State of Kansas Veterans Benefit Enhancement Project Department of Social & Rehabilitation Services Kristi Scheve, Data Exchange Manager March 2012

Public Assistance Participation Average Monthly Caseloads (Based on First 6 Months of SFY2012) TANF 13,841 households 35,871 persons SNAP 141,356 households 302,700 persons Child Care 9,671 households 18,237 children Medical 379,630 individuals (includes 46,130 CHIP children)

Kansas’ PARIS Veteran Match Numbers MATCH EXPECTATIONS Expectations based on… Number of Vets in the State Number of Individuals with VA Income coded on the Eligibility System Number of past PARIS matches (in better times) and taking into consideration caseload growth rates

PARIS Veterans Match Numbers Historically, Kansas VA match returns are 60% veteran & 40% spouse/other Even with first VETSNET match being within the “Expectation Range”, approximately 270 individuals with VA income are on the eligibility system not being matched thru PARIS

VBE Project - Working the Match You have the data, so now what? Aid and Attendance Living arrangement compared to amount of A&A being received Not receiving any, but needing long term care (NF or HCBS) Third Party Liability Veteran, the Spouse, & the family Service-connected Disability Rating Living arrangement is long term care Do they have health coverage on TPL? Medicaid Veteran, but no VA income Do they need help with their review? Claims Diagnosis/Era of Service

Kansas’ Veterans Benefit Enhancement Project (VBE) Project is a Multi-State Agency Effort Kansas Department of Social and Rehabilitation Services Agency that administers TANF, SNAP, Child Care, LIEAP, and whose staff determines eligibility for Medical programs Sends, Receives, & Filters PARIS files Produces reports for the VBE project & eligibility staff 2. Kansas Department on Aging Agency that is responsible for the Nursing Facility and Home & Community Based Services (HCBS) for Frail Elderly budget Agency with staff resources and commitment to build database to track VBE project results Agency “unofficially” spearheading the VBE project team

4. State Commission on Veterans Affairs 3. Kansas Dept. of Health and Environment, Division of Health Care Finance (formerly the Kansas Health Policy Authority ) Single State Agency for Medicaid Policy Operates the HealthWave Clearinghouse (determines eligibility for Medical programs for children and families) Medicaid claims system Third Party Liability Interests 4. State Commission on Veterans Affairs Agency responsible for outreach to veterans Agency that selected VBE pilot counties VBE project implementation with mobile vehicles and dedicated staff to travel the state assisting veterans and their families

VBE Project - Coming Together Memorandum of Agreement Each agency’s legal and program staff involved Competing Agency Priorities Different Levels of Understanding Terms Agency Jargon Only one agency, SRS, had touched the PARIS data

Kansas’ VBE Project Goals Outreach to veterans and their families What family couldn’t use more household income? What family wouldn’t want more health coverage options? Reduced Medicaid expenditures Prescriptions Durable Medical Equipment Long Term Care (Nursing Facilities & HCBS) Reduced expenditures in other program areas

Kansas’ Veterans Benefit Enhancement Project (VBE) Kansas Veteran Facts Source: Veteran Population Model, VetPop2007, US Department of Veterans Affairs, Office of the Assistant Secretary for Policy & Planning, Office of Policy (008A2), Document Released in January 2008.

VBE Project Pilot VBE Project Started in Pilot Counties October 2010 60 of the State’s 105 counties are in the pilot. Numbers for the Pilot Estimated 43,518 veterans in pilot counties. 247 on first report for VBE project outreach (August 2010 PARIS VA match – Prior to VETSNET) Coordinated effort to track results

Progress After Pilot Start No new individuals identified on subsequent PARIS VA matches (until VETSNET) Veterans Commission Outreach Staff were still being hired and trained after first outreach list Legislative Post Audit began soon after start To date no information has been returned to VBE team from first outreach list Medicaid agency now using file each quarter to identify TPL

Kansas Legislative Post Audit Scope Audit to address the following questions Has the Veterans’ Claims Assistance Program helped more veterans obtain services through staff located at the State’s three Veteran’s Affairs medical centers? Could Kansas achieve cost savings by helping veterans and their dependents user federal Veterans Affairs’ programs instead of state-funded programs such as Medicaid?

Kansas Legislative Post Audit Information Gathering Four agencies to interview Multiple staff members for each agency interviewed Repeated Interviews/Conflicting Information Group Meeting with Auditors Auditor Contacting other States Besides Washington and California, most states with VA projects like this are in the same building phase as Kansas

Kansas Legislative Post Audit Results Full Audit report is available on-line Entitled “Kansas Commission on Veterans’ Affairs: A K-GOAL Audit Reviewing Issues Related to Veterans’ Benefits” Pages 15-21 are related to question #2 in the scope of the audit and related to the Kansas Veteran’s Benefit Enhancement project http://www.kansas.gov/postaudit/audits_perform/r-11-012.pdf

Kansas Legislative Post Audit Results In 2009, Kansas Commission on Veterans’ Affairs own analysis estimated Kansas could save between $1.3-$1.9 million Audit confirms Kansas could reduce State spending on Medicaid by almost $1.3 million a year Audit estimates with VETSNET returning more matches the State’s savings could double to about $2.5 million a year

Kansas Legislative Post Audit Results

Kansas Legislative Post Audit Results In the last year, KDHE identified 243 Medicaid beneficiaries with previously undisclosed TRICARE coverage SRS continues to identify discrepancies in matched VA income to eligibility system budgeted income First VETSNET match provided astounding monthly discrepancy numbers

Kansas Legislative Post Audit Recommendations The State needs to reprioritize resources to achieve the estimated savings Not Necessarily New Resources The State needs to establish a structure to better coordinate efforts between several state agencies MOU Changes Suggested Select a lead agency Clearly identify Roles and Responsibilities of each agency Determine the priority of work Create deadlines and follow-up procedures Capture cost savings!!!

Moving Ahead “Following the Yellow Brick Road”

Questions? Kristi Scheve, Data Exchange Manager SRS-Economic & Employment Support Docking State Office Building 915 SW Harrison, Suite 580 Topeka, KS 66612 Phone:  (785) 296-6706 Fax:  (785) 296-6960 E-mail:  Kristi.Scheve@srs.ks.gov

The Washington State Story Veteran’s Benefit Enhancement Program A partnership between: Washington State Health Care Authority Washington State Department of Veterans Affairs

Washington State Success Story In 2002, Washington State Health Care Authority (HCA) established a partnership with Washington State Dept of Veteran’s Affairs (WDVA) to identify Vets and their dependents eligible for military related health care and the maximization of monthly cash benefits Facilitation results in acquiring/increase in federal benefits while reducing Medicaid expenditures. Established Application Referral process HCA utilizes PARIS match data to identify Vets and spouses which warrant a referral to WDVA. WDVA then initiates the process of increasing the entitlements.

Washington State Utilizes PARIS Federal File - Military related matches for TRICARE coverage of veteran and dependents Confirmed by COB and third party screens coded Retroactive coverage of 12 months allowed for recoupment of Medicaid paid expenses VA File - Maximize current VA benefit Aid and Attendance $90 not in NH $0 listed amounts – Need review 70 - 100% service connected disability Spouses with DIC monthly benefits/CHAMPVA

Washington State VA Healthcare System Enrollments All Vets are potentially eligible for VA medical care, but WA focuses on Vets who are receiving A&A or service-connected disability compensation at a 50% disability rating or higher. These Vets are not required to obtain a prescription from a VA doctor to receive drugs or medicines from the VA, but can have their own doctor provide a prescription to the VA pharmacy. Project Total: 3006 enrollments

Veteran Benefit Enhancement Program Cost Avoidance Savings

Saves Medicaid Expenditures

Questions? Please contact Bill Allman William.allman@hca.wa.gov 360-725-1020 Or Tim Dahlin Tim.dahlin@hca.wa.gov 360-725-2077