Claudia Brown Jim Wotring Gwen White August 10, 2010

1. HEALTHY TRANSITIONS INITIATIVEHEALTH CARE REFORM: OPPORTUNITIES AND CHALLENGES FOR YOUNG ADULTS OF TRANSITION AGE Claudia Brown Jim Wotring Gwen White August 10, 2010

2. Health Care and Young Adults of Transition Age • Issues well documented • Opportunity for change • Challenges to address

3. Be At The Table • Decisions will be made at the state level • Medicaid Eligibility • Combine low income and disability categories • SSI - “child” list of diagnosis up to age 25 / 30 • Remove Disincentives for work / employment • Include disability OR condition • Functional Definition – readiness to assume adult roles • Include “at risk” categories • Service array • Cover needed transition support services • Linkages to families

4. Specific Issues and Considerations Youth and Young Adults and Health Reform Eligibility – 2014 Is Now • Parent’s private insurance • Parent’s public coverage • Family of One • Poverty guidelines Implementation Pits Falls • Access • Enrollment –help with navigation skills • Information dissemination • Social marketing • Youth culture

5. Specific Issues and Considerations Youth and Young Adults and Health Reform Eligibility – 2014 Is Now • Parent’s private insurance • Parent’s public coverage • Family of One • Poverty guidelines Implementation Pits Falls • Access • Enrollment –help with navigation skills • Information dissemination • Social marketing • Youth culture

6. Eligibility – 2014 Is Now Parent’s private Insurance • How will you advise youth and families in your program when the parent has private insurance and the youth’s coverage under the parent’s plan can continue on until age 26, when other coverage options exists: • Medicaid expansion • Additional private coverage thru Health Insurance Exchanges

7. Eligibility 2014 is Now Parent’s public coverage or Family of One • How will you advise a youth and family when the 19 turns 19 and the parent has public coverage. Do you advise remain under the parent’s coverage or do you advise the youth to seek his own coverage?

8. Health Reform Implementation Access • How would a youth of today access health care or health insurance coverage? • Access isn’t just about eligibility it is also knowing where to go and how to get there Enrollment • Modifications will be necessary to work with and enroll this population into coverage. • System navigation assistance, role for providers.

9. Health Reform Implementation Information Dissemination • Youth culture is driven by technology • Social marketing leverage it • Social media – use it (facebook, tweeter, etc)

10. Money Follows the Person Jim Wotring

11. Money Follows the Person • $2.25 billion in Grants to Extend the Money Follows the Person Rebalancing Demonstration to More States • The extension of the MFP Demonstration Program is through 2016 • Under the MFP demonstration, states will receive an enhanced Federal Medical Assistance Percentage (FMAP) for a one-year period for each individual they transition from an institution to a qualified home and community-based program.

12. Youth/Young Adult Eligibility Criteria • Placed in one of the following institutions for 90 days or more • Psychiatric Residential Treatment Facilities for Children, • Institutions for Mental Diseases for Children (under 21) and Older Adults (over 65) and ; • Adults over 22 with behavioral health disorders that reside in nursing facilities.

13. State Eligibility Criteria • If your State is currently participating, CMS will not require a State to compete again through a new solicitation process. States will only need to submit a written request to the CMS Grants Office in the summer of 2011 for continued participation in the MFP grant program. • States currently not participating in the MFP Demonstration Project Grant will have the opportunity to apply for a grant through a competitive award process.

14. Benefits of Participating • Participation in the MFP Demonstration Program also gives States access to the following benefits: • Enhanced Federal Medical Assistance Percentage (FMAP) • National Technical Assistance (TA) • HCBS and Demonstration Services • Supplemental Services • Full Reimbursement for Specific Administrative Costs

15. Benefits of Participating • Enhanced Federal Medical Assistance Percentage (FMAP): The MFP Demonstration Program provides an FMAP rate for qualified services, which includes HCBS services and demonstration services. This rate is equal to taking the published FMAP for a State, subtracting it from 100 percent, and dividing the total by half, and adding that percentage to the published FMAP. As an example, a State that normally has a 50 percent FMAP will have a 75 percent FMAP under MFP. The enhanced MFP FMAP cannot exceed 90 percent. The enhanced rate is available for qualified services provided to an MFP participant for 365 days after transition from an institution.

16. Demonstration Program • If interested in the MFP Demonstration Program, an Applicant Teleconference will be held Wednesday, August 11, 2010, 2: 00-4:00 PM EST to answer any questions about the Solicitation. The participant call in number is 800-603-1774 and conference code ID is 88811531. CMS will also conduct a series of technical assistance (TA) teleconferences which will be held throughout the fall of 2010 to assist applicants to meet the requirements for each section of the Operational Protocol. The schedule and call in information for the TA teleconferences will be provided at http://www.cms.gov/CommunityServices/20_MFP.asp

17. Grant Opportunity • On August 4, 2010 CMS released a Solicitation for MFP Planning Grants. CMS recognizes that States will be required to provide needed resources to develop and submit an Operational Protocol to meet the requirements of the 2011 Money Follows the Person Rebalancing Demonstration (Funding Opportunity Number (FON) CMS-1LI-11-001 by January 7, 2011. This solicitation affords States the opportunity to receive MFP Planning Grants with funding awarded to produce the Operational Protocol based on the criteria of the MFP solicitation. States that will be submitting an application for an award under Funding Opportunity Number CMS-1LI-11-001 may also submit an application to receive a Planning Grant award up to $200,000.

18. Money Follows the Person Links • A copy of the invitation to apply for the “FY2010 Money Follows the Person Rebalancing Grant Demonstration,” including the application forms and information concerning a national call for applicants, will be posted at www.grants.gov: • http://www.cms.gov/CommunityServices/20_MFP.asp • http://www.cms.gov/CommunityServices/Downloads/MFP2011SolicitationFinalJuly29RH.pdf • http://www.cms.gov/CommunityServices/Downloads/MFP_Planning_Grant_Solicitation_2010.pdf

19. Current MFP States • Arkansas • California • Connecticut • District of Columbia • Delaware • Georgia • Hawaii • Iowa • Illinois • Indiana • Kansas • Kentucky • Louisiana • Maryland • Michigan • Missouri • North Carolina • North Dakota • Nebraska • New Hampshire • New Jersey • New York • Ohio • Oklahoma • Oregon • Pennsylvania • Texas • Virginia • Washington • Wisconsin

20. Resources • POLICY DOCUMENTS: (CD Rom from Annapolis Meeting) • Policy recommendations to promote and sustain effective community transition systems. (Clark, HB, Deschênes, N., & Unruh, DK,, 2010).Tampa, FL: National Network on Youth Transition for Behavioral Health. • Summary of Center for Mental Health Services Youth Transition Policy Meeting: National Experts Panel, Held June 8-9, 2005, Rockville, MD (M. Davis, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School & C. Koyanagi, Bazelon Center for Mental Health Law for the Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, Final Report September 2005)  • WEB SITES: • www.healthcare.gov (U.S. Department of Health & Human Services) • http://www.nasmd.org/Home/home_news.asp (The National Association of State Medicaid Directors) • http://www.thenationalcouncil.org (National Council for Community Behavioral Healthcare) • OTHER: • http://georgetownuniversity.na5.acrobat.com/p37088569/ (Webinar on parity) • http://www.allhealth.org/briefing_detail.asp?bi=186. (Video / Podcast: Rites of Passage: young Adults and the Affordable Care Act of 2010. The Commonwealth Fund)