ParellaView Graph # 1 OVERVIEW OF PRESENTATION Program Design Options Program Design Conclusions Benefit Package Design Husky Plus Outreach Efforts Evaluation and Monitoring

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

ParellaView Graph # 3 To Medicaid, or Not to Medicaid, That Is the Question? Concern About the Creation of a New Entitlement - Prospects for continued federal funding beyond 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 STAGE ONE: PROGRAM DESIGN

ParellaView Graph # 4 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, 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 STAGE ONE: PROGRAM DESIGN (cont.)

ParellaView Graph # 5 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 STAGE TWO: CONCLUSIONS

ParellaView Graph # 6 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 PHASE THREE: BENEFIT DESIGN

ParellaView Graph # 7 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 PHASE FOUR: HUSKY PLUS

ParellaView Graph # 8 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 PHASE FOUR: HUSKY PLUS (cont.)

ParellaView Graph # 9 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 PHASE FOUR: HUSKY PLUS (cont.)

ParellaView Graph # 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

ParellaView Graph # 11 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 PHASE FIVE: OUTREACH (cont.)

ParellaView Graph # 12 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 PHASE FIVE: OUTREACH (cont.)

ParellaView Graph # 13 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) PHASE SIX: EVALUATION AND MONITORING

ParellaView Graph # 14 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 PHASE SIX: EVALUATION AND MONITORING (cont.)

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

ParellaView Graph # 16 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 SIX PHASES OF EVERY PROJECT

ParellaView Graph # 17 HUSKY ACTIVITY JUNE 1, AUGUST 9, 1998

ParellaView Graph # 18 HUSKY B