Transcript Document

HEALTHY TRANSITIONS INITIATIVE
HEALTH CARE REFORM: OPPORTUNITIES
AND CHALLENGES FOR YOUNG ADULTS OF
TRANSITION AGE
Claudia Brown
Jim Wotring
Gwen White
August 10, 2010
Health Care and Young Adults of
Transition Age
• Issues well documented
• Opportunity for change
• Challenges to address
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Be At The Table
• Decisions will be made at the state level
• Medicaid Eligibility
– Combine low income and disability categories
– SSI - “child” list of diagnosis up to age 25 / 30
• Remove Disincentives for work / employment
– Include disability OR condition
– Functional Definition – readiness to assume adult roles
– Include “at risk” categories
• Service array
– Cover needed transition support services
– Linkages to families
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Specific Issues and Considerations
Youth and Young Adults and Health
Reform
Eligibility – 2014 Is Now Implementation Pits Falls
• Access
• Parent’s private
• Enrollment –help with
insurance
navigation skills
• Parent’s public coverage
• Information
• Family of One
dissemination
• Social marketing
• Poverty guidelines
• Youth culture
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Specific Issues and Considerations
Youth and Young Adults and Health
Reform
Eligibility – 2014 Is Now Implementation Pits Falls
– Access
• Parent’s private
– Enrollment –help with
insurance
navigation skills
• Parent’s public coverage
– Information
• Family of One
dissemination
• Social marketing
• Poverty guidelines
• Youth culture
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Eligibility – 2014 Is Now
Parent’s private Insurance
• How will you advise youth
and families in your
program when the parent
has private insurance and
the youth’s coverage
under the parent’s plan can
continue on until age 26,
when other coverage
options exists:
– Medicaid expansion
– Additional private coverage
thru Health Insurance
Exchanges
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Eligibility 2014 is Now
Parent’s public coverage
or Family of One
• How will you advise a
youth and family when
the 19 turns 19 and the
parent has public
coverage. Do you advise
remain under the
parent’s coverage or do
you advise the youth to
seek his own coverage?
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Reform Implementation
Access
Enrollment
• How would a youth of • Modifications will be
today access health care necessary to work with and
or health insurance
enroll this population into
coverage?
coverage.
• Access isn’t just about • System navigation
eligibility it is also
assistance, role for
knowing where to go
providers.
and how to get there
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Health Reform Implementation
Information
Dissemination
• Youth culture is driven
by technology
• Social marketing
leverage it
• Social media – use it
(facebook, tweeter, etc)
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Money Follows the Person
Jim Wotring
Money Follows the Person
• $2.25 billion in Grants to Extend the Money Follows
the Person Rebalancing Demonstration to More
States
• The extension of the MFP Demonstration Program
is through 2016
• Under the MFP demonstration, states will receive an
enhanced Federal Medical Assistance Percentage
(FMAP) for a one-year period for each individual
they transition from an institution to a qualified
home and community-based program.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Youth/Young Adult Eligibility
Criteria
• Placed in one of the following institutions for 90 days or
more
– Psychiatric Residential Treatment Facilities for Children,
– Institutions for Mental Diseases for Children (under 21) and Older
Adults (over 65) and ;
– Adults over 22 with behavioral health disorders that reside in nursing
facilities.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
State Eligibility Criteria
• If your State is currently participating, CMS will not
require a State to compete again through a new
solicitation process. States will only need to submit
a written request to the CMS Grants Office in the
summer of 2011 for continued participation in the
MFP grant program.
• States currently not participating in the MFP
Demonstration Project Grant will have the
opportunity to apply for a grant through a
competitive award process.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Benefits of Participating
• Participation in the MFP Demonstration Program also gives
States access to the following benefits:
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Enhanced Federal Medical Assistance Percentage (FMAP)
National Technical Assistance (TA)
HCBS and Demonstration Services
Supplemental Services
Full Reimbursement for Specific Administrative Costs
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Benefits of Participating
• Enhanced Federal Medical Assistance Percentage (FMAP):
The MFP Demonstration Program provides an FMAP rate for
qualified services, which includes HCBS services and
demonstration services. This rate is equal to taking the
published FMAP for a State, subtracting it from 100 percent,
and dividing the total by half, and adding that percentage to
the published FMAP. As an example, a State that normally
has a 50 percent FMAP will have a 75 percent FMAP under
MFP. The enhanced MFP FMAP cannot exceed 90 percent.
The enhanced rate is available for qualified services provided
to an MFP participant for 365 days after transition from an
institution.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Demonstration Program
• If interested in the MFP Demonstration Program, an
Applicant Teleconference will be held Wednesday, August
11, 2010, 2: 00-4:00 PM EST to answer any questions about
the Solicitation. The participant call in number is 800-6031774 and conference code ID is 88811531. CMS will also
conduct a series of technical assistance (TA) teleconferences
which will be held throughout the fall of 2010 to assist
applicants to meet the requirements for each section of the
Operational Protocol. The schedule and call in information
for the TA teleconferences will be provided at
http://www.cms.gov/CommunityServices/20_MFP.asp
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Grant Opportunity
• On August 4, 2010 CMS released a Solicitation for MFP
Planning Grants. CMS recognizes that States will be required
to provide needed resources to develop and submit an
Operational Protocol to meet the requirements of the 2011
Money Follows the Person Rebalancing Demonstration
(Funding Opportunity Number (FON) CMS-1LI-11-001 by
January 7, 2011. This solicitation affords States the
opportunity to receive MFP Planning Grants with funding
awarded to produce the Operational Protocol based on the
criteria of the MFP solicitation. States that will be submitting
an application for an award under Funding Opportunity
Number CMS-1LI-11-001 may also submit an application to
receive a Planning Grant award up to $200,000.
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Money Follows the Person Links
• A copy of the invitation to apply for the “FY2010 Money
Follows the Person Rebalancing Grant Demonstration,”
including the application forms and information concerning a
national call for applicants, will be posted at
www.grants.gov:
– http://www.cms.gov/CommunityServices/20_MFP.asp
– http://www.cms.gov/CommunityServices/Downloads/MF
P2011SolicitationFinalJuly29RH.pdf
– http://www.cms.gov/CommunityServices/Downloads/MF
P_Planning_Grant_Solicitation_2010.pdf
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Current MFP States
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Arkansas
California
Connecticut
District of Columbia
Delaware
Georgia
Hawaii
Iowa
Illinois
Indiana
Kansas
Kentucky
Louisiana
Maryland
Michigan
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Missouri
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Texas
Virginia
Washington
Wisconsin
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY
Resources
• POLICY DOCUMENTS: (CD Rom from Annapolis Meeting)
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Policy recommendations to promote and sustain effective community transition systems. (Clark, HB, Deschênes, N., & Unruh,
DK,, 2010).Tampa, FL: National Network on Youth Transition for Behavioral Health.
Summary of Center for Mental Health Services Youth Transition Policy Meeting: National Experts Panel, Held June 8-9,
2005, Rockville, MD (M. Davis, Center for Mental Health Services Research, Department of Psychiatry, University of
Massachusetts Medical School & C. Koyanagi, Bazelon Center for Mental Health Law for the Substance Abuse and Mental
Health Services Administration, Center for Mental Health Services, Final Report September 2005)
• WEB SITES:
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www.healthcare.gov (U.S. Department of Health & Human Services)
http://www.nasmd.org/Home/home_news.asp (The National Association of State Medicaid Directors)
http://www.thenationalcouncil.org (National Council for Community Behavioral Healthcare)
• OTHER:
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http://georgetownuniversity.na5.acrobat.com/p37088569/ (Webinar on parity)
http://www.allhealth.org/briefing_detail.asp?bi=186. (Video / Podcast: Rites of Passage: young Adults and the Affordable
Care Act of 2010. The Commonwealth Fund)
© 2010 NATIONAL TECHNICAL ASSISTANCE CENTER FOR CHILDREN’S MENTAL HEALTH, GEORGETOWN UNIVERSITY