Foster Care/Adoption Assistance Transition to Virginia Medicaid Managed Care
1. www.dmas.virginia.gov 1
Department of Medical Assistance Services
Foster Care / Adoption Assistance
Transition to Virginia Medicaid
Managed Care
National Institute for
Health Care Management
April 2013
www.dmas.virginia.gov 1
Department of Medical Assistance Services
3. www.dmas.virginia.gov 3
Department of Medical Assistance Services
Richmond Foster Care Pilot Program
• The Richmond Foster Care Medicaid Pilot
Program was developed in response to a
request from the City to provide more
coordinated care for children in foster
care.
• The Virginia Department of Medical
Assistance Services (DMAS) received
permission from the federal government
to move foster care children in the City
into managed care health plans.
4. www.dmas.virginia.gov 4
Department of Medical Assistance Services
Authority for Pilot Program
• In 2011, the Virginia General Assembly and
the Governor formally endorsed a pilot
project with the City of Richmond Department
of Social Services to meet the health care
needs of children in foster care through the
managed care delivery system.
• Item 297 MMMM1.b. of the 2011
Appropriations Act required the Department
to allow on a pilot basis, foster care
children, under the custody of the City of
Richmond Department of Social Services, to
be enrolled in Medicaid managed care
(Medallion II).
5. www.dmas.virginia.gov 5
Department of Medical Assistance Services
Richmond Foster Care Pilot Program
• Workgroup developed of SMEs serving the
Richmond area to make the transition as
smooth as possible
– 1 Department of Medical Assistance Services
– 1 Department of Social Services
– 120 Local Department of Social Services – all
locally driven
– 6 Managed Care Organizations
– Numerous Advocacy Groups
– Numerous Child Placement Agencies
6. www.dmas.virginia.gov 6
Department of Medical Assistance Services
Richmond Foster Care Pilot Program
• December 1, 2011 - Implementation
– Foster care children under the custody of the
City of Richmond Department of Social
Services and who are not in residential care
– Non-custodial children who are not in
residential care
– Minor children of eligible foster care children
– Excluded children receiving adoption
assistance
7. www.dmas.virginia.gov 7
Department of Medical Assistance Services
Statewide Transition
• The Richmond Foster Care Pilot Program
has been successful.
– Pilot program enhanced communication
between state and local agencies and the
managed care plans.
– Pilot program enhanced communication
between local eligibility workers and case
workers.
– MMIS eligibility system has been cleaned up so
that children are correctly identified is system
as well as have correct addresses.
8. www.dmas.virginia.gov 8
Department of Medical Assistance Services
Statewide Transition
• Virginia General Assembly and the
Governor approved for the managed care
statewide expansion of children in foster
care and receiving adoption assistance.
• Virginia is implementing the statewide
transition this year in two phases.
10. www.dmas.virginia.gov 10
Department of Medical Assistance Services
Managed Care Enrollment
• Statewide Medicaid Enrollment
for children as of March 2013:
–Managed Care 89%
–Fee-for-Service 11%
11. www.dmas.virginia.gov 11
Department of Medical Assistance Services
Anticipated Improvements
• Coordination of health care
• Case management
• 24 hour nurse hotline
• Increased access to practitioners
• Targeted services for chronic conditions
• Better coordination
• Choice of primary care providers
12. www.dmas.virginia.gov 12
Department of Medical Assistance Services
Comparison of Member Services
Medicaid Fee-For-Service
(FFS)
• Medicaid ID Card
• Recipient helpline
(not toll-free)
• Member handbook
• No co-payments for under 21
Managed Care Organization
(MCO)
• MCO member ID
card, handbook, and provider
directory
• Toll-free member helpline
• Access to free translation services
/language telephone line
• 24-hour nurse advice line
• Access to assistance with medical
issues (case management)
• Member outreach and health
education materials
• Access to credentialed providers
• No co-payments
13. www.dmas.virginia.gov 13
Department of Medical Assistance Services
MCO Carved Out Services
• Community Mental Health
Rehabilitative Services
– Intensive In-Home Services for
Children and Adolescents
– Therapeutic Day Treatment for
Children and Adolescents
– Day Treatment/Partial
Hospitalization
– Psychosocial Rehabilitation
– Crisis Intervention
– Intensive Community Treatment
– Crisis Stabilization Services
– Mental Health Support Services
– Case Management
– Level A & B Group Homes
• Mental Retardation Community
Services
– Case Management Services
• Private Duty Nursing for HCBS
waiver enrollees
• Substance Abuse Treatment
Services
– Substance Abuse Crisis Intervention
– Substance Abuse Intensive Outpatient
– Substance Abuse Day Treatment
– Opioid Treatment
– Substance Abuse Case Management
• Dental (Smiles For Children)
• School Health Services
• Specialized Infant Formula for
Children Under Age 21
• Health Department Lead
Investigations
• Early Intervention Services
• Personal Care services
14. www.dmas.virginia.gov 14
Department of Medical Assistance Services
Virginia Managed Care Partners
• Anthem HealthKeepers Plus
• Amerigroup
• CoventryCares of Virginia
• Optima Family Care
• Virginia Premier Health Plan
• MajestaCare
16. www.dmas.virginia.gov 16
Department of Medical Assistance Services
Who will move to Managed Care?
• Effective July 1, 2013 for Central and
Tidewater managed care regions;
– Children receiving Medicaid as part of Adoption
Assistance
– Children placed in Foster Care who are not in
Level C residential care
– Children in non-custodial placement
agreements who are not in Level C residential
care
– Minor children of eligible foster care youth
17. www.dmas.virginia.gov 17
Department of Medical Assistance Services
Who is Excluded from MC Expansion?
• Children who are hospitalized at time of
enrollment
• Children placed in Level C residential
treatment care
• Children who are also covered under other
comprehensive insurance
• Children in Medicaid home and community
based waivers
• FYI - July 1st expansion will only include those
FC/AA children residing in a Central or
Tidewater locality
– FC children must also be in the custody of a Central
or Tidewater LDSS or CPA
18. www.dmas.virginia.gov 18
Department of Medical Assistance Services
MC Expansion Timeline – Phase I
• May 18, 2013 - MCO Pre-assignments
occur
• First week of June 2013 - Pre-assignment
letters received by LDSS Case Worker
(CW) for foster care or adoptive parent
• June 18, 2013 – Last day for CW/adoptive
parent to request MCO change before
assignment to MCO
19. www.dmas.virginia.gov 19
Department of Medical Assistance Services
MC Expansion Timeline – Phase I
• June 18, 2013 - MCO assignment
processing occurs
– MCOs mail ID card, handbook and provider
directory to parents/placement providers
• July 1, 2013 - MCO enrollment begins
– Must go to doctor that is part of MCO network
• Phase II – October 1, 2013
– Will follow similar timeline beginning August
2013.
20. www.dmas.virginia.gov 20
Department of Medical Assistance Services
Changing MCOs – Foster Care
• Request for changes to MCO can occur at
any time during the year
– Foster care parents/placement providers must
contact the Case Worker at the LDSS or CPA to
request an MCO change
– Only the Case Worker is authorized to contact
the Managed Care Helpline to request the
change
• Foster care parents/placement providers
cannot make changes to the youth’s MCO
21. www.dmas.virginia.gov 21
Department of Medical Assistance Services
Changing MCOs – Adoption Assistance
• Request for changes to MCO can occur at
any time during the year
– The Adoptive parent may contact the Managed
Care Helpline directly to request an MCO
change
• Adoptive parent is responsible for
requesting MCO changes
22. www.dmas.virginia.gov 22
Department of Medical Assistance Services
Loss of Coverage
• If Medicaid eligibility is cancelled, the
child’s MCO enrollment ends.
• If Medicaid eligibility is regained within 60
days, MCO reinstated on the first of the
next available month.
• Child may be disenrolled from MCO but
remain eligible for Medicaid if placed in a
Level C psychiatric residential treatment
facility. The child will be re-enrolled in
Managed Care once released.
24. www.dmas.virginia.gov 24
Department of Medical Assistance Services
Impact on Families/Providers
• Parents/placement providers will have two
ID cards for each child.
– Medicaid plastic ID card – received from LDSS.
– MCO ID card – received from MCO.
– Both cards must be taken to appointments.
• Parents/CWs will need to choose the best
MCO to ensure that their child’s
provider(s) participate in the assigned
MCO.
25. www.dmas.virginia.gov 25
Department of Medical Assistance Services
Managed Care Implementation
• Systems Updates for Eligibility Records
• Training and Communications
• Transition/Continuity of Care
• Rate Setting
26. www.dmas.virginia.gov 26
Department of Medical Assistance Services
Managed Care Experience
• Seamless Integration with Membership
and Processes
• Minimal Access and Care Management Issues
• Preparation for 2013 Expansions
27. www.dmas.virginia.gov 27
Department of Medical Assistance Services
Lessons Learned
• Trainings critical among various agencies
involved (state agencies, local
DSSs, managed care plans)
• Cross training to educate DSS on managed
care, health plans on foster care/ adoption
assistance processes, etc.
• Information infrastructure needs established
• Including families/placement providers in
process
• Need for review of utilization data to
determine trends and special care
management needs
28. www.dmas.virginia.gov 28
Department of Medical Assistance Services
Thank you
Anthem HealthKeepers Plus
Katina Goodwyn
Program Director
Virginia Dept. of Medical Assistance Services
Ashley Harrell, Acting Manager
Maternal and Child Health Division
Tammy Whitlock
Senior Programs Advisor
Editor's Notes
The next slides discuss the benefits and services provided through Managed Care.
This slide shows a current snapshot of Managed Care enrollment in Virginia. As you can see, the majority of Medicaid enrollees are receiving their services through a Managed Care organization.
Coordination of health careCase managementprovided through licensed registered nurses (RNs) or individuals with appropriate professional clinical expertise. 24 hour nurse hotlineIncreased access to physicians and other providersTargeted services for chronic conditions including Disease Management & Chronic Care Programs Better coordination between DSS and MCOs which will improve outcomes for childrenFamilies may choose to have multiple children in one MCO and with one primary care physician
These services are not readily available or not available at all for the fee-for-service members but are provided for Managed Care enrollees:MCO member ID card, handbook, and provider directoryToll-free member helpline Access to free translation services /language telephone line 24-hour nurse advice lineAccess to assistance with medical issues (case management)Member outreach and health education materialsAccess to credentialed providersNo co-payments
This slides details the carved out services which are not covered through the MCOs but paid through the Medicaid Fee-For-Service Program
In Virginia, we have six Medicaid Managed Care partners operating across the state.As of July 1, 2012managed care is available statewide, althoughnot all six MCOs are available in every area. For information about which Managed Care organizations participate in which localities refer to the Managed Care Resource Guide on the DMAS website.
Children in Foster Care/Adoption Assistance in the Managed Care Central and Tidewater Regions will transition to managed care effective July 1, 2013.This includes the following;Children receiving Medicaid as part of Adoption Assistance;Children placed in Foster Care and residing in Managed Care Central and Tidewater Regions, who are not in Level C residential care;Children in non-custodial placement agreement who are not in Level C residential care; and ***just FYI - don’t share on Webinar***(Parent/guardian retains custody as agreement with LDSS and LDSS serves as the case manager and eligible for same services).Minor children of eligible foster care youth.Residential care are level C / Psychiatric Residential Treatment Facilities***just FYI - don’t share on Webinar***Children with parental agreements ARE NOT considered to be in foster care for Medicaid eligibility purposes. This is an agreement between the child’s parent/guardian and an agency OTHER THAN DSS which is designated by the CPMT (Community Policy and Management Team).
Children will obtain services through fee-for-service (regular Medicaid) until MCO enrollment
Request for changes to MCO can occur at any time during the yearAdoption Assistance parents may contact the Managed Care Helpline directly to request an MCO change.Parents are responsible for requesting MCO changes.The open period for changes to MCOs is unique for FC and AA children. Normally MCO changes are allowed in the first 90 days after the individual becomes a member, at open enrollment time, or with special approval from DMAS.
If Medicaid eligibility is cancelled, the child’s MCO enrollment ends.If Medicaid eligibility is regained within 60 days, child is reinstated in the same MCO on the first of the next available month.DMAS will mail the CW/parent a letter notifying of the re-enrollment.Child may be disenrolled from MCO but remain eligible for Medicaid if placed in a Level C psychiatric residential treatment facility. This process of disenrollment and re-enrollment in Managed Care is coordinated through KEPRO and DMAS and does not require action by the LDSS.
Parents/placement providers will have two ID Cards for each child.Medicaid plastic ID card – received from DSS.MCO ID card – received from MCO.Both cards must be taken to appointmentsParents/CWs will need to choose the best MCO to ensure that their child’s provider(s) participate in the assigned MCO.For parents with questions about MCOs and providers can call the DMAS Managed Care Helpline – 1-800-643-2273
