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THE FUTURE OF NJKiDS & MEDICAL SUPPORTTHE FUTURE OF NJKiDS & MEDICAL SUPPORT…early connection to coverage prior to court order establishment…early connection to coverage prior to court order establishment
4848thth Annual ERICSA Training Conference & Exposition Annual ERICSA Training Conference & ExpositionMay 22-26, 2011May 22-26, 2011
Allison J. DavisAllison J. DavisNJ OCSSNJ OCSS
OBJECTIVESOBJECTIVES
National ReflectionNational Reflection
NJ Reflection NJ Reflection
NJ 1115 Medical Support Demonstration Grant NJ 1115 Medical Support Demonstration Grant
The Future of Medical Support for NJKiDS & the The Future of Medical Support for NJKiDS & the Child Support ProgramChild Support Program
Future Considerations for Federal InitiativesFuture Considerations for Federal Initiatives
NATIONAL REFLECTIONNATIONAL REFLECTION
NATIONAL STATISTICSNATIONAL STATISTICS
7.3 million children uninsured in 20087.3 million children uninsured in 2008
Employer Sponsored Insurance (ESI) is decreasing, Employer Sponsored Insurance (ESI) is decreasing, between 2001-2008:between 2001-2008: ESI for poor workers fell, 37% to 20%ESI for poor workers fell, 37% to 20% ESI for near poor workers fell, 59% to 41%ESI for near poor workers fell, 59% to 41% ESI for those >= 400% of poverty fell 93% to 88%ESI for those >= 400% of poverty fell 93% to 88%
70% of uninsured workers had no access to ESI70% of uninsured workers had no access to ESI
Sources: Cindy Mann, “Connecting Kids to Coverage,” Director, Center for Medicaid and State Operations (January 2010); Sources: Cindy Mann, “Connecting Kids to Coverage,” Director, Center for Medicaid and State Operations (January 2010); Linda J. Blumberg, ”Key Issues in the National Health Care Reform Process,” Senior Fellow for the Health Policy Center Linda J. Blumberg, ”Key Issues in the National Health Care Reform Process,” Senior Fellow for the Health Policy Center (January 2010)(January 2010) . Presented at the . Presented at the Medical Support and Heath Reform Medical Colloquium, sponsored by the Office of the Medical Support and Heath Reform Medical Colloquium, sponsored by the Office of the Assistant Secretary for Planning & Evaluation of the Federal Department of Health and Human Services.Assistant Secretary for Planning & Evaluation of the Federal Department of Health and Human Services.
NATIONAL EFFORTS TO INSURE CHILDRENNATIONAL EFFORTS TO INSURE CHILDREN
Presidential Initiatives: Joint inter-divisional mtgs in Presidential Initiatives: Joint inter-divisional mtgs in Department of Health & Human Services’s (DHHS)--Department of Health & Human Services’s (DHHS)--Administration of Children & Families (child support and child Administration of Children & Families (child support and child welfare) and Center for Medicaid & State Operations welfare) and Center for Medicaid & State Operations Public policy & data/information exchangesPublic policy & data/information exchanges
OCSE July 21, 2008 Final RegulationOCSE July 21, 2008 Final Regulation Both parents; cash medical; cp enforcementBoth parents; cash medical; cp enforcement
Children’s Health Insurance Program Reauthorization Act Children’s Health Insurance Program Reauthorization Act (CHIPRA) 2009(CHIPRA) 2009 Extends CHIP funds and provisions to increase enrollment & outreachExtends CHIP funds and provisions to increase enrollment & outreach
Affordable Care Act 2010Affordable Care Act 2010 Health Information Exchanges; affordability/accessibility; cultural Health Information Exchanges; affordability/accessibility; cultural
sensitivitysensitivity
New Jersey ReflectionNew Jersey Reflection
NJ STATISTICSNJ STATISTICS
2006-2007 US Census Current Population Survey reports NJ has 293,790 uninsured children
9.1% unemployment rate (Dec 2010)
57% open cs caseload is TANF & Former TANF (FFY10)
OCCS Medical Performance status (FFY10)
311,424 Court Ordered Cases 166,037 (53.3%) cases had medical support ordered 35,962 (21.6%) had medical support being provided as ordered
New Jersey Efforts to Insure ChildrenNew Jersey Efforts to Insure Children
NJ Health Care Reform Act NJ Health Care Reform Act (July 08)(July 08)
Mandates all children <18 ; expands FC; ^ affordability to small Mandates all children <18 ; expands FC; ^ affordability to small business marketsbusiness markets
Division of Medical and Health Services Outreach EffortsDivision of Medical and Health Services Outreach Efforts 360k mailing; web-based expedited enrollment 360k mailing; web-based expedited enrollment
Supreme Court Family Practice Committee—Quadrennial Supreme Court Family Practice Committee—Quadrennial Review of GuidelinesReview of Guidelines Review current socio-economic trends to promote relative uniformityReview current socio-economic trends to promote relative uniformity
OCSS Grant 1115OCSS Grant 1115 Early connection to coverage prior to court order establishmentEarly connection to coverage prior to court order establishment
Ongoing agency review of policies, procedures and automated Ongoing agency review of policies, procedures and automated systemssystems
……STEERING INTO THE FUTURESTEERING INTO THE FUTURE
Reflection Helps Navigate to a New Day
Access & OptionsAccess & Options CollaborationCollaboration Data ExchangeData Exchange PurposePurpose Performance Performance Policies and RegulationsPolicies and Regulations
NEW JERSEY 1115 MEDICAL SUPPORT NEW JERSEY 1115 MEDICAL SUPPORT DEMONSTRATION GRANTDEMONSTRATION GRANT
THE FUTURE OF NJKiDS & MEDICAL SUPPORTTHE FUTURE OF NJKiDS & MEDICAL SUPPORT……Early Connection to CoverageEarly Connection to Coverage
THE PROJECT BASICSTHE PROJECT BASICS
GRANT PURPOSE AND SCOPEGRANT PURPOSE AND SCOPE
Purpose: Purpose: Increase # of children with health insurance coverage on Increase # of children with health insurance coverage on
IV-D caseload that is reasonable in cost.IV-D caseload that is reasonable in cost. Recoup and/or defray the State’s out of pocket costs for Recoup and/or defray the State’s out of pocket costs for
public subsidized insurance coverage.public subsidized insurance coverage.
Scope:Scope: A 3 year commitment with measured resultsA 3 year commitment with measured results Pilot program in Ocean, Hunterdon and Camden Pilot program in Ocean, Hunterdon and Camden
CountiesCounties New FD establishment cases entered on NJKiDS New FD establishment cases entered on NJKiDS
EXECUTIVE SUPPORTEXECUTIVE SUPPORT
Medical Support Work Group: Medical Support Work Group: DFD/OCSS DFD/OCSS Judiciary (AOC, Pilot County: Family & Probation, Judiciary (AOC, Pilot County: Family & Probation,
Hearing Officers, Judges)Hearing Officers, Judges) CWA/BSSCWA/BSS MedicaidMedicaid Medical Support FacilitatorsMedical Support Facilitators
PROJECT APPROACH/METHODOLGYPROJECT APPROACH/METHODOLGY
Connecting families to coverage prior to Connecting families to coverage prior to court order establishmentcourt order establishment
Mediation, education, and facilitation of Mediation, education, and facilitation of Relationships with FamiliesRelationships with Families
Medical Support Facilitator (MSF)—role to Medical Support Facilitator (MSF)—role to be absorbed in existing staff functions be absorbed in existing staff functions
Manual tracking of data Manual tracking of data
OVERALL PILOT IMPLEMENTATIONOVERALL PILOT IMPLEMENTATION
Phased ImplementationPhased Implementation
Ocean: Launched April 2009Ocean: Launched April 2009 Hunterdon: Launched Sept. 2009Hunterdon: Launched Sept. 2009 Camden: Launched Feb 2010Camden: Launched Feb 2010
GETTING DOWN TO THE “NITTY GRITTY”GETTING DOWN TO THE “NITTY GRITTY”
PILOT SPECIFICSPILOT SPECIFICS
GETTING STARTEDGETTING STARTED......early connection to coverage prior to court order early connection to coverage prior to court order
establishmentestablishment
We:We: Conducted site visitsConducted site visits Assessed agency business practicesAssessed agency business practices Identified key staff and their roleIdentified key staff and their role Reviewed logistics and computer access needsReviewed logistics and computer access needs
Outcome: Decided the best fit for the MSF is to Outcome: Decided the best fit for the MSF is to sit with the Family Division and BSS sit with the Family Division and BSS
WHOWHO HAS A KEY ROLE IN DAILY PILOT HAS A KEY ROLE IN DAILY PILOT OPERATIONS OPERATIONS
...early connection to coverage prior to court order establishment...early connection to coverage prior to court order establishment
Family Division ClericalFamily Division Clerical Family Division Probation Family Division Probation BSS/CWA Child Support WorkersBSS/CWA Child Support Workers Medicaid Eligibility WorkersMedicaid Eligibility Workers Child Support Hearing OfficersChild Support Hearing Officers Judges and Law ClerksJudges and Law Clerks Medical Support FacilitatorMedical Support Facilitator
WHYWHY DID WE CHOOSE THESE STAFF? DID WE CHOOSE THESE STAFF?...early connection to coverage prior to court order establishment...early connection to coverage prior to court order establishment
…………IT MADE SENSEIT MADE SENSE
NJ Courts implemented their 1NJ Courts implemented their 1stst mediation mediation program in 1982!program in 1982!
WHATWHAT DID WE DO? DID WE DO?...early connection to coverage prior to court order establishment...early connection to coverage prior to court order establishment
We developed two new forms:We developed two new forms:Health Insurance Questionnaire Health Insurance Questionnaire (intake)(intake)
Medical Support Summary Sheet Medical Support Summary Sheet (court file)(court file)
Applied two tools:Applied two tools:The FamilyCare Income Guideline Chart The FamilyCare Income Guideline Chart (published (published by DMAHS)by DMAHS)
Medical Support Decision Matrix Medical Support Decision Matrix (fed regs)(fed regs)
HOWHOW DID WE ACCOMPLISH THIS? DID WE ACCOMPLISH THIS? …early connection to coverage prior to court order establishment…early connection to coverage prior to court order establishment
Cross trained all key staffCross trained all key staff Introduced new MSF roleIntroduced new MSF role Duties of their role in processDuties of their role in process Expanded worker knowledge of healthcare options, Expanded worker knowledge of healthcare options,
application and enrollment processapplication and enrollment processIncorporated new functions into daily business Incorporated new functions into daily business practicespracticesEducated families so they could make better Educated families so they could make better decisions and be involved in their order decisions and be involved in their order establishment establishment
Mid-term AssessmentMid-term Assessment…early connection to coverage prior to court order establishment…early connection to coverage prior to court order establishment
As a project status, our pilot peers indicatedAs a project status, our pilot peers indicated
Accept new challenges and business changesAccept new challenges and business changes Recognize the benefits of the processRecognize the benefits of the process Be proactive—we’re getting better information Be proactive—we’re getting better information
upfront upfront Communicate with partnering agenciesCommunicate with partnering agencies Automate this in the futureAutomate this in the future Recognize county difference and adaptRecognize county difference and adapt
PILOT DATAPILOT DATA
AVERAGE PILOT FILINGSAVERAGE PILOT FILINGS
Ave. filings 125 to 1200 per month (FV/FD/FM)Ave. filings 125 to 1200 per month (FV/FD/FM) Calendar Types: Hearing Officer; Judge; Non Calendar Types: Hearing Officer; Judge; Non
Dissolution Workshops & Non Dissolution ConsentsDissolution Workshops & Non Dissolution Consents 8 to 16 Calendars per month8 to 16 Calendars per month
Average Pilot Timeframes: 13.3: # Days between filing complaint and
completing pilot medical coverage documentation. 48.8: # Days between filing complaint and hearing
PILOT CENSUS
1,660 Pilot Cases (574) Transferred, Dismissed, Withdrawn, Other
1,086 Support Orders Established (147) W/out Medical Support Provision
939 Support Orders Established w/Medical Provision—All had HIQ & MSS’s
ANALYSIS of 939 HIQ’s & MSS’sANALYSIS of 939 HIQ’s & MSS’s…prior to court order establishment …prior to court order establishment
.Pre-Order Medical Status (Enrolled)
# Cases %Cases
Enrolled CP Ins. Plan 159 16.9
Enrolled NCP Ins Plan 174 18.5
Enrolled Both Ins Plans 20 2.1
Enrolled Other Ins Plan 10 1.1
Enrolled Family Care 62 6.6
Enrolled Medicaid 428 45.6
Enrolled Both Private & Public
27 2.9
Not Enrolled 59 6.3
Total # Cases 939 100
ANALYSIS—OUTCOME of COURT ORDERANALYSIS—OUTCOME of COURT ORDER
.Pre-Order
Medical Status (Enrolled)
# Cases(Enrolled Prior
to Court)
% CP
Ordered
% NCP
Ordered
% Both
Ordered
CP Ins. Plan 159 73 8.2 18.8
NCP Ins Plan 174 1.1 87.4 11.5
Both Ins Plans 20 25 15 60
Other Ins Plan 10 30 40 30
Family Care 62 29.1 30.6 40.3
Medicaid 428 11.4 42.8 45.8
Both Private & Public
27 14.8 48.2 37
Enrolled 59 11.8 42.4 45.8
Total # Cases 939
SNAPSHOTSNAPSHOT
Currently:Currently: 57% open caseload is TANF & Former TANF57% open caseload is TANF & Former TANF 21.6% w/medical orders are providing as ordered21.6% w/medical orders are providing as ordered
PilotPilot 93.7% children are enrolled in healthcare prior to court93.7% children are enrolled in healthcare prior to court 52.2% are enrolled in public or subsidized healthcare 52.2% are enrolled in public or subsidized healthcare
prior to courtprior to court
SNAPSHOT (cont’d)SNAPSHOT (cont’d)
Of those enrolled in….Of those enrolled in…. CP insurance prior to court, 73% CP’s were ordered CP insurance prior to court, 73% CP’s were ordered
to continue (18% both were ordered)to continue (18% both were ordered) NCP insurance prior to court, 87% NCP’s were NCP insurance prior to court, 87% NCP’s were
ordered to continue (11.5% both ordered)ordered to continue (11.5% both ordered) Public insurance prior to court, 13.5% CP ordered; Public insurance prior to court, 13.5% CP ordered;
41.6% ordered NCP; 44.9% ordered both41.6% ordered NCP; 44.9% ordered both Of those not enrolled prior to court, 11.8% ordered Of those not enrolled prior to court, 11.8% ordered
CP; 42.4% ordered NCP; 45.8% ordered bothCP; 42.4% ordered NCP; 45.8% ordered both
POST PROJECT OBSERVATIONSPOST PROJECT OBSERVATIONS
BENEFITS of EARLY INTERVENTIONBENEFITS of EARLY INTERVENTION
Establishes Meaningful Court Orders—less Establishes Meaningful Court Orders—less modificationsmodifications
Assists families in maintaining self autonomy in Assists families in maintaining self autonomy in medical choicesmedical choices
Promotes interagency cooperation Promotes interagency cooperation Promotes goals of healthcare reform—Promotes goals of healthcare reform—
affordable healthcareaffordable healthcare Improves outcome measuresImproves outcome measures
WHAT DID NJ LEARN ABOUT ITSELF?WHAT DID NJ LEARN ABOUT ITSELF?
There are 5 main points of contact to collect medical There are 5 main points of contact to collect medical information: IV-D application; intake; during court, information: IV-D application; intake; during court, after court; ongoing case maintenance after court; ongoing case maintenance
Systemically, we are not early intervention friendly Systemically, we are not early intervention friendly (cs model/system)—information is predominately (cs model/system)—information is predominately captured post court order establishmentcaptured post court order establishment
Partner with DMAHS for better data/insurance Partner with DMAHS for better data/insurance information exchangeinformation exchange
Healthcare reform and education is a cultural shift—Healthcare reform and education is a cultural shift—message is not reaching local courts & child support message is not reaching local courts & child support workersworkers
Staff and the public do adapt to changeStaff and the public do adapt to change
NEAR TERM AREAS of IMPROVEMENTSNEAR TERM AREAS of IMPROVEMENTSfor New Jerseyfor New Jersey
Review impact to court ordered use of “both”—our Review impact to court ordered use of “both”—our interpretation of it, the cost to parents, and impacts to interpretation of it, the cost to parents, and impacts to NMSN programNMSN program
Enhance IV-D application & NJKiDS to accept data Enhance IV-D application & NJKiDS to accept data elements for early intervention model—capture and elements for early intervention model—capture and store information for informed decisionstore information for informed decision
Review business practices—pre, during, postReview business practices—pre, during, post Expand to all 21 countiesExpand to all 21 counties Expedite MOU establishment with DMAHS Expedite MOU establishment with DMAHS
data/information exchangedata/information exchange Educate staff: healthcare reform = cultural shift in Educate staff: healthcare reform = cultural shift in
ways we view “what is coverage”ways we view “what is coverage”
FUTURE PROGRAM CONSIDERATIONS FUTURE PROGRAM CONSIDERATIONS NATIONALLYNATIONALLY
Greater alignment between federal initiatives for Greater alignment between federal initiatives for universal health coverage, medical support & NMSN universal health coverage, medical support & NMSN regulations & data exchange regulations & data exchange Review goals: have health coverage vs. coverage Review goals: have health coverage vs. coverage
compliant to court ordercompliant to court order A child’s coverage option does not always equal their A child’s coverage option does not always equal their
parent’s ability to provide through employer optionsparent’s ability to provide through employer options Data sharing…data sharing…data sharingData sharing…data sharing…data sharing Balancing public accountabilityBalancing public accountability
Child support enforcement & early intervention modelChild support enforcement & early intervention model—we already automated enforcement—we already automated enforcement
Better automated interfaces/data exchanges support Better automated interfaces/data exchanges support decisions prior to courtdecisions prior to court
Mediation and workshops promote family autonomyMediation and workshops promote family autonomy
Contact InformationContact Information
Allison J. DavisAllison J. DavisManagerManager
Division of Family DevelopmentDivision of Family DevelopmentNJ Office of Child Support ServicesNJ Office of Child Support Services
David BroselliDavid BroselliAsst. ChiefAsst. Chief
Family Practice DivisionFamily Practice DivisionAdministrative Office of the CourtsAdministrative Office of the [email protected]@judiciary.state.nj.us
