vermont section 1115 demonstration grant project unimed 2005-2008 a unified approach to medical...

Vermont Section 1115 Vermont Section 1115 Demonstration GrantDemonstration GrantPROJECT UNIMEDPROJECT UNIMED

2005-20082005-2008

A Unified Approach to Medical Support A Unified Approach to Medical Support Through Intra-Agency Through Intra-Agency

Collaboration/Data ExchangeCollaboration/Data Exchange

Prepared by Sean Brown of the Vermont Office of Child SupportPrepared by Sean Brown of the Vermont Office of Child Support

Presented and Co-Prepared by Christin L. Semprebon, Esq.Presented and Co-Prepared by Christin L. Semprebon, Esq.

ERICSA Conference 2011, Atlantic City, New JerseyERICSA Conference 2011, Atlantic City, New Jersey

Project GoalsProject Goals

Improve collaboration with key partnersImprove collaboration with key partners

Collect and analyze medical support dataCollect and analyze medical support data

Report lessons learned and best practicesReport lessons learned and best practices

Goal 1- Improve CollaborationGoal 1- Improve Collaboration

Prior to applying for grant OCS identified the key Prior to applying for grant OCS identified the key partners and secured their participation in the partners and secured their participation in the grant via a written agreement.grant via a written agreement.

The key partners included:The key partners included:

Office of Vermont Health Access (OVHA)Office of Vermont Health Access (OVHA)

Economic Services Division (ESD)Economic Services Division (ESD)

Health Access Eligibility Unit (HEAU)Health Access Eligibility Unit (HEAU)

Goal 1- Improve CollaborationGoal 1- Improve Collaboration

OVHA is responsible for administering the OVHA is responsible for administering the Medicaid program in Vermont. It operates Medicaid program in Vermont. It operates essentially as a managed care organization.essentially as a managed care organization.

ESD is responsible for making eligibility ESD is responsible for making eligibility determinations and enrollment for applicant’s determinations and enrollment for applicant’s applying for Medicaid and other benefits such as applying for Medicaid and other benefits such as TANF.TANF.

HAEU is responsible for making eligibility HAEU is responsible for making eligibility determinations and enrollment for applicant’s determinations and enrollment for applicant’s applying solely for Medicaid. applying solely for Medicaid.

Goal 1- Improve CollaborationGoal 1- Improve Collaboration A workgroup was created with staff from OVHA, ESD, A workgroup was created with staff from OVHA, ESD,

HAEU and OCS to develop new policies, procedures and HAEU and OCS to develop new policies, procedures and forms to increase Medicaid referrals to OCS. The forms to increase Medicaid referrals to OCS. The workgroup: workgroup:

Created new assignment of rights for medical support for Created new assignment of rights for medical support for Medicaid-only cases and new process for referring cases to Medicaid-only cases and new process for referring cases to OCS. In 2006 about 2,864 and in 2007 about 2832 of the new OCS. In 2006 about 2,864 and in 2007 about 2832 of the new forms were processed by OCS.forms were processed by OCS.

Developed and implemented Medicaid sanctions for custodial Developed and implemented Medicaid sanctions for custodial parents who did not cooperate with OCS.parents who did not cooperate with OCS.

Developed and implemented Medicaid waivers of cooperation Developed and implemented Medicaid waivers of cooperation for custodial parents with domestic violence concerns.for custodial parents with domestic violence concerns.

Agreed not to pursue child-only Medicaid cases due to lack of Agreed not to pursue child-only Medicaid cases due to lack of cooperation from custodial parents and lack of sanctions.cooperation from custodial parents and lack of sanctions.

Goal 2- Collect & Analyze DataGoal 2- Collect & Analyze Data

Many changes were made to ACCESS, the shared Many changes were made to ACCESS, the shared mainframe computer system, to collect and share data mainframe computer system, to collect and share data among the IV-D, IV-A and Medicaid agencies. Key among the IV-D, IV-A and Medicaid agencies. Key changes allowed for:changes allowed for:

Improved communication between staff.Improved communication between staff. Improved collection and exchange of employment/wage data.Improved collection and exchange of employment/wage data. Improved collection and exchange of health insurance data.Improved collection and exchange of health insurance data. Improved collection and exchange of court hearing/order data.Improved collection and exchange of court hearing/order data.

The new data elements in ACCESS were uploaded into The new data elements in ACCESS were uploaded into the OCS data warehouse (PEAKS) for reporting and the OCS data warehouse (PEAKS) for reporting and analysis.analysis.


Court Orders Resulting in Health Insurance for NCP

75%

13% 12%

-10%

10%

30%

50%

70%

90%

Insurance Unavailable Ordered Available but Not Ordered

May 2007 - February 2008


Other examples include NCP’s employer does not offer, NCP works Other examples include NCP’s employer does not offer, NCP works part-time, NCP is Medicaid active, and NCP has a waiting period part-time, NCP is Medicaid active, and NCP has a waiting period before insurance is available.before insurance is available.

Insurance not Available to NCP

46%

22%

16%12%

4%

0%

20%

40%

60%

Other Unemployed Affordability Self Employed Disabled



Health Insurance Available to NCP but not Ordered

79%

1% 0%

20%

0%

20%

40%

60%

80%

100%

Reasonable Cost Accessibility Comprehensiveness Other



Health Insurance Ordered for NCP

51%

44%

5%

0%

20%

40%

60%

Reasonable Cost Other No Additional Cost to Party



Court Orders Resulting in Health Insurance for CP

85%

8% 7%

-10%

10%

30%

50%

70%

90%

Insurance Unavailable Ordered Available but Not Ordered



Other examples include CP’s employer does not offer, CP works part-time, Other examples include CP’s employer does not offer, CP works part-time, CP is Medicaid active, and CP is full-time student.CP is Medicaid active, and CP is full-time student.

Insurance not Available to CP

48%

32%

11%

5% 4%

0%

20%

40%

60%



Health Insurance Available to CP but not Ordered

81%

3% 1%

15%

0%

20%

40%

60%

80%

100%

Reasonable Cost Accessibility Comprehensiveness Other



Health Insurance Ordered for CP

58%

39%

3%

0%

20%

40%

60%

80%

Reasonable Cost Other No Additional Cost to Party



Part A Response Reasons

800

900

1,000

1,100

1,200

1,300

1,400

Not Employed No Coverage Not Eligible CCPA &Reasonable

Cost

32%

26%

22%

20%


Part B Response Reasons

-

200

400

600

800

1,000

1,200

1,400

Enrolled Waiting Period Not Able to Enroll

57%

1%

42%


783P Notice Responses

67%

25%

7%

1%0%

20%

40%

60%

80%

Coverage notAvailable

Children Enrolled Reasonable Cost Unemployment

July 2007 - February 2008

Data Mining Model SummaryData Mining Model Summary

8.56% of IV-D cases used in the data mining 8.56% of IV-D cases used in the data mining model have confirmed health insurance in place.model have confirmed health insurance in place.

Almost 89% of the cases with current monthly Almost 89% of the cases with current monthly wages greater than $5,900 have insurance wages greater than $5,900 have insurance coverage.coverage.

Cases with the lowest obligation to arrears ratio Cases with the lowest obligation to arrears ratio range (0 to 2.5) had the highest percentage of range (0 to 2.5) had the highest percentage of health insurance coverage at 10.4%.health insurance coverage at 10.4%.

Of all case types, Medicaid-only cases are the Of all case types, Medicaid-only cases are the least likely to have health insurance coverage.least likely to have health insurance coverage.


95% of the cases with nominal child 95% of the cases with nominal child support orders, $100 or less per month, do support orders, $100 or less per month, do not have insurance.not have insurance.

NCP earnings above $5000 per quarter NCP earnings above $5000 per quarter are indicative of health insurance are indicative of health insurance coverage.coverage.

Cases under 2 years of age had the Cases under 2 years of age had the highest percentage of coverage (10.25%) highest percentage of coverage (10.25%) than all other case age groups.than all other case age groups.


The difference in health insurance The difference in health insurance coverage for interstate (8.71%) and non-coverage for interstate (8.71%) and non-interstate (7.41%) cases is not significant.interstate (7.41%) cases is not significant.

There is a higher likelihood of insurance if There is a higher likelihood of insurance if the NCP changes jobs.the NCP changes jobs.

The more phone contacts logged on a The more phone contacts logged on a case, the higher the likelihood of insurance case, the higher the likelihood of insurance enrollment.enrollment.

Goal 3- Lessons & Best PracticesGoal 3- Lessons & Best Practices

Exclude “inappropriate” cases from the referral process. Exclude “inappropriate” cases from the referral process. OVHA, ESD, HAEU and OCS have agreed to exclude OVHA, ESD, HAEU and OCS have agreed to exclude the following cases from the referral process:the following cases from the referral process:

The SSN for the NCP is unknown to custodial parent, the The SSN for the NCP is unknown to custodial parent, the Access system and ESD/HAEU not able to find it.Access system and ESD/HAEU not able to find it.

The NCP is currently or has been on a IV-A program (TANF, The NCP is currently or has been on a IV-A program (TANF, General Assistance or Food Stamps) or Medicaid in the past 12 General Assistance or Food Stamps) or Medicaid in the past 12 months.months.

The NCP is currently incarcerated or has been in the past.The NCP is currently incarcerated or has been in the past. The NCP is currently unemployed.The NCP is currently unemployed. The NCP is not able to work due to a disability (SSI, SSDI).The NCP is not able to work due to a disability (SSI, SSDI).

Note: ESD/HEAU staff are currently manually Note: ESD/HEAU staff are currently manually reviewing and excluding the above cases pending reviewing and excluding the above cases pending programming to automate the process.programming to automate the process.


A National Medical Support Notice (NMSN) A National Medical Support Notice (NMSN) should be sent on a periodic basis when should be sent on a periodic basis when insurance is not being provided.insurance is not being provided.

The data mining model identified a high correlation The data mining model identified a high correlation between a case having health insurance and the number between a case having health insurance and the number of employment changes.of employment changes.

A NCP with recent job changes is more likely to have A NCP with recent job changes is more likely to have private health insurance than a non-custodial parent who private health insurance than a non-custodial parent who has maintained the same employment for a long period has maintained the same employment for a long period of time.of time.

OCS has requested new ACCESS programming to OCS has requested new ACCESS programming to automatically send a NMSN to employers on a periodic automatically send a NMSN to employers on a periodic basis (once a year).basis (once a year).


Implement a collaborative workgroup that Implement a collaborative workgroup that consists of partners from the IV-D, IV-A and consists of partners from the IV-D, IV-A and Medicaid agencies. It can and does work.Medicaid agencies. It can and does work.

The workgroup increased the number of Medicaid case The workgroup increased the number of Medicaid case referrals to OCS which increased the number of insured referrals to OCS which increased the number of insured children for Medicaid cost avoidance and recovery.children for Medicaid cost avoidance and recovery.

The workgroup continues to share data on an ongoing The workgroup continues to share data on an ongoing basis.basis.

The workgroup continues to meet twice a year to review The workgroup continues to meet twice a year to review data and processes to ensure that progress continues.data and processes to ensure that progress continues.


Pursue cash medical support in cases where Pursue cash medical support in cases where health insurance is not available.health insurance is not available.

Health insurance was ordered and obtained in only 13% Health insurance was ordered and obtained in only 13% of these cases mainly due to cost.of these cases mainly due to cost.

Pursuing cash medical contributions in the remaining Pursuing cash medical contributions in the remaining 87% of the cases could result in more cost recovery for 87% of the cases could result in more cost recovery for the Medicaid agency.the Medicaid agency.

Vermont law currently limits the ability of OCS to pursue Vermont law currently limits the ability of OCS to pursue cash medical contributions in Medicaid-only cases.cash medical contributions in Medicaid-only cases.

Goal 4 – Look to the FutureGoal 4 – Look to the Future

Vermont law formerly limited cash medical Vermont law formerly limited cash medical contribution in lieu of insurance coverage to contribution in lieu of insurance coverage to 5% of the child’s actual premium cost under 5% of the child’s actual premium cost under a Medicaid program (i.e., = $-0-).a Medicaid program (i.e., = $-0-).

A new Vermont law (15 V.S.A. sec. 658(f) has A new Vermont law (15 V.S.A. sec. 658(f) has eliminated the 5% limit language of a child’s eliminated the 5% limit language of a child’s premium cost under a Medicaid program premium cost under a Medicaid program when ordering a parent to pay a cash medical when ordering a parent to pay a cash medical contribution. This will further contribute to contribution. This will further contribute to cost avoidance and recovery in the cost avoidance and recovery in the administration of the Medicaid program.administration of the Medicaid program.

Goal 4 – Look to the FutureGoal 4 – Look to the Future The Patient Protection and Affordable Care The Patient Protection and Affordable Care

Act (H.R.3590) makes quality, affordable Act (H.R.3590) makes quality, affordable health care coverage available to 95% of all health care coverage available to 95% of all Americans.Americans.

Acceptable health care coverage is private, Acceptable health care coverage is private, public or publicly subsidized (this includes public or publicly subsidized (this includes Medicaid).Medicaid).

The IRS Code is amended effective 2014 to The IRS Code is amended effective 2014 to require that the parent who claims the child require that the parent who claims the child as a dependent on their tax return is as a dependent on their tax return is responsible for demonstrating that the child responsible for demonstrating that the child has acceptable health care coverage.has acceptable health care coverage.

Questions??Questions??

Contact InformationContact Information

Christin L. Semprebon, Esq.Christin L. Semprebon, Esq.

Office of Child SupportOffice of Child Support

100 Mineral Street, Suite 202100 Mineral Street, Suite 202

Springfield, Vermont 05156Springfield, Vermont 05156

(802)-885-6293(802)-885-6293

(802)-885-6213 (fax)(802)-885-6213 (fax)

[email protected]@ahs.state.vt.us

mailto:[email protected]

vermont section 1115 demonstration grant project unimed 2005-2008 a unified approach to medical...

Documents

medicaid cases

medicaid sanctions

new data elements

improved collection

medicaid referrals

medicaid program

medicaid agencies

grant ocs