Expanded Access Coalition Meeting

April 27, 2004, 10:10-11:50 a.m., OHP Central Processing

MINUTES

Attending:

Linda Herman (Clackamas County Health Dept)                Kaaren Driscoll (OHSU)

Rhonda Walker (OHAP/LC-CKF Coalition)                     Sandy Wood (OMAP)

Katie Gauthier (Oregonians for Health Security)                       Joy Soares (CareOregon)

LoriAnn Sheridan (OHAP-CKF)                          John Holmes (NAMI-Multnomah Cty)

Jennie Hamilton (OPCA)                                               Michele Wallace (DHS)

Laura Brennan (DHS)                                                  Kelly Harms (IPGB)

Lorey Freeman (Oregon Law Center)                         Margorie Waley (Progressive Options)

Kara Pattinson (NAMI-OPA)                                      Marcie Sugarman (Multnomah County Health             

I.          Call To Order & Introductions:  Jennie called the meeting to order at 10:10 a.m., Introductions followed.    

II.         CKF Process Improvement Collaborative Update:  Michele Wallace gave a brief update on the CKF Process Improvement Collaborative she is participating in with LoriAnn Sheridan, OHAP, and Lisa Hendricks of the Community Health Center in Medford. She explained the process involves diagnosing and assessing the gaps that occur relative to enrollment and attempting to fix them.  Fifteen states were chosen to participate, including Oregon.  The goal of the Oregon team is to reduce the pend rate of applications by 15%.  She added the direction from CKF is to pilot a project, starting small, and learning from failures.  Two staff members have been assigned to manually track clients in the Jackson County area.  Through the use of a customized application checklist and internal staff trainings at OHP Central, the team is hopeful to realize a decrease in the pend rate by the time the project ends in November.  She briefly addressed the latest Learning Session in Chattanooga, Tennessee in which all states were required to bring their Medicaid applications for review and discussion.  She said LoriAnn brought the 52-page application packet.  Sandy clarified the application is only 10 pages.  LoriAnn added this was explained at the conference.  Michele pointed out the checklist continues to be revised to best address clarity in application assistance.  She added they wish to send all the draft notices on OHP next steps to Maximus for review as well as the new application once they complete the task of having two different client groups review the application.  She addressed the workshop by Penny Lane of Maximus on readability of materials.

                                Linda Herman said she had heard DHS was going to use the application used for food stamps and TANF for the OHP application.  Michele explained the decision has not been made, however, there is discussion currently going on relative to this.  They have about 17,000 OHP Plus clients that receive benefits from field offices and they’re in the process of having those cases going back to the field offices.  There are about 40,000 of existing clients get benefits through other programs.  She agreed the DHS Form 415F can be used to determine OHP eligibility, however, they do not want two applications out there.  Sandy added the 415F almost covers all the questions DHS needs for OHP; they only needed to add three questions. The 415F has been sent to a vendor to determine readability. At this point, they are waiting to see what happens relative to OHP Standard over the next few weeks.  Michele added Food Stamps is looking at computerizing the application so it would be better for the clients.  In regards to the green addendum, Form 7211, Michele explained they need that to determine presumptive eligibility.

                        Sandy stressed the Form 7211 allows them to determine what programs clients belong in and that one form is a benefit in training field staff, so they don’t have to learn two different forms.  Michele pointed out the current issue is what DHS will have as of August 1, open or closed enrollment, wait list, etc.  She added there will be more answers by May 14.   

III.            Provider & Managed Care Tax – Joy Soares told attendees the MCO tax has been approved by CMS.  She explained there will be an enrollment limit of 24,000 people on OHP Standard and they have until July 1, 2005 to reduce the enrollment to this number; enrollment will be closed as of August 1.  She added methods to be utilized to get enrollment down to 24,000 include (1) attrition; (2) capping at a certain Federal Poverty Level; and/or (3) premium lockout (if a client fails to pay premiums on time, they’re disenrolled indefinitely, not just for six months).  She said she heard they will also want to eliminate premium sponsorship programs. 

                        Joy said the OHP Standard package will include mental health, chemical dependency, dental, emergency hospitalization and maybe durable medical equipment.  Co-pays and premiums will remain the same.  The negative impact Joy addressed with the containment actions include the impact on the client health, the economy, families and communities.  She pointed out the regular session begins in January, so there’s still opportunity to effect change.

                        Sandy provided the DHS perspective, pointing out enrollment for OHP Standard closes July 1.  A letter is going out to OHP Standard clients, informing them that if they get their applications in on time and pay their premiums on time, they will be able to stay enrolled.  If not, they go back into the queue. She pointed out the enrollment at 24,000 is contingent upon having a provider tax and MCO tax, and CMS has not approved the provider tax yet.  The State will have to do a waiver amendment and state plan amendment for that.  On July 1, DHS will do the three-line movement on the prioritized list of services.  On August 1, DHS will bring up mental health and chemical dependency.  She explained the intent is to reduce OHP Standard enrollment through attrition.

                        Kaaren pointed out that most hospitalizations are not covered now because benefits don’t go into effect until the first of the month following enrollment.  Joy said she understands the provider tax includes $5.7 million for OHP Standard, rate increases and presumptive eligibility.  Jennie said she would check it out to see what’s involved. 

IV.            Premium Sponsorship Update – Sandy said DHS is getting advice from the Department of Justice (DOJ) at this time, and DOJ indicated the sponsoring agencies haven’t presented a policy that meets the necessity in the law.  She explained a program cannot benefit one group of people or region of people; it needs to be equal to everyone.  She added only 50% of a business can be committed to premium sponsorships.  She stressed there is a Federal regulation on statewideness, and there will be more discussion on this.  She further explained that April 1 was the deadline for sponsors to come up with a permanent policy.  Marcie explained when people come in to them, they provide application assistance.  Only when the premium assistance issue comes up by the client do they step in to assist them and the people come from all over the state.

                        Laura said there had been an interim plan allowing sponsors to continue until January 1 paying premiums.  She recalled from meetings on the issue, they were directed to keep on doing what they’re doing, but make a plan to avoid the anti-kickback issue.  Jennie added the plan was to have a non-profit organization, Community Health Partnership, step forward that’s not involved in direct services.  She expressed her concern about interpretations of the law becoming more stringent.  Sandy said the DOJ has determined none of the policies have met the requirements of the law. 

                        In regards to attrition, Jennie asked if there were going to be policies written around William Earhart and administrative errors due to all the changes.  Sandy said some decisions have not been made relative to dealing with OHP Standard yet, so she’s uncertain at this time. 

                        Michele said some decisions may be made April 28 in the Governor’s Office and on April 29 at the Medicaid Advisory Committee, and she’s having a meeting tomorrow about process, closing, open enrollment, waiting lists, etc.  She said there are project timelines and decisions need to be made May 14.  The goal is to do a June stuffer and July notice.  Sandy added they are currently working on a notice on capping enrollment if this goes into effect July 1, and State law requires 30-day notice. 

V.        OHP Standard disenrollment & efforts to re-enroll consumers with disabilities in accordance with ADA reasonable accommodation -  Lorey explained the State has a responsibility to make reasonable accommodation in accordance with ADA, and this is being done on a case-by-case basis.  In response to Jennie’s question about qualifying disabilities, LoriAnn explained she understood it involved cognitive disabilities and a doctor’s letter is required.  Michele said Carolyn Ross was working on the policy rules, which may be already completed.  Lorey added the rules may be posted on the Secretary of State’s website.   

VI.       OHP Notices to Clients – Jennie asked Sandy about getting draft notices to review prior to them being sent out.  Sandy said they are currently updating the lists.  In response to Rhonda’s question about sending out notices, Sandy explained they cannot do anything until CMS approves the waiver, except they can cap and stop enrollment by July 1.  She stressed the number of people to be allowed on OHP Standard will depend on whether or not the provider tax is approved.  Joy added the waiver is all about exempting VA hospitals as well as Type A and Type B hospitals from the provider tax.

                        Michele explained that by mid-May, decisions have to be made in order to implement program changes by August 1.  Jennie restated what OMAP will be sending out in regards to notice on changes to OHP Standard.  Michele explained OHP Central will send out notices relative to denials and closures.  Sandy explained notices go to the households on June 1 and will refer them to their medical ID cards to see who is impacted since someone in the household may belong to OHP Plus. 

                        Marge asked if some OHP Standard clients might qualify for OHP Plus.  Michele explained that when a client applies, they are put on OHP Standard.  Then they look at how the questions on disabilities were answered, and if they are affirmative, OHP Central sends the application to the folks that run program eligibility for the disability programs, stressing the importance of completing the addendum.  She explained they are required to look at all programs when an application comes in.

                        Rhonda expressed her concern that with the notices that will be going out to parents as it’s going to be difficult keeping children enrollment.  Joy added studies show that uninsured parents are less likely to take their children in for health concerns.  Michele suggested this is an area where EAC members can help educate clients.

                        Using an example, Jennie asked if a single mother with a child has a horrible drinking problem, can she be considered to have a disability.  It was pointed out she would have to be diagnosed.  Jennie then questioned if she is diagnosed and has a doctor’s letter.  Michele explained it would fall into SSI disability criteria, adding if she earns less than $400/month, she would qualify for TANF.

                        Michele asked what everyone thought about open enrollment versus waiting list.  Kelly said FHIAP’s wait list has 12,000 people currently on it.  Michele used different scenarios to describe the two processes, explaining everything is budget-driven.  Joy pointed out she did not expect to see an open enrollment any time soon.  Michele added she will be losing 50-70 staff at OHP Central on July 1.  They have to go to the Legislature to ask for staff to deal with what is left of OHP, indicating there is some administrative money built into the provider/MCO tax.  It was the consensus that open enrollment would work better than a waiting list as many of the clients are so transient although it would be difficult to process caseload during a one-day open enrollment.  Michele pointed out they have 110-115 field offices around the state. 

VII.            OHP/SCHIP & FHIAP Enrollment Numbers –             LoriAnn explained OHP Standard enrollment as of March wa at 46,904, SCHIP at 20,334, and OHP Plus at 301,097.  According to the FHIAP Snapshot as of 4/26/04, there are 7,532 lives enrolled.  In regards to the pend issue, she further explained the original pend rate in November 2003 was at 48%.  Through use of the application checklist and internal staff training, they are hopeful to see a reduction in pends.  She pointed out the numbers shared at the last meeting relative to the pend rate were incorrect as the data has not been fully evaluated.

                        Marcy questioned whether or not the pregnant CAWEM will be included in the 24,000 OHP Standard enrollment cap.  Sandy said they will be included, but the CAWEM expansion population (beyond Federal requirements) will be reduced.  DHS will do a direct mail to this population, giving them notice. CAWEM  will be reduced by FPL.  She added she thought it was unlikely that pregnant women would be reduced due to the Governor’s mandate to cover children and pregnant women to 185% FPL.

                        Linda asked if a woman on OHP Standard gets pregnant, goes on OHP Plus while pregnant, can she return to OHP Standard after the two months following the baby’s birth.  Sandy will check into that.  

VIII.     COER Update – Laura told the group COER is dealing with issues relative to outreach, simplification, coordination and premium issues.  Their next meeting is May 25 and she will give an update in June.  She explained recommendations from EAC go to COER, which works with DHS, OMAP, OHP Central and OHPPR to address changes.  Sandy added they made additional changes to the premium notice and disqualification notice regarding children being eligible for continued coverage. 

IX.       Local CKF Project Updates – Lori Ann gave a brief update on the local pilots.  Health Network for Rural Schools in Eastern Oregon recently held a training in which Tim Miller did application assistance training and Mark from FHIAP gave a presentation.  There were 43 attendees who serve Baker, Union and Wallowa counties.  Rogue Valley CKF has been very active with the Process Improvement Collaborative, creating very useful forms for OEWS and application assistants.  Rhonda gave a brief update on the Lincoln County CKF Coalition.  She will be meeting tomorrow with a women from the school district to discuss ways of outreaching to school-based clinics. 

X.            Announcements & Adjournment

A.  Next meeting:  May 25, 10:00-12:00 p.m., DHS Parkway Bldg., Upstairs, Room 6

Note:  Limited parking; overflow at Fred Meyer across the street 

B.  Cover The Uninsured Week – May 10-16; LoriAnn invited anyone interested in volunteering for the health

      fair at Pioneer Square on May 14 to let her know. 

C.     Adjournment:  11:50 a.m.  

Handouts:

OMAP Medically Eligibles Data (March 2004)                       CTUW Flyer                                                    

     March 2004 EAC minutes                                                      Job Announcement-Safety Net Enterprise ED

    FHIAP Snapshot of Program Activity 4/25/04                            Summary of Emergency Board Action

 EAC Minutes-042704.doc                                                                                                             Recorded by LoriAnn Sheridan, OHAP