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Planning for Healthy Babies. Georgia Medicaid’s Family Planning Waiver Implementation Date – January 1, 2011. Dr. Janice Carson, Deputy Director, Performance, Quality & Outcomes. DCH Mission. RESPONSIBLE. HEALTHY. ACCESS. Access to affordable, quality health care in our communities.

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planning for healthy babies

Planning for Healthy Babies

Georgia Medicaid’s Family Planning Waiver

Implementation Date – January 1, 2011

Dr. Janice Carson, Deputy Director, Performance, Quality & Outcomes

dch mission
DCH Mission

RESPONSIBLE

HEALTHY

ACCESS

Access

to affordable, quality health care in our communities

Responsible health planning and use of health care resources

Healthy behaviors and improved health outcomes

dch initiatives fy 2011
DCH InitiativesFY 2011

FY 2011

Continuity of Operations Preparedness

Customer Service

Emergency Preparedness

Financial & Program Integrity

Health Care Consumerism

Health Improvement

Health Care Transformation

Public Health

Workforce Development

p4hb overview
P4HB Overview

Purpose

Financial Support

Eligibility

Providers

Implementation Plan

Evaluation

p4hb purpose
P4HB Purpose

Outgrowth of LBW Reduction Initiative (multiple stakeholders)

July 2009 DCH data analysis for Medicaid, SHBP, commercial, PH data

Initiative set target to reduce LBW over 5 yrs to the 2000 level (from 9.5% to 8.6%)

p4hb purpose1
P4HB Purpose
  • Developed Strategic Work Plan with three objectives:
    • Increase access to and utilization of Preventive Health Services for all females from birth through child-bearing age.
    • Increase number of intended and appropriately timed births to plan members (Medicaid FFS, Medicaid Managed Care, SHBP, Commercial Insurers)
    • Facilitate early access to prenatal care providers
p4hb purpose2
P4HB Purpose
  • Family Planning Waiver – primary strategy to achieve Objective 2
  • Goals
    • Reduce Georgia’s LBW and VLBW rates
    • Reduce number of unintended pregnancies in Georgia
    • Reduce Georgia’s Medicaid costs
  • Participation in the waiver is voluntary for all participants - women who have not been pregnant and women who would otherwise lose Medicaid eligibility 60 days post partum.
waiver approval process
Waiver Approval Process
  • Submitted formal application in February 2010
  • Responded to CMS concerns re financial support for waiver – funding to be included in SFY 11 budget
  • Established positive working relationship with project officer (PO). Very responsive to her informal requests for information
    • Understood PO was Georgia’s messenger to the Federal Review Team
  • Official RAI sent late March 2010. Responded early April 2010
waiver approval process1
Waiver Approval Process
  • Additional data provided as quickly as possible to PO when requested
  • Georgia: PO dialogue included clear messaging re waiver population and components. Gave justification why SPA option not viable for Georgia.
  • PO communicated federal teams concerns re IPC and collaborated with Georgia to resolve those concerns
  • PO worked with Georgia to develop new methodology for budget neutrality that incorporated reductions in VLBW births.
approvals
Approvals

State legislature approved waiver funding for FY 11 inclusive of IPC in April 2010.

$15,000,000 budget for first six (6) months of waiver operation

90% Federal Funds

10% State Funds

Legislature identified total FP savings for FY 11

$10,000,000 for the first six (6) months of FY 11

CMS approved waiver October 29, 2010 – 8 mos after formal application

eligibility criteria
Eligibility Criteria

Family Planning Only – new Medicaid eligibility category

Women: 18 – 44

Uninsured

< 200 FPL

Interpregnancy Care (IPC) – new Medicaid eligibility category

All of the above, plus

Women who delivered a VLBW infant on or after the first day of implementation of the waiver

Waiver eligibility is for 24 months for IPC with re-determination after 12 months of participation

providers
Providers

Family Planning services delivered via three Medicaid managed care organizations and their contracted provider networks

CMO Provider Networks

Physicians, Nurse Practitioners, PAs

Hospitals

Pharmacies

Local Public Health Departments

Waiver requires women be linked to Primary Care services. To be delivered via Georgia Primary Care Association providers

Provider Network

FQHCs

RHCs

Free Clinics

providers1
Providers
  • P4HB Waiver program to use evidence-based practice models for improving preconception health and reducing low birth weights
    • Improve preconception health through consumer awareness and preventive visits
    • Interconception Care and Pre-pregnancy visits
    • Health insurance coverage for women with low incomes
providers2
Providers

Interpregnancy Care

Utilized Grady/Emory model as basis for these additional services

Participants have access to Family Planning Services plus in-network services:

Primary care services

Limited Dental services

Limited Substance Abuse Treatment Services

Limited Pharmacy Benefits

“Resource Mothers” and Nurse Case Managers within the CMOs’ networks

Dr. Anne Dunlop provided education to CMOs regarding Grady project

implementation plan
Implementation Plan

DCH and the CMOs

New contract for application process

Modified enrollment process – eligible waiver participants transition directly to CMO bypassing FFS

New MMIS processes developed at DCH and CMO levels

Amended CMO contracts; incorporated new waiver cap rates

implementation plan1
Implementation Plan
  • Marketing plan included:
    • Trademark approval for “P4HB” name and logo
    • All materials include trademark
    • Press releases; posters and postcards; radio interviews; education to providers, RSM workers, public health
    • Letters to pregnant women in their 8th month
    • Outreach to stakeholders of the LBW reduction Initiative
evaluation plan
Evaluation Plan

Evaluation plan must utilize quasi-experimental design

Draft plan to CMS by end of February 2011

Contracted with Emory University to evaluate waiver

Incorporated evaluation plan components into CMO contracts and placed them at risk for meeting performance targets

evaluation plan1
Evaluation Plan
  • Quarterly and Annual tracking including:
    • % Eligible Population Enrolled
    • Reduction in pregnancy rate
    • Number of births
    • Number of persons who choose sterilization
    • Births by weight category
    • Member and Provider Satisfaction
    • Cost savings
additional information

Interaction with Title X

Title X clinics can provide services under the waiver

Waiver vs Title X

Continuity of care

Approx. 50,000 women lost Medicaid coverage following their deliveries in 2009.

60 days of care post partum only allows limited family planning services

CMS aware of efficacy of Medicaid FP services

Medicaid cost savings are significant at both the Federal and State levels

Accessing Public Health Clinics

Women choosing FP services via Medicaid will have access to all CMO network FP waiver providers

Additional Information