Transcript Connecting Kids to Health Care Coverage: How Can We Help?

Vermont Section 1115
Demonstration Grant
PROJECT UNIMED
2005-2008
A Unified Approach to Medical Support
Through Intra-Agency
Collaboration/Data Exchange
Prepared by Sean Brown of the Vermont Office of Child Support
Presented and Co-Prepared by Christin L. Semprebon, Esq.
ERICSA Conference 2011, Atlantic City, New Jersey
Project Goals
 Improve
collaboration with key partners
 Collect
and analyze medical support data
 Report
lessons learned and best practices
Goal 1- Improve Collaboration

Prior to applying for grant OCS identified the key
partners and secured their participation in the
grant via a written agreement.

The key partners included:
Office of Vermont Health Access (OVHA)
Economic Services Division (ESD)
Health Access Eligibility Unit (HEAU)
Goal 1- Improve Collaboration

OVHA is responsible for administering the
Medicaid program in Vermont. It operates
essentially as a managed care organization.
 ESD is responsible for making eligibility
determinations and enrollment for applicant’s
applying for Medicaid and other benefits such as
TANF.
 HAEU is responsible for making eligibility
determinations and enrollment for applicant’s
applying solely for Medicaid.
Goal 1- Improve Collaboration

A workgroup was created with staff from OVHA, ESD,
HAEU and OCS to develop new policies, procedures
and forms to increase Medicaid referrals to OCS. The
workgroup:




Created new assignment of rights for medical support for
Medicaid-only cases and new process for referring cases to
OCS. In 2006 about 2,864 and in 2007 about 2832 of the new
forms were processed by OCS.
Developed and implemented Medicaid sanctions for custodial
parents who did not cooperate with OCS.
Developed and implemented Medicaid waivers of cooperation for
custodial parents with domestic violence concerns.
Agreed not to pursue child-only Medicaid cases due to lack of
cooperation from custodial parents and lack of sanctions.
Goal 2- Collect & Analyze Data

Many changes were made to ACCESS, the shared
mainframe computer system, to collect and share data
among the IV-D, IV-A and Medicaid agencies. Key
changes allowed for:





Improved communication between staff.
Improved collection and exchange of employment/wage data.
Improved collection and exchange of health insurance data.
Improved collection and exchange of court hearing/order data.
The new data elements in ACCESS were uploaded into
the OCS data warehouse (PEAKS) for reporting and
analysis.
Goal 2- Collect & Analyze Data
Court Orders Resulting in Health Insurance for NCP
May 2007 - February 2008
90%
75%
70%
50%
30%
13%
12%
Ordered
Available but Not Ordered
10%
Insurance Unavailable
-10%
Goal 2- Collect & Analyze Data
Insurance not Available to NCP
May 2007 - February 2008
60%
46%
40%
22%
20%
16%
12%
4%
0%
Other
Unemployed
Affordability
Self Employed
Disabled
Other examples include NCP’s employer does not offer, NCP works
part-time, NCP is Medicaid active, and NCP has a waiting period
before insurance is available.
Goal 2- Collect & Analyze Data
Health Insurance Available to NCP but not Ordered
May 2007 - February 2008
100%
80%
79%
60%
40%
20%
20%
1%
0%
Accessibility
Comprehensiveness
0%
Reasonable Cost
Other
Goal 2- Collect & Analyze Data
Health Insurance Ordered for NCP
May 2007 - February 2008
60%
51%
44%
40%
20%
5%
0%
Reasonable Cost
Other
No Additional Cost to Party
Goal 2- Collect & Analyze Data
Court Orders Resulting in Health Insurance for CP
May 2007 - February 2008
90%
85%
70%
50%
30%
10%
Insurance Unavailable
-10%
8%
7%
Ordered
Available but Not Ordered
Goal 2- Collect & Analyze Data
Insurance not Available to CP
May 2007 - February 2008
60%
48%
40%
32%
20%
11%
5%
4%
0%
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Other examples include CP’s employer does not offer, CP works part-time,
CP is Medicaid active, and CP is full-time student.
Goal 2- Collect & Analyze Data
Health Insurance Available to CP but not Ordered
May 2007 - February 2008
100%
81%
80%
60%
40%
20%
15%
3%
1%
Accessibility
Comprehensiveness
0%
Reasonable Cost
Other
Goal 2- Collect & Analyze Data
Health Insurance Ordered for CP
May 2007 - February 2008
80%
60%
58%
39%
40%
20%
3%
0%
Reasonable Cost
Other
No Additional Cost to Party
Goal 2- Collect & Analyze Data
Part A Response Reasons
1,400
1,300
32%
1,200
26%
1,100
1,000
22%
900
20%
800
Not Employed
No Coverage
Not Eligible
CCPA &
Reasonable
Cost
Goal 2- Collect & Analyze Data
Part B Response Reasons
1,400
1,200
57%
42%
1,000
800
600
400
200
1%
Enrolled
Waiting Period
Not Able to Enroll
Goal 2- Collect & Analyze Data
783P Notice Responses
July 2007 - February 2008
80%
67%
60%
40%
25%
20%
7%
1%
0%
Coverage not
Available
Children Enrolled
Reasonable Cost
Unemployment
Data Mining Model Summary

8.56% of IV-D cases used in the data mining
model have confirmed health insurance in place.
 Almost 89% of the cases with current monthly
wages greater than $5,900 have insurance
coverage.
 Cases with the lowest obligation to arrears ratio
range (0 to 2.5) had the highest percentage of
health insurance coverage at 10.4%.
 Of all case types, Medicaid-only cases are the
least likely to have health insurance coverage.
Data Mining Model Summary
 95%
of the cases with nominal child
support orders, $100 or less per month, do
not have insurance.
 NCP earnings above $5000 per quarter
are indicative of health insurance
coverage.
 Cases under 2 years of age had the
highest percentage of coverage (10.25%)
than all other case age groups.
Data Mining Model Summary
 The
difference in health insurance
coverage for interstate (8.71%) and noninterstate (7.41%) cases is not significant.
 There is a higher likelihood of insurance if
the NCP changes jobs.
 The more phone contacts logged on a
case, the higher the likelihood of insurance
enrollment.
Goal 3- Lessons & Best Practices
Exclude “inappropriate” cases from the referral process.
OVHA, ESD, HAEU and OCS have agreed to exclude
the following cases from the referral process:


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The SSN for the NCP is unknown to custodial parent, the Access
system and ESD/HAEU not able to find it.
The NCP is currently or has been on a IV-A program (TANF,
General Assistance or Food Stamps) or Medicaid in the past 12
months.
The NCP is currently incarcerated or has been in the past.
The NCP is currently unemployed.
The NCP is not able to work due to a disability (SSI, SSDI).
Note: ESD/HEAU staff are currently manually
reviewing and excluding the above cases pending
programming to automate the process.
Goal 3- Lessons & Best Practices
A National Medical Support Notice (NMSN)
should be sent on a periodic basis when
insurance is not being provided.


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The data mining model identified a high correlation
between a case having health insurance and the number
of employment changes.
A NCP with recent job changes is more likely to have
private health insurance than a non-custodial parent who
has maintained the same employment for a long period
of time.
OCS has requested new ACCESS programming to
automatically send a NMSN to employers on a periodic
basis (once a year).
Goal 3- Lessons & Best Practices
Implement a collaborative workgroup that
consists of partners from the IV-D, IV-A and
Medicaid agencies. It can and does work.

The workgroup increased the number of Medicaid case
referrals to OCS which increased the number of insured
children for Medicaid cost avoidance and recovery.
 The workgroup continues to share data on an ongoing
basis.
 The workgroup continues to meet twice a year to review
data and processes to ensure that progress continues.
Goal 3- Lessons & Best Practices
Pursue cash medical support in cases where
health insurance is not available.

Health insurance was ordered and obtained in only 13%
of these cases mainly due to cost.
 Pursuing cash medical contributions in the remaining
87% of the cases could result in more cost recovery for
the Medicaid agency.
 Vermont law currently limits the ability of OCS to pursue
cash medical contributions in Medicaid-only cases.
Goal 4 – Look to the Future
Vermont law formerly limited cash medical
contribution in lieu of insurance coverage to
5% of the child’s actual premium cost under
a Medicaid program (i.e., = $-0-).
A new Vermont law (15 V.S.A. sec. 658(f) has
eliminated the 5% limit language of a child’s
premium cost under a Medicaid program
when ordering a parent to pay a cash
medical contribution. This will further
contribute to cost avoidance and recovery in
the administration of the Medicaid program.
Goal 4 – Look to the Future
The Patient Protection and Affordable Care
Act (H.R.3590) makes quality, affordable
health care coverage available to 95% of all
Americans.
Acceptable health care coverage is private,
public or publicly subsidized (this includes
Medicaid).
The IRS Code is amended effective 2014 to
require that the parent who claims the child
as a dependent on their tax return is
responsible for demonstrating that the child
has acceptable health care coverage.
Questions??
Contact Information
Christin L. Semprebon, Esq.
Office of Child Support
100 Mineral Street, Suite 202
Springfield, Vermont 05156
(802)-885-6293
(802)-885-6213 (fax)
[email protected]