ASSURING ACCESS THROUGH SERVICE DELIVERY ARRANGEMENTS

1. ASSURING ACCESS THROUGH SERVICE DELIVERY ARRANGEMENTS • Overview of Michigan's CHIP • Medicaid Expansion versus Private Insurance • Service Delivery Capacity • Historic Medicaid Providers • Mental Health and Substance Abuse Carve Out • Children's Special Health Care Services Coordination • Performance Monitoring

2. Overview of Michigan CHIPState Characteristics

3. Overview of Michigan’s CHIP Healthy Kids Medicaid Expansion 53,200 estimated eligibles Kids must: - Be under 19 - Live in a family with approximate monthly income under: $1,357 for a family of 2 $1,707 for a family of 3 $2,057 for a family of 4 $2,407 for a family of 5 - MAY have other health insurance You will have 30 days to choose a health plan after you are notified that the child qualifies. No premium is required. MIChild Private Insurance Plan 112,500 estimated eligibles The child must: - Be under 19 - Live in a family with approximate monthly income under: $1,809 for a family of 2 $2,275 for a family of 3 $2,742 for a family of 4 $3,209 for a family of 5 - NOT have other health insurance You must choose a health plan at the time you apply. You pay a monthly premium of only $5. Even if you have more than one child you pay only $5 a month.

4. OVERVIEW OF MICHIGAN'S CHIPCOMPARISON OF FEATURES

5. MEDICAID EXPANSION VERSUS PRIVATE INSURANCEMedicaid Advantages • Service Delivery Network established and in place, no need for new contracts • Large number of beneficiaries give state bargaining strength with providers, i.e., development of new health plans • Can use non-licensed, Medicaid defined HMOs • Historical providers familiar with needs of Medicaid population

6. MEDICAID EXPANSION VERSUS PRIVATE INSURANCEPrivate Insurance Model Advantages • Flexibility to change design features to promote access • Provider rates can be higher than Medicaid and still affordable to state • No Medicaid "stigma," seen as mainstream health insurance program • HMOs can use either their Medicaid provider network or their commercial network

7. TOTAL NUMBER OF COMMERCIAL HMOS (IN EACH COUNTY) • 21counties have 0plans • 18 counties have 1 plan • 34 counties have 2-5 plans • 8 counties have 6-10 plans

8. 38 counties have 0 Medicaid plans 24 counties have 1 Medicaid plan 6 counties have 2 Medicaid plans 7 counties have 3 Medicaid plans 8 counties have 4 or more Medicaid plans 1 county has 3 Medicaid plans 20 counties have 4 Medicaid plan 23 counties have 5 Medicaid plans 13 counties have 6 Medicaid plans 26 counties have 7 or more Medicaid plans SERVICES DELIVERY CAPACITYPRE AND POST RFP POST PRE

9. 1977 Enrolled = 3,382 1996 Participation = 2,056 1996 Billing more than $1,000 = 1,628 1998 Total Dentists Participating = $4,188 Must adhere to access standard: Take new patients provide appointment within 3 weeks emergency appointment within 24 hours. SERVICES DELIVERY CAPACITY1977 Total Licensed Dentists in Michigan = 6,346 MedicaidDentalCoverage MIChild Dental Coverage

10. SERVICE DELIVERY CAPACITY

11. SERVICE DELIVERY CAPACITYMIChild Physician and Health Plan Incentives • 20% Adverse Risk Supplement for First 7 Months - $12.70 • Physician Rates Based on Medicare, 95% Above Medicaid Almost Doubles Rates • Maternity Case Rate $4,000 • Vaccines Supplied by State

12. SERVICE DELIVERY CAPACITYHospital Issues • Monopoly hospitals refusing to negotiate hospital contracts with health plans • Department position, health plans are agents of Medicaid and can not be charged higher prices them Medicaid DRG in absence of a contract

13. HISTORIC MEDICAID PROVIDERSComparison Chart

14. HISTORIC MEDICAID PROVIDERSComparison Chart

15. MENTAL HEALTH AND SUBSTANCEAbuse Carve Out Access • Public Community Mental Health and Substance Abuse Network are the traditional providers for the uninsured and Medicaid population • Access to service for "non-severe" problems may be an issue

16. MENTAL HEALTH AND SUBSTANCE Abuse Carve Out • Boundary Issues for Medicaid • Psychotropics • 20 visit coverage by plans • Fewer boundary issues anticipated for MIChild

17. CHILDREN’S SPECIAL HEALTH CARE SERVICES COORDINATIONChildren’s Managed Care Plan • Two CSHCS managed care plans tailored to high medical needs children with statewide coverage phased in over next 2-3 years • MIChild eligible children qualifying for CSHCS can: • join a MIChild plan • join a CSHCS managed care plan • get CSHCS specialty services on a fee-for-service basis

18. PERFORMANCE MONITORING • Member Satisfaction • Quality and Access Study • HEDIS • Encounter Data • Appeal Reporting