Below is the HillCo client report from the May 12 Medicaid/CHIP Regional Advisory Committee meeting
Medicaid/Medicare Dual Demonstration Project
- Demonstration will begin March 1, 2015 and run through 2018
- 6 demonstration counties including Bexar, Dallas, El Paso, Hidalgo, Tarrant and Harris
- Will enroll up to 150,000 individuals
- Excludes individuals in the IDD population who are in STAR+PLUS for acute services only and individuals being served under a 1915c waiver
- Through this demonstration, HHSC proposes a fully integrated, capitated approach that involves a three-party agreement between the state, CMS, and a managed care organization that has both an existing STAR+PLUS contract and a Medicare Advantage Special Needs Plan contract with the federal government
- The goal of this demonstration project is to achieve savings and reduce costs through integrated and improved care management for Medicaid and Medicare services for these individuals.
- HHSC is currently finalizing negotiations for the Memorandum of Understanding with CMS
Texas Women’s Health Program
- The Texas Department of State Health Services awarded $45.4 million in new state funding to 55 agencies across the state to expand access to women's health services
- With $100 million in additional funds from the Legislature for the next two years, DSHS expanded its Primary Health Care program to increase access to essential comprehensive women’s health care services in Texas
- The expansion will serve about 170,000 low-income women per year and covers a range of services including family planning and health screenings
Please see the attached chart for details on the 3 women’s health initiatives
Update on the Affordable Care Act
- HHSC is seeing two types of referrals
- Inbound from the marketplace to HHSC
- Outbound from HHSC to the marketplace
- HHSC will accept enrollments year round and evaluate them for special circumstances to allow access outside of an enrollment period
- Out of the 167,000 enrollments, only 17,000 were approved for Medicaid
- Out of this total, 79% didn’t qualify for coverage
- 4% withdrew applications
- Out of the 167,000 enrollments, only 17,000 were approved for Medicaid
- Every week since they open enrollment ended HHSC has been receiving up to 1000 applications a week
- There is a discrepancy in eligibility between CMS and HHSC
- CMS is basing eligibility on past tax returns
- HHSC is basing eligibility on current income
- Reason that many didn’t qualify for coverage at the state level
- Individuals coming through the “Texas door” will be processed more effectively
Healthy Eating Initiatives
- SNAP Nutrition Education
- HB 3401 passed in the 83rd legislative session directing HHSC to provide wellness and nutrition information on a website for the recipients of SNAP food benefits
- http://yourtexasbenefits.hhsc.state.tx.us/eat-healthy/
- Helps recipients to learn about making healthy food choices, practicing food safety, stretching a limited SNAP budget and increasing physical activity
- The committee agreed that they liked the layout of the website
The Community Partner Program
- HHSC is partnering with community based organizations to help people learn how they can get the most out of the Medicaid eligibility portal, www.yourtexasbenefits.com
- 620 organizations have joined, with 100 in the pipeline
- The organizations that become community partners represent a wide range of non-profit, faith based, local and statewide community groups
- https://www.texascommunitypartnerprogram.com/ui/UI/HomePage.aspx
Overview of Statewide Advisory Committees
State Medicaid Managed Care Advisory Committee
The State Medicaid Managed Care Advisory Committee, created by Senate Bill 7 of the 83rd Texas Legislature, provides recommendations and ongoing input to HHSC on the statewide implementation and operation of Medicaid managed care. The committee looks at a range of issues, including program design and benefits, systemic concerns from consumers and providers, efficiency and quality of services delivered by Medicaid managed care organizations, contract requirements for Medicaid managed care, provider network adequacy, and trends in claims processing.
The committee also will help HHSC with policies related Medicaid managed care and share information on best practices with the Medicaid Regional Advisory Committees. The State Medicaid Managed Care Advisory Committee serves as the central source for stakeholder input on the implementation and operation of Medicaid managed care.
STAR KIDS Advisory Committee
The STAR Kids Advisory Committee, created by Senate Bill 7 of the 83rd Texas Legislature, advises HHSC on the establishment and implementation of the STAR Kids Medicaid managed care program. The STAR Kids Medicaid managed care program is legislatively mandated to provide services for children with disabilities who have Medicaid coverage to improve coordination and customization of care, access to care, health outcomes, cost containment and quality of care. The STAR Kids model must require a health home, care management, and provide comprehensive coordination of acute care and long-term service benefits.
Intellectual and Developmental Disability System Redesign Advisory Committee
The Intellectual and Developmental Disability (IDD) System Redesign Advisory Committee, created by Senate Bill 7 of the 83rd Texas Legislature, will advise HHSC and DADS on the implementation of the acute care services and long-term services and supports (LTSS) system redesign for individuals with intellectual and developmental disabilities. SB 7 requires HHSC and DADS to design and implement an acute care services and LTSS system for individuals with IDD that supports the numerous goals.
STAR+PLUS Quality Council
The STAR+PLUS Quality Council, created by Senate Bill 7 of the 83rd Texas Legislature, will advise HHSC on the development of policy recommendations to ensure eligible Medicaid consumers receive quality, person-centered, consumer-directed acute care and long-term services and supports in an integrated setting under the STAR+PLUS Medicaid managed care program. The council is legislatively mandated to annually report to the HHSC executive commissioner an analysis and assessment of the quality of acute care services and long-term services and supports provided by STAR+PLUS, recommendations on how to improve STAR+PLUS services, and recommendations to ensure STAR+PLUS consumers receive person-centered, consumer-directed care in the most integrated setting achievable. The STAR+PLUS Quality Council, in conjunction with HHSC, is also legislatively mandated to report to the legislature every even numbered year the assessments and recommendations contained in the annual reports to the HHSC executive commissioner.