Posts Tagged ‘medicaid’

Sequestration and Our Mission

March 12th, 2013

No doubt the word “ Sequestration” is front and center in your vocabulary these days.  This is just a quick note to forecast how it might impact our mission.  For starters… the main impacts from federal sequestration (i.e. the federal budget reduction for some programs) will be related to the services that we provide and the planning that we do related to our federal cooperative agreements and grants.  The primary agencies that award us funding are within HHS (CMS, HRSA, CDC, SAMHSA) and USDA (WIC).  Not all federal programs are subject to the federal budget reduction that will go into effect shortly. 

For example, the behavioral health services that we provide via Medicaid are largely exempt from the reductions… but most of our cooperative agreements and federal grants are subject to the reductions. We receive a total of about $255M in federal funds that look like they’ll be subject to reductions for the remainder of this federal fiscal year.  WIC is the biggest chunk, at about $161M (or 63% of our total grant funds affected). 

How we manage these reductions will vary depending on how much flexibility the parent federal agency gives us.  As we make these decisions, we’ll consider grant variables…  like how much of the award we’ve spent so far this fiscal year and whether the grant is mainly service dollars or strategic planning etc.  For some programs we may be able to identify under-performing areas of the grant or agreement and focus our adjustments there.  

For example: Karen Sell’s WIC team has done a fair amount of planning already to mitigate the immediate and even mid-term impact…  like changing the food package starting July 1 (adopting less expensive brands) and identifying some current unspent funds.  We won’t need to put WIC applicants on a waiting list for at least a month…  but depending on how things go, we may need to start a list later in the year. 

I’ve asked the executive management team to work with each of the programs that look like they’ll be affected and start the planning process for making the reductions- focusing on identifying ways that we can make reductions that will minimize impacts in the field (like the way WIC will be moving to less expensive food brands).  Anyway…  stay tuned.  Things at the federal level look like they’re still in flux.  The more nimble and creative we are the better off our mission will be.

Doctor Shortage – a Public Health Concern

January 30th, 2013

Public Health tracks the number of healthcare workers – physicians, dentists and psychiatrists – to make sure we have enough to take care of the community.  In Arizona we’ve been challenged to recruit and keep those professionals – and we have numerous Health Professional Shortage Areas.  Just to eliminate the current shortages, we’d need an additional 313 primary care physicians, 250 Dentists, and 136 Psychiatrists… and a new study shows that we’ll need even more as AZ aligns Medicaid eligibility with the Affordable Care Act.  The study estimates the country will need about 52,000 more primary care physicians to meet the nation’s health care needs through 2025.  The biggest reason for the increase is the growing population, but the number of people getting older and the insurance change impact the number too. 

Fortunately, we have some creative people working on solutions here in Arizona.  This month our Health Systems Development shop along with the Arizona Alliance of Community Health Centers and the UA’s Center for Rural Health brought together folks from the healthcare industry, academia, Arizona Area Health Education Centers, and clinicians to discuss strategies to address the shortage of healthcare workers in Arizona.  The group showed strong support for the National Rural Recruitment and Retention Network (3RNet) – a tool that helps businesses solve healthcare workforce issues.  The 3RNet Program invites healthcare facilities in Arizona to register and use 3RNet as a recruitment tool.  Agencies that use 3RNet can post and update vacancies and post videos or pictures of their facility or their community to better market and attract candidates.  If you have questions about the program, you can contact Ana Roscetti, Workforce Section Manage, at Ana.Lyn.Roscetti@azdhs.gov or 602-542-1066.

Essential Benefit Package 101

August 21st, 2012

The future health insurance exchange under the Affordable Care Act will need to offer an Essential Benefit Package. In fact, most health insurance plans will need to cover each state’s Essential Benefit Package starting New Year’s Day in 2014. There are 10 key service categories that future plans will need to cover- including behavioral health services. 

States need to pick a plan from a set of existing options as their “benchmark” plan- which will serve as the state-specific essential benefit package. The options to choose from include: 1) the largest plan by enrollment in any of the three largest small group insurance products in the small group market; 2) any of the largest three state employee health benefit plans by enrollment; 3) any of the largest three national federal employees health plans; or 4) the largest insured commercial non-Medicaid HMO in the State.  If the benchmark plan doesn’t include all the 10 key service categories then it needs to be supplemented. 

The due date for states to pick a benchmark plan is September 30 of this year.  If a state doesn’t want to pick a benchmark plan, the Fed’s will make the choice for them- and they intend to choose “…  the largest small group market product in the State’s small group market” which (in Arizona) is Aetna’s PPO plan.  Once a state picks the benchmark plan (or has it picked for them)- it becomes a “reference plan” for the state for a couple of years- meaning that future exchange health plans must be “substantially equal” to the benchmark plan in the scope, limitations and exclusions (e.g. visit limits). 

Obviously there’s a lot more to it than that…  and you or your Stakeholders can get a lot more in-depth info about what an Essential Health Benefit is and what it means in this document that provides an Arizona specific analysis of the issues and the various services that are covered by potential benchmark plans.

 

Public Health Budget

May 9th, 2012
 The Governor signed the budget this week – here’s a look at how some of it affects public health:

Behavioral Health Services for folks that don’t Qualify for Medicaid

The budget that was just signed includes about $39M in new funding for services for folks with a serious mental illness that don’t qualify for Medicaid.  With it, we’ll be able to provide some services like supported employment and housing, peer and family support, living skills training, and health promotion to help folks along their Recovery journey.  We’ll also be expanding the list of medications for the folks with a serious mental illness so it matches the list for folks that qualify for Medicaid.  Our behavioral health team has already begun working closely with the RBHAs, providers, and members/families to plan for the most effective use of this funding.

Newborn Screening

Our newborn screening program has been running in the red for the last couple of years- despite the fact that we’ve squeezed just about every efficiency out of the program and are collecting more than 95% of our service fees.  The current screening fee is $30 for the 1st (hospital) screen and $40 for the 2nd (which happens in the pediatric office a couple of weeks after birth).  These fees haven’t been raised in several years- meanwhile the instruments and reagents we use have become increasingly expensive.  We’ve been supplementing the program with Title V funds that really should be used for other more effective purposes. The budget that was just signed allows us to set new fees for the 2nd screen in Rule…  and we’ll be starting that process shortly.

County Contribution toward Hospital Patients and Residents

The “Budget Reconciliation Bill” or BRBs included specific instructions regarding how much counties are obligated to pay (50%) for the patients and residents at the Hospital and ACPTC (the sexually violent person’s unit).

ASH Administration building

Hospital Operating Fund

Despite all our efforts to reduce overtime, cut shift overlap, streamline services and other efficiency measures- our hospital operating fund was headed for big trouble next fiscal year- partly because the Hospital Fund (which had provided funds to operate the Hospital) went dry. The state budget that was just signed rescued us from needing to cut our staffing ratio’s to below Licensing standards (which would have put us in jeopardy of losing Medicare and Medicaid funds).  Whew.

Step Right Up: Get your Masters in Public Health in Phoenix!

March 14th, 2012

When I got into public health 25 years ago, it was kind of a boutique profession. Since then, it’s really gone mainstream- and public health is increasingly being recognized as a key element in driving down our country’s increasing health care costs.  So if you’re a beginning or mid-career professional- get in on the ground floor and snap up your MPH right here in Phoenix. 

Lucky for you, the U of A’s Mel & Enid Zuckerman College of Public Health is offering a Master of Public Health (MPH) (with a concentration in Public Health Practice) in Phoenix at the Biomedical Campus.  The next bolus of students will start this Fall.  There’s still time to apply for the fall classes- but the May 1st application deadline is rapidly approaching. 

The Phoenix program offers the Master of Public Health in Public Health Practice which prepares students to develop the public health skills needed to work in a variety of governmental and non-governmental settings including the local, county and state departments of health, the Indian Health Service, Medicaid and Medicare programs, hospitals, and community health centers.  Students work as part of multidisciplinary teams and develop skills to manage and evaluate real-life public health programs. 

Here’s a link about admissions criteria and how to apply.  You can also contact Kim Barnes at kim.barnes@arizona.edu or 602-827-2070 for more info.

For the Modern AZ Mom

March 7th, 2012

Please join us in encouraging pregnant women and new moms to sign up for Text4baby.  Text4baby is a program of the National Healthy Mothers, Healthy Babies Coalition that provides pregnant women and new moms with information to help them give their babies the best possible start in life. Text4baby is the country’s first free, health education program using text messages. Participating national cell phone companies deliver Text4baby messages to their subscribers at no charge. Pregnant women and new mothers receive expert advice texted directly to their cell phones. The weekly messages are timed to their due date or their baby’s birth date through the baby’s first year. The messages deal with nutrition, immunizations and birth defects prevention, among many other topics.  

CMS announced today that it will partner with Text4Baby to promote enrollment in Medicaid.  Current Text4Baby users are receiving a new message providing a connection to the InsureKidsNow phone number and website for information about how to sign up.  So far, 6,000 Arizonans have enrolled in Text4baby since the program started in February 2010.  You can help increase Arizona’s enrollment by spreading the word among pregnant women and new families or by encouraging other organizations to sign up as an official partner with the Text4baby program.  To learn more about the Text4baby Program, go to www.text4baby.org.

Inside the Governor’s Budget

January 25th, 2012

Dr. Nelson wrote a great blog this week that discusses the behavioral health aspects of the Governor’s

2012 State of the State Address which was followed by the release of her policy agenda called The Four Cornerstones of Reform: Centennial Edition.  Please visit Dr. Nelson’s blog for the details of the Governor’s remarks about behavioral health including information about the FY2013 Executive Budget which proposes almost $39M in additional funding be set aside for certain community-based services for folks struggling with a serious mental illness (who don’t qualify for Medicaid)…  for things like peer and family support, supported employment, supported housing, health promotion, and living skills training.  This is great (and welcome) news. 

There are a number of other elements related to our Agency budget proposal in the budget report- including a provision that would allow us to set appropriate fees for our newborn screening program, which has been running in the red for the last couple of years despite aggressive cost-cutting measures.

Behavioral Health Services Block Grant

August 17th, 2011

Our Behavioral Health team has completed the draft of our ($27M) 2012-2013 Joint Block Grant Application for Mental Health and Substance Abuse Prevention and Treatment Services. This year SAMHSA streamlined the application process to allow States to apply for grant funds under one combined application and has moved away from a standardized reporting template, allowing the States to determine their own needs and service directions.  Our (150 page) application has been posted for public comment (through August 26) on our grant application website.  Folks can provide comments to grantsmanagement@azdhs.gov.  

States use this Block Grant for prevention, treatment, recovery supports and other services that will supplement services covered by Medicaid, Medicare and private insurance. For example, we use block grant funds to fill in for priority behavioral health treatment and support services for folks without insurance or for services not covered by Medicaid, Medicare or private insurance.  Block grant funds also go toward primary prevention services like universal, selective and indicated prevention activities and services.

AHCCCS Coverage Changes?

February 24th, 2011

A few weeks ago I wrote about the portion of the proposed FY 2012 budget that would suspend for 2 years AHCCCS (Medicaid) eligibility for adults without children (called childless adults).  As I mentioned in the earlier post, that kind of change would need to be approved by then federal government.  Last week, the Secretary of HHS sent the Governor a letter that outlines steps Arizona could take to manage its Medicaid program and balance its budget without violating  requirement, including taking action to not new coverage for childless adults beginning October 1, 2011.  Here’s Secretary Sebelius’ Letter to Governor Brewer 2/15/11.  The letter from the Secretary doesn’t mean that the rollback is certain because a number of other things would need to happen first including resolving potential legal issues.

We currently provide behavioral health services to about 5,200 persons with serious mental illnesses that are childless adults.  We were initially concerned that this would mean that childless adults with a serious mental illness could lose their current benefits if the proposal is implemented, but after further analysis we found a way to ensure that more than 80% of these folks can maintain their current benefits under a different Medicaid category.  The bottom line is that one of our top priorities over the coming months is to do the necessary work to reclassify these folks into the new category so that we can continue providing services if the proposal is ultimately implemented.

Title This, Title That

July 28th, 2010

You’ve most likely heard the words Title XIX, Title XXI, and Title V (aka Title 19, Title 21, Title 5) bandied about in the halls and elevators throughout your careers- but some of you might not know what those words mean.  Here’s a thumbnail sketch:

Title V

When you hear someone say “Title V”, they’re talking about our maternal; and child health prevention programs.  “Title V” is the shortcut way of talking about maternal and child health because it’s Title V of the Social Security Act. 2010 is the 75th Anniversary of the Social Security Act which established the Title V Maternal and Child Health Services program.  Our Bureau of Women’s & Children’s Health and our Office of Children with Special Health Care Needs executes the Title V program in Arizona.

Title V programs provide the infrastructure that has led to big health improvements among our most vulnerable citizens.  The primary goals are to: 1) Reduce infant mortality and disabilities; 2) Increase immunization rates; 3) Increase the number of kids in low-income households that get assessments and follow-up diagnostic and treatment services; and 4) Ensure access to comprehensive perinatal care for women; 5) Ensure preventative and comprehensive care (including long-term care services) for kids with special health care needs; 6) Enhance rehabilitation services for blind and disabled children under 16 years of age who are eligible for Supplemental Security Income; and 7) Facilitate the development of comprehensive, family-centered, community-based, culturally competent, coordinated systems of care for kids with special healthcare needs.

Title XIX

When you hear the words Title XIX, it’s a shortcut for saying Medicaid- which is the national health care program for low income folks.  Medicaid was created in 1965, through Title XIX of the Social Security Act (that’s why it’s called Title XIX).  Each state administers its own Medicaid program.  The federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs, matches state investments in the program (normally at about a 2:1 ratio- but more than that during certain times like now), and establishes requirements for service delivery, quality, funding, and eligibility standards.  In our state, the Medicaid program is run by AHCCCS.  Many of the services that we provide (most of our behavioral health services and children’s rehabilitative services) are run through the Title XIX state Medicare program (AHCCCS).

Title XXI

Title XXI is the shortcut way to describe the Children’s Health Insurance Program (CHIP).  It’s a program administered by the fed’s, providing matching funds to states for health insurance for families with kids.  The program was designed to cover uninsured children in families with incomes that are pretty low, but too high to qualify for Medicaid.  CHIP was created in 1997, and was the largest expansion of health insurance coverage for kids since Medicaid began.  It’s called Title XXI because CHIP was formed under Title XXI of the Social Security Act.

In Arizona, the program is called KidsCare, which is administered by AHCCCS.  Some of the services that we provide run through the Title XXI program- like some of our behavioral health services for kids and some of the kids in our children’s rehabilitative services program.