Title V and Medicaid

1. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Title V and Medicaid A Collaborative Relationship Stephanie Birch RNC, BSN, MPH Title V / CSHCN Director State of Alaska State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

2. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Alaska size comparison to the contiguous United States Alaska is 586,412 square miles in area (with 33,904 miles of shoreline) Alaska has 33% of America’s total shoreline! State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

3. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Unique Challenges in Alaska • Distance of delivering services • Several partners: Federal-IHS, State and DOD agreements to deliver services • Different levels of service delivery including: • Tribal community health aides located in rural villages • Public Health nurses-EPSDT exams and immunizations; moving towards community planning • Federally qualified health centers and community health centers-Advance Practice Nurses and P.A.’s • Private providers-both Advance Practice Nurses and physicians in independent solo or dual practices in urban and rural locations State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

4. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Delivery of Services cont. • Sub-regional health clinics in rural communities service native beneficiaries • Large private practice groups in urban centers of five communities • Import services of many specialties from other states • For acute specialty services not provided, we transfer to other states. Washington, Oregon and Utah receive the majority of this business. State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

5. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Uniqueness of Payers • No managed care • Some preferred provider agreements- Blue Cross and Aetna-but only applies to urban areas • Approximately 50% of the children in Alaska are Medicaid eligible/receive Medicaid as a payer source • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

6. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Long History of Title V and Medicaid Working Together in Alaska • 2001-EPSDT outreach program • Include outreach across Alaska for the SCHIP expansion program with a focus on native villages and rural parts of the state • Focus was also on educating Medicaid beneficiaries about the benefits of EPSDT, what to expect and how to be better prepared for their visit. State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

7. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Collaboration: continued • Consultation role in SFY03 included: • Regulations affecting women and children and families were updated using solid data for decision making • Fee schedule updates • Audiology-supported the EHDI program • Laboratory-Newborn Metabolic Screening • DME-specialized supplies for CSHCN State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

8. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Collaboration-cont. • Data analysis and cost benefit analysis prior to decisions being made • Integration of the Title V /CSHCN Director on any preferential relationships that we have with specialty providers Outside. Worked with these specialty organizations to improve their cultural responsiveness to the needs of Alaska Native families with children who have to travel. • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

9. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS FY05 and FY06 Show me the money • Medicaid became a payer of data and analysis • Funded many of the WCFH staff • In return: continued to work on regulations and planning together • . • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

10. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS FY06-New opportunities • Recipient of T.A. from HRSA led by Johnson Consulting to foster increased cooperation between State Title V, Medicaid and partner agencies around the goals of EPSDT • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

11. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS 6 Priorities • Data Sharing and Integration • Develop a network of community care coordinators with a focus on targeted care coordination • Improve the quality of EPDST screens • Increase parent engagement and focused education • Look for cross-system funding and partnerships • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

12. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Recent Event Led the state team which met in Denver in June on “Using Limited Health Dollars Wisely” • Jointly sponsored by: • Association of Maternal Child Health Programs • National Counsel of State Legislators • National Governor’s Association • Assoc. of State and Territorial Health Officials • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

13. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Take Away Messages • Get to know your Medicaid staff one on one and find out who works on payments for providers, DME and facilities • Familiarize yourself with your state statutes and regulations around Medicaid payments • Invite Medicaid staff to your meetings-offer data even when it has not been requested • Include them in the distribution of your publications • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

14. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS Other Take Away Messages • Weigh in on new regulations • Assist with linking Medicaid staff with providers • Know what you want and what it will cost-do your homework • Get to know your Medicaid director and find out what their priorities are • Find your voice and be persistent! • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health

15. PUBLIC HEALTHPROTECTING AND PROMOTING THE HEALTH OF ALL ALASKANS For more information • Stephanie_birch@health.state.ak.us • www.hss.state.ak.us/dph/wcfh • . State of Alaska, DHSS, Division of Public Health, Section of Women’s Children’s and Family Health