criteria is applied to all families
• Scheduled updates & revisions
Ongoing Review of Policy
FCP scale is updated annually to include most current Federal Poverty Guidelines and other necessary changes
Modifications are Based on Ongoing Monitoring
Local monitoring & site reviews
Complaints
Identification of new fund sources
Revisions that Occurred in Response to Ongoing
Monitoring
Revised Policies:FCP & Medicaid-eligibility -
Provisions applied family cost participation to non-covered
services for all families
Revisions that Occurred in Response to Ongoing
Monitoring
Revised Policies:“Spend Down” & Adjusted
Income -Revisions to refine, clarify, and
define allowable and disallowed “spend downs”
Revisions that Occurred in Response to Ongoing
Monitoring
Revised Criteria:For families with multiple children enrolled in Part C -
Provisions to reduce FCP percentage by 5% for each child after the first enrolled
child
Revisions that Occurred in Response to Ongoing
Monitoring
New Funding Sources & Coordination:
• Private Insurance provisions
• Expansion of FCP to Title V
Things previously considered but not implemented in GA
• Out of pocket maximum costs per year for each family
• Separate scales for families who access insurance and those who deny access
Why does FCP Work for GA?
Consistent Policies:• Determination of “inability to
pay”
Ongoing Monitoring:• Widespread acceptance &
expectations
Family Cost Participation -
What’s Next in GA?Changes in Political and
Economic Context:• Look at FCP fee scale, levels
Infrastructure Changes:• Data system enhancements
Anticipated Possible Future Revisions
• Flat fee per month for families rather than percentage of each unit of fee-for-service– Easier for families to budget monthly– Fits better with primary service
provider/coaching approach to service delivery
– Looking at states who have some variation of this model (CT, KY, MA, TX, VA, UT, WI)
Anticipated Possible Future Revisions
• Data system changes (Central billing???) – Cannot currently report total funds
collected through family cost participation system because fees are collected at the local provider level in GA
• Stakeholders
• Data
• Other options
• Authority needed
Consider this as you study FCP in your state…
Any Questions???
Georgia’s FCP forms are included in your Symposium materials.
Contact Stephanie Moss at [email protected]
or 404-657-2721