County & MA Site Administration County Incentives Program and County Grant Program County Relations: Joshua Montoya and Crestina Martinez January 13, 2016 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Role of the Counties FY 2014-15 Agenda County Incentive Program County Grant Program FY 2015-16 County Incentive Program County Grant Program Engagement Tips with County Partners Q&A 3
Role of the Counties Eligibility determination functions written in state statue Colorado is a state-supervised, county-administered system This allows for variation based on local political and economic realities Classified based on caseload: Small: 32 counties Medium: 22 counties Large: 10 counties 4
Role of the Counties, continued Based on the state-supervised, county-administered system, each entity shares in the cost of administering the Department s programs Typical administrative costs split is 50% federal funds, 30% state funds, 20% local funds Local shared based on Random Moment Sample (RMS) Local funds: primary source is property taxes Different resources available in different communities County incentives funds earned are essentially a reimbursement of the county s local share 5
Counties: By the Numbers 64 counties 5 county districts 4000+ eligibility workers $50 million in County Administration Funding $1 million in Grant Program Funding Timeliness for December 2015: 98.69% timely processing for new applications 96.09% timely processing for redeterminations County call centers: Adams, Arapahoe, Boulder, Denver, Larimer 6
Counties: Beyond Eligibility Determinations SEP services for LTSS clients C4HCO Assistance Sites Healthy Community Sites Family Health Coordinator(s) Many other services outside of HCPF programs 7
FY 2014-15 County Administration Changes Budget Request R6 2013 used some county administration funding to create an incentive program Incentive contracts encourage increased county eligibility processing performance and community collaboration Contracts signed by all 64 counties in both FY 2014-15 and FY 2015-16 Incentive payments totaled $2.8 million for FY 2014-15 but increased to $4.3 million for FY 2015-16 Incentives payments are unrestricted and can be used per county discretion 8
FY 2014-15 Incentives There were four incentives for FY 2014-15: Achieve and maintain 95% timeliness for new applications and redeterminations Achieve and maintain minimal backlog of new applications and redeterminations, based on county size Collaborate with approved local partners quarterly Sign a MOU to work with local correctional facilities for inmate eligibility 9
FY14-15 Incentive Results 64 counties signed incentive contracts 52 counties met at least 3 of the 4 incentives 61 counties met backlog requirements 58 counties met timeliness requirements 10
Incentives: New Application Timeliness 11
Incentives: Redeterminations Timeliness Progress 12
Incentives: Collaboration Collaboration Partners: Regional Care Collaborative Organizations Behavioral Health Organizations Local Public Health Agencies Medical Assistance Sites Connect for Health Colorado Many other partners Minimum 1 partner per quarter Submitted supporting documentation 13
Incentives: Correctional Facility 42 counties signed MOUs with their local correctional facilities; 3 additional after contract period Business processes include: An avenue for Medicaid applications to be forwarded to the county for processing The out stationing of eligibility technicians at correctional facilities The installation of PEAK kiosks and/or computers to provide Real Time Eligibility (RTE) determinations Better communication between County Sheriffs and county human services 14
FY15-16 Incentive Program Timeliness for new applications and redeterminations Backlog for new applications and redeterminations Collaboration with local partners Additional eligible partners; minimum 3 partners per quarter Medicaid Eligibility Quality Improvement Plan (MEQIP) added Training added 75% of county eligibility FTEs undergo a minimum of 9 training hours MOU with Correctional Facilities removed 15
FY15-16 Incentive Weights FY14-15 Incentive FY14-15 Weights FY15-16 Incentive FY15-16 Weights Timeliness at 95% 50% Timeliness at 95% 40% Backlog 20% Backlog 20% Collaboration 15% Collaboration 15% Correctional Facility MOU 15% MEQIP (quality) 10% Training 15% Total 100% Total 100% 16
County Grant Program: Overview Authorized by Budget Request R6 2013 Funded one-time infrastructure or business process improvements Grant program funds must be used on Medicaid clients only Does not cover anything related to ongoing costs such as overtime for application processing If grant proposal includes programs other than Medicaid, they must be cost allocated County covers portion not funded through grant 17
FY14-15 Grant Results County Project Summary Infrastructure/Process Improvements Requested Adams Boulder El Paso Larimer Mesa Park To build a technological infrastructure that encourages clients to become more self-reliant for their own health and other benefits regardless of where they are located in the county. Procure and install key client service hardware in the renovated Boulder and Longmont locations, and develop the kiosk and workflow tools to wrap around these devices. Decrease in the length of time it takes for Long Term Care to be approved and the process completed on both the county level and the provider level. Dedicate a current experienced Technician to be the liaison to the community to answer questions concerning Medicaid and it s interactions with the new Affordable Care Act. Improve client access by making applications for Medicaid available through collaboration with Mesa County Sheriff s Office. Research a sustainable solution for NEMT in Park County. PEAK kiosks in strategic locations throughout county, increasing client access; lobby queue system to manage and track in-person visits; application/redetermination process improvements PEAK kiosks for lobbies; self-service tools for appointment check-in and in-office document submission; workflow tools for task tracking, increasing timeliness; technology upgrades including signature pads and scanners LTC/LTSS new application process improvements; technology upgrades for LTC staff, including scanners and software licenses; increased collaboration with community LTC providers Implement specific phone-line with CBMS-qualified eligibility technician for providers and other community members to call with questions regarding benefits and ACA implementation Technology upgrades, including computers and kiosks, to be placed in the community where access to high-speed internet and technology is lacking Collaborate with area agencies to develop a local solution to rural Colorado s lack of access to NEMT 18
FY15-16 Grant Program: Updates to Program Criteria Proposals must now meet 2 of 3 criteria Criteria 1 Geographic Application (Required) Ability to be applied statewide or by other counties, if they choose Criteria 2 Operational Excellence (Option 1) Focus on business process reengineering for intake and ongoing functions Criteria 3 Person and Family-Centeredness (Option 2) Proposals must improve the client experience with counties 19
FY14-15 and FY15-16 Grant Program Comparison Metrics FY 2014-15 FY 2015-16 Applications Submitted 12 22 Counties Impacted 11 39 (3 regional collaborations) Amount of Funds Requested $398,226.96 $992,374.72 Applications Approved 11 21 Amount of Funds Awarded $236,062.87 $982,374.72 Required Local Match $162,164.09 $262,225.32 Accepted Conditions of Funding 6 19 Completed Projects 4 TBD Amount of Funds Expended $167,488.00 TBD 20
FY15-16 Proposals: Process Improvements County Project Summary Project Description Arapahoe Denver El Paso Fremont Larimer Pueblo NW CO Reg. Collab. Technician outstation at county jail for recently released inmate Medicaid eligibility Disability Benefit Advocate for SSI/SSDI applicants and Medicaid eligibility Leadership Training Academy for supervisors, leads, and management Floating Certified Trainer/QA Specialist for county and regional county partners Technician outstation at county jail for recently released inmate Medicaid eligibility Train-the-trainer/LEAN initiative for Medicaid technicians and management Floating Certified Trainer to support staff vacancies throughout the region Eligibility technician stationed at Arapahoe County Detention Center to enroll released inmates in MA/C4 programs only Benefit advocate to enroll eligible clients in MA program while providing assistance for SSI and SSDI applications Increase empathy, leadership skills, and program knowledge base for decision-makers Technician responsible for QA reviews and developing trainings based on results of review; floats between counties based on need. Two eligibility technicians stationed at Alternative Sentencing building to enroll released inmates in MA programs only Two staff to become resident experts on continuous improvement through LEAN and new trainings Floating trainer allows for staff vacancies to be filled and provide over-the-shoulder support after training completion; supports multiple counties 21
FY15-16 Proposals: Tech Upgrades County Project Summary Project Description Archuleta Baca Pilot document scanning technology for Medicaid-only eligibility technicians Teleconference system for training and education of Medicaid-only eligibility techs County will begin to develop internal processes for scanning documentation around Medicaid-only clients Allow for training and communication with state agencies Broomfield Document scanning for all county technicians Implement scanning tech for all programs Boulder Boulder County Dashboard for collecting and analyzing data for trends and real-time data for decisionmaking Client Engagement Portal expansion for local clinics and health care providers Allows for real-time tracking of status of cases pending, backlogged, etc. Connection to local clinics and providers Chaffee Document scanning for all county technicians Implement scanning tech for all programs Eagle Document scanning for all county technicians Implement scanning tech for all programs La Plata SW CO Reg. Collab. Document scanning for all county technicians; training support room; Call Center technology Upgrade to regional call center for Medicaid Implement scanning documentation for all programs; implement new Call Center technology Dedicated line for regional providers; connects to HCPF Customer Contact Center 22
FY15-16 Proposals: Health Initiatives County Project Summary Project Description El Paso Larimer NE CO Reg. Collab. Partnership with Local Public Health Agency and Library District to provide classes on healthy living Public Health Nurse outstation with local community partners to develop coordinated mental health services for high risk children Motivational Interviewing for pregnant mothers newly enrolled in Medicaid Links families to medical assistance and prevention activities, including nutrition, cooking, and shopping; immunizations; breastfeeding; and fitness Work with targeted families to identify their children s social and emotional needs and partner with local agencies to assist in successful upbringing Enhance birth outcomes for pregnant mothers on Medicaid by using motivational interviewing to support behavior change and healthy birth outcomes 23
County Engagement: Tips for Success Start with a shared goal we are all helping Coloradans Mutual respect goes a long way towards improving collaboration Understand workload, competing priorities Open enrollment is one small part of county work Understand one size does not fit all Wide variations in financial resources, structure, staffing and capacity Different political realities on the ground 24
County Engagement: Tips for Success Engage regularly and develop relationships directly with county partners Every county is different Relationships and trust are built over time Don t wait until you need something The collaboration incentive is a great opportunity to start this conversation Share both achievements and challenges Open dialogue and honest discussion can lead to better outcomes for clients and more collaborative partnerships 25
Questions or Concerns? 26
Contact Information County Relations Team: Crestina Martinez Government Relations & Partner Outreach crestina.martinez@state.co.us Joshua Montoya County Programs and Communications Specialist joshua.montoya@state.co.us 27
Thank You! 28