1. HolmesView Graph # 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. HolmesView Graph # 2 Overview of Michigan CHIP State Characteristics

3. HolmesView Graph # 3 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. Overview of Michigan’s CHIP

4. HolmesView Graph # 4 OVERVIEW OF MICHIGAN'S CHIP COMPARISON OF FEATURES

5. HolmesView Graph # 5 MEDICAID EXPANSION VERSUS PRIVATE INSURANCE Medicaid 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. HolmesView Graph # 6 MEDICAID EXPANSION VERSUS PRIVATE INSURANCE Private 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. HolmesView Graph # 7 TOTAL NUMBER OF COMMERCIAL HMOS (IN EACH COUNTY) 21 counties have 0 plans 18 counties have 1 plan 34 counties have 2-5 plans 8 counties have 6-10 plans

8. HolmesView Graph # 8 SERVICES DELIVERY CAPACITY PRE AND POST RFP 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 PRE POST

9. HolmesView Graph # 9 SERVICES DELIVERY CAPACITY 1977 Total Licensed Dentists in Michigan = 6,346 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. Medicaid Dental CoverageMIChild Dental Coverage

10. HolmesView Graph # 10 SERVICE DELIVERY CAPACITY

11. HolmesView Graph # 11 SERVICE DELIVERY CAPACITY MIChild 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. HolmesView Graph # 12 SERVICE DELIVERY CAPACITY Hospital 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. HolmesView Graph # 13 HISTORIC MEDICAID PROVIDERS Comparison Chart

14. HolmesView Graph # 14 HISTORIC MEDICAID PROVIDERS Comparison Chart

15. HolmesView Graph # 15 MENTAL HEALTH AND SUBSTANCE Abuse 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. HolmesView Graph # 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. HolmesView Graph # 17 CHILDREN’S SPECIAL HEALTH CARE SERVICES COORDINATION Children’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. HolmesView Graph # 18 PERFORMANCE MONITORING Member Satisfaction Quality and Access Study HEDIS Encounter Data Appeal Reporting