Medicaid Managed Care Partnership Bridging Hospital and Home. Ohio Department of Medicaid

Transcription

1 Medicaid Managed Care Partnership Bridging Hospital and Home Ohio Department of Medicaid

2 Agenda Brief Discussion of Medicaid Eligibility Scenarios NICU and Medicaid Managed Care Partnership working together for better outcomes Questions 9/19/2016 2

3 Eligibility Scenarios 9/19/2016 3

4 Medicaid Eligibility Scenarios 1. Mom enrolled in MCP at time of delivery 2. Mom with presumptive eligibility at time of delivery 3. Mom with no Medicaid at time of delivery 9/19/2016 4

5 Mom enrolled in MMCP at the time of delivery Note: Baby will remain a deemed newborn and eligible for Medicaid through 1 st birthday even if separated from mom (ex: foster care or adoption) 9/19/2016 5

6 Mom has presumptive Medicaid eligibility at delivery 9/19/2016 6

7 Mom with presumptive Medicaid eligibility at delivery Hospitals who are Qualified Entities can enroll individuals and help them receive presumptive eligibility (PE).» PE is always FFS Medicaid, but the individual will transition to a MMCP upon completion of the application and approval for full Medicaid benefits» Failure to complete the Medicaid application will lead to the presumptively eligible case being closed and the end of Medicaid benefits 9/19/2016 7

8 Mom with no Medicaid at the time of delivery Financially Eligible If anticipate Mom/Baby financially eligible for Medicaid, can initiate presumptive eligibility and then facilitate Medicaid application If found eligible, will receive FFS Medicaid until parent selects a Managed Care Plan Institutional Pathway If Mom/Baby over income for Medicaid, but baby has hospital stay >30 days, facilitate Medicaid application to see if baby eligible for Institutional Medicaid (FFS). Baby will be discharged on a Managed Care Plan and will remain eligible for 12 months. 9/19/2016 8

9 Mom with no Medicaid at time of delivery financially eligible 9/19/2016 9

10 Mom with no Medicaid at time of delivery (overincome) Institutional Medicaid pathway 9/19/

11 NICU Managed Care Partnership 9/19/

12 Putting it into context Smart AIM: Decreased time from when infant is medically eligible for discharge to care at home. Key Drivers:» Strengthened family capacity to care for infant during transition to home and long term» Earliest and standardized process for transition to home» Enhanced coordination of care through a prepared medical home and needed community resources Interventions:» Identify and communicate with Medicaid Care Manager/Case Manager» Standardize roles and responsibilities of discharge point person at Children s hospital and Medicaid, and include family in communication

13 How are things now? Issues reported with securing Home Nursing services Issues reported with securing transportation for educational visits and general visiting of infant in the NICU Lack of strong relationship between NICU staff and Medicaid Managed Care staff 9/19/

14 How can we make it better? 9/19/

15 NICU Proposed Role Utilize the Deemed and Presumptive Portal Notify the MCP upon identification of an infant that will require significant services upon discharge Participate in communication with MCP re: infant s needs prior to discharge and family s progress in learning to care for the infant» When family requests, consider allowing MCP to meet with family at hospital Note Please connect with the MCP even if they are the secondary coverage 9/19/

16 Managed Care Plan Proposed Role Pre-Discharge In collaboration with the NICU discharge planner, locate and secure needed services» Transportation (incl. educational visits)» Home Nursing/DME Post-Discharge Identify and remove barriers to attending follow up appointments Connect family with any local resources that could be of assistance Monitor and be responsive to changes in infant s condition (ramp up and down services as needed) 9/19/

17 Real Life Perspective and Discussion Kelly Powell of Akron Children s 9/19/

18 Feedback and Assistance 9/19/

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