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Dr. Janice Carson, Deputy Director, Performance, Quality & Outcomes Planning for Healthy Babies Georgia Medicaid’s Family Planning Waiver Implementation.

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Presentation on theme: "Dr. Janice Carson, Deputy Director, Performance, Quality & Outcomes Planning for Healthy Babies Georgia Medicaid’s Family Planning Waiver Implementation."— Presentation transcript:

1 Dr. Janice Carson, Deputy Director, Performance, Quality & Outcomes Planning for Healthy Babies Georgia Medicaid’s Family Planning Waiver Implementation Date – January 1, 2011

2 ACCESS Access to affordable, quality health care in our communities RESPONSIBLE Responsible health planning and use of health care resources HEALTHY Healthy behaviors and improved health outcomes DCH Mission

3 FY 2011 DCH Initiatives FY 2011 Continuity of Operations Preparedness Customer Service Emergency Preparedness Financial & Program Integrity Health Care Consumerism Health Improvement Health Care Transformation Public Health Workforce Development

4 P4HB Overview Purpose Financial Support Eligibility Providers Implementation Plan Evaluation

5 P4HB Purpose Outgrowth of LBW Reduction Initiative (multiple stakeholders) –July 2009 DCH data analysis for Medicaid, SHBP, commercial, PH data Initiative set target to reduce LBW over 5 yrs to the 2000 level (from 9.5% to 8.6%)

6 P4HB Purpose Developed Strategic Work Plan with three objectives: –Increase access to and utilization of Preventive Health Services for all females from birth through child-bearing age. –Increase number of intended and appropriately timed births to plan members (Medicaid FFS, Medicaid Managed Care, SHBP, Commercial Insurers) –Facilitate early access to prenatal care providers

7 P4HB Purpose Family Planning Waiver – primary strategy to achieve Objective 2 Goals –Reduce Georgia’s LBW and VLBW rates –Reduce number of unintended pregnancies in Georgia –Reduce Georgia’s Medicaid costs Participation in the waiver is voluntary for all participants - women who have not been pregnant and women who would otherwise lose Medicaid eligibility 60 days post partum.

8 Waiver Approval Process Submitted formal application in February 2010 Responded to CMS concerns re financial support for waiver – funding to be included in SFY 11 budget Established positive working relationship with project officer (PO). Very responsive to her informal requests for information –Understood PO was Georgia’s messenger to the Federal Review Team Official RAI sent late March Responded early April 2010

9 Waiver Approval Process Additional data provided as quickly as possible to PO when requested Georgia: PO dialogue included clear messaging re waiver population and components. Gave justification why SPA option not viable for Georgia. PO communicated federal teams concerns re IPC and collaborated with Georgia to resolve those concerns PO worked with Georgia to develop new methodology for budget neutrality that incorporated reductions in VLBW births.

10 Approvals State legislature approved waiver funding for FY 11 inclusive of IPC in April –$15,000,000 budget for first six (6) months of waiver operation –90% Federal Funds –10% State Funds Legislature identified total FP savings for FY 11 –$10,000,000 for the first six (6) months of FY 11 CMS approved waiver October 29, 2010 – 8 mos after formal application

11 Eligibility Criteria Family Planning Only – new Medicaid eligibility category –Women: 18 – 44 –Uninsured –< 200 FPL Interpregnancy Care (IPC) – new Medicaid eligibility category –All of the above, plus –Women who delivered a VLBW infant on or after the first day of implementation of the waiver Waiver eligibility is for 24 months for IPC with re- determination after 12 months of participation

12 Providers Family Planning services delivered via three Medicaid managed care organizations and their contracted provider networks –CMO Provider Networks Physicians, Nurse Practitioners, PAs Hospitals Pharmacies Local Public Health Departments Waiver requires women be linked to Primary Care services. To be delivered via Georgia Primary Care Association providers –Provider Network FQHCs RHCs Free Clinics

13 Providers P4HB Waiver program to use evidence-based practice models for improving preconception health and reducing low birth weights –Improve preconception health through consumer awareness and preventive visits –Interconception Care and Pre-pregnancy visits –Health insurance coverage for women with low incomes

14 Providers Interpregnancy Care –Utilized Grady/Emory model as basis for these additional services –Participants have access to Family Planning Services plus in- network services: Primary care services Limited Dental services Limited Substance Abuse Treatment Services Limited Pharmacy Benefits “Resource Mothers” and Nurse Case Managers within the CMOs’ networks –Dr. Anne Dunlop provided education to CMOs regarding Grady project

15 Implementation Plan DCH and the CMOs –New contract for application process –Modified enrollment process – eligible waiver participants transition directly to CMO bypassing FFS –New MMIS processes developed at DCH and CMO levels –Amended CMO contracts; incorporated new waiver cap rates

16 Implementation Plan Marketing plan included: –Trademark approval for “P4HB” name and logo –All materials include trademark –Press releases; posters and postcards; radio interviews; education to providers, RSM workers, public health –Letters to pregnant women in their 8 th month –Outreach to stakeholders of the LBW reduction Initiative

17 Evaluation Plan Evaluation plan must utilize quasi-experimental design Draft plan to CMS by end of February 2011 Contracted with Emory University to evaluate waiver Incorporated evaluation plan components into CMO contracts and placed them at risk for meeting performance targets

18 Evaluation Plan Quarterly and Annual tracking including: –% Eligible Population Enrolled –Reduction in pregnancy rate –Number of births –Number of persons who choose sterilization –Births by weight category –Member and Provider Satisfaction –Cost savings

19 Additional Information Interaction with Title X –Title X clinics can provide services under the waiver Waiver vs Title X –Continuity of care Approx. 50,000 women lost Medicaid coverage following their deliveries in days of care post partum only allows limited family planning services CMS aware of efficacy of Medicaid FP services Medicaid cost savings are significant at both the Federal and State levels Accessing Public Health Clinics –Women choosing FP services via Medicaid will have access to all CMO network FP waiver providers

20 Questions


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