OVERVIEW OF PRESENTATION

1. OVERVIEW OF PRESENTATION • Program Design Options • Program Design Conclusions • Benefit Package Design • Husky Plus • Outreach Efforts • Evaluation and Monitoring

2. THE STARS IN THEIR COURSES... William Shakespeare • A State Budget Surplus • An Enhanced Federal Match • An Election Year • A Clambake

3. STAGE ONE: PROGRAM DESIGN • To Medicaid, or Not to Medicaid, That Is the Question? • Concern About the Creation of a New Entitlement • Prospects for continued federal funding beyond 2002 • Concern about individual cause of action (litigation about notices, fair hearings, etc.) • Concern about the “T” in EPSDT: Unlimited benefit package • Concern About Ability to Draw Down Full Federal Match If We Stick to the Limits on Expansion in the BBA • 200% FPL or • 50 percentage points higher than current Medicaid eligibility

4. STAGE ONE: PROGRAM DESIGN (cont.) • Federal Allotment for Connecticut ($35 Million in FFY 1998) Was Based on the Number of Uninsured Children Below 200% FPL • As of April, 1997 Connecticut Already Covered Children Born After September 30, 1983 up to 185% FPL • Further Medicaid eligibility expansions to 185% FPL already enacted by the legislature • children born after July 1, 1981 effective July 1, 1997 • children born after January 1, 1980 effective January 1, 1998 • Wanted a Package for All Working Families • no Medicaid stigma • coordinated outreach to Medicaid and Non-Medicaid • accessible outreach to Medicaid eligible populations • did not want intake through the “welfare office” • wanted a buy-in option regardless of income

5. STAGE TWO: CONCLUSIONS • Combination Approach • Capture enhanced Title XXI Match (65%) on previously enacted Medicaid expansions for children up through age 18 up to 185% FPL • Above 185% FPL, a non-Medicaid expansion • took advantage of the open-ended reference to income disregards to extend subsidized coverage to 300% FPL • full buy-in option available above 300% FPL

6. PHASE THREE: BENEFIT DESIGN • Of the Three Non-Medicaid Options (FEHBP, Largest HMO, State Employees), State Employees Selected As Most Generous • Within State Employee Option, Three Benefit Packages Available • Blue Cross (discounted Fee For Service) • MD Health Plan (IPA model) • Kaiser Permanente (staff model) • Compared All Three Plans on Each Covered Service, Selected the Most Generous Option • Copayments Capped at $650 Per Family Per Year Premiums Capped at $600 Per Family Above 235% FPL Total Annual Cost Sharing Maximum - $1,250

7. PHASE FOUR: HUSKY PLUS • Even With a Generous Commercial Insurance Benefit Package, There Was a Concern That the Needs of Children With Special Health Care Needs Would Not Be Accommodated • Options Were: • Bring back Medicaid • Offer a risk adjusted rate for special needs kids, similar to what we do in Husky A (Medicaid Managed Care) • Provide a supplemental, wraparound package that would not count against the 10% cap on administrative costs • Selected the Supplemental Package • Children will be dual eligible, simultaneously receiving benefits from Husky B and Husky Plus • Husky Plus modeled on care coordination under existing Title V program • Title V eligibility expanded to 300% FPL

8. PHASE FOUR: HUSKY PLUS (cont.) • Plan Established for Children With Special Physical Needs • Two Title V centers of excellence selected as providers • Connecticut Children’s Medical Center • Yale Childrens Hospital • Title V steering committee becomes the steering committee for Husky Plus • A New Plan Established for Children With Special Behavioral Health Needs • Yale Child Study Center designated as plan coordinator • Community providers selected by RFP process • Both Plans Funded With $2.5 Million for SFY 1999

9. PHASE FOUR: HUSKY PLUS (cont.) • Children Determined to Be Medically Eligible for Both Plans Based on Designated Screening Tools to Measure Level of Impairment • In Each Plan, Care Coordinators Develop a Treatment Plan in Coordination With the Primary Care Provider and the Utilization Review Staff in the Child’s Husky B Plan • Each Plan Has Final Decision Over Payment Decisions for the Services in Their Benefit Package • The Goal Is Collaboration and Consensus • If the Husky B and the Husky Plus Plan Cannot Agree on Who Pays for a Service in the Treatment Plan, the Final Decision Goes to the Department

10. PHASE FIVE: OUTREACH • Medical Assistance for Children Has Now Become One New Program (Husky) With Three Distinct Parts: • Husky A (Medicaid) • Husky B (Title XXI expansion) • Husky Plus (special needs) • Coordinated Marketing and Outreach for All Three Programs • De-stigmatize Medicaid • Bring in the Medicaid eligible children • Take advantage of the new name for the program • A Four Page Application Developed for Husky A & B • Application process invisible to the client between the two programs

11. PHASE FIVE: OUTREACH (cont.) • A Single Point of Entry Servicer (SPES) Contracted to Screen and Process Applications for the Two Programs • Benova, the Medicaid managed care enrollment broker, selected as the SPES • Benova screens all applications for Medicaid eligibility. • if Medicaid eligible, application referred to a DSS office • Benova and the DSS offices are linked electronically • Benova and DSS staff are co-located at each other’s offices • If the applicant is eligible for Husky B, Benova processes the eligibility in their own system • Benova processes managed care enrollments for both Husky A & Husky B

12. PHASE FIVE: OUTREACH (cont.) • Outreach Effort Is Coordinated With Funded Projects in Schools, School Based Health Centers, Community Health Centers, and Hospitals • Future Plans Include Presumptive Eligibility for Husky A (Medicaid) at WIC Sites, Healthy Start, and Child Care Providers • Outreach Is Critical, Not Only to Reach Uninsured Population, but to Negate the Impact of Adverse Selection

13. PHASE SIX: EVALUATION AND MONITORING • In Husky A, There Is a Comprehensive Data Reporting Mechanism in Place With the Health Plans on a Range of Measures Including Encounter Data • Desire Was to Not Make Husky B Like Medicaid but to Follow a Commercial Model • In Connecticut, We Do Have Legislation That Requires HMOs to Submit Comprehensive HEDIS Data to the Department of Insurance • HEDIS data is for the entire plan book of business • Couldn’t Accept Not Having at Least HEDIS Data That Was Specific to Husky B Reported Annually • HEDIS will be supplemented by a report on well child visits (EPSDT-LIGHT)

14. PHASE SIX: EVALUATION AND MONITORING (cont.) • No Encounter Data on Husky B Plans • For Husky Plus, We Felt the Data Set of Paid Services Would Be Small Enough That We Could Require Quarterly Encounter Data From Both Husky Plus Physical and Husky Plus Behavioral • We’re Going to Measure Our Success in Enrolling Uninsured Kids Against the Same Data the Interval Census (CPAS) Data • Remains to be seen whether the census provides an accurate baseline on the number of uninsured children

15. KEY DATES • August, 1997 Balanced Budget Act Passes • October, 1997 Husky Legislation Enacted • January, 1998 State Plan Submitted • April, 1998 State Plan Approved • June, 1998 Enrollment Begins • July, 1998 Services Begin in Managed Care Plans and Husky Plus

16. SIX PHASES OF EVERY PROJECT Phase One: Enthusiasm Phase Two: Disillusionment Phase Three: Panic Phase Four: The Assessment of Blame Phase Five: The Punishment of the Innocents Phase Six: Praise for the Non-Participants

17. HUSKY ACTIVITYJUNE 1, 1998--AUGUST 9, 1998

18. HUSKY B