Medi-Cal & Children California Association of Health Plans Kelly Hardy August 3, 2017
Overview 1) Enrollment; federal threats 2) Preventive care 3) Developmental screenings 4) Quality measurement 5) Consumer/family engagement
About Children Now Children Now is California s umbrella research, policy development, communications, and advocacy organization working on all key kids issues, including early childhood, education reform, children s health, foster care, and juvenile justice
Medi-Cal: Medicaid in California Medicaid & CHIP = Medi-Cal in California Medi-Cal provides a package of preventive services & well-child visits through EPSDT benefit entitlement EPS of EPSDT = AAP s Bright Futures periodicity schedule Medi-Cal is THE primary source of kids coverage
ACA Improves Kids Coverage Rates
Health4All Kids In 2015, California passed SB 75 to expand full-scope Medi- Cal to undocumented children who meet income eligibility Since May 2016, 198,241 children have enrolled in full-scope Medi-Cal http://www.dhcs.ca.gov/services/medi-cal/eligibility/documents/sb75/sb75_enrollees_county_060717.pdf
Enrolling Eligible But Uninsured Kids
Federal Threats All Congressional options considered this spring/summer would severely impact kids coverage E.g., increase uninsured kids in California from 3% to 10% Approx 539,000 kids could lose coverage
Are California kids getting the preventive screenings they should? % of kids (by age group) who should receive at least one initial or periodic screen that receive at least one initial or periodic screen 0.58 0.51 0.78 0.89 0.78 0.69 0.68 0.68 0.55 0.53 0.47 0.46 0.38 0.44 0.25 0.21 Total < 1 1-2 3-5 6-9 10-14 15-18 19-20 California National Source: Form CMS-416, FY 2015, Participant Ratio
Ensuring Coverage Translates Into Preventive Care
What are Developmental Screenings? Developmental screenings refer to the use of an age-appropriate validated tool (e.g., Ages and Stages Questionnaire) to identify children with or at-risk of developmental delays so they can be referred to early intervention services (e.g., IDEA Part C) Per AAP s Bright Futures periodicity schedule, developmental screenings are recommended at the 9-, 18-, and 24- /30-month wellchild visit (in addition to autism screening at 18- and 24-month visits)
How is CA doing on Developmental Screenings? Screening rates for 2- & 3-year-olds vary by Medi-Cal health plan from 19% to 89%
What is [Child] Health Quality? Institute of Medicine (IOM) health care services that are effective, efficient, equitable, safe, timely, and patient-centered Agency for Health Care Research and Quality (AHRQ) doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results
What is Child Health Quality Measurement? Quality measures are tools that assess or quantify organizational structure and/or systems, health care processes, health outcomes and patient perceptions that are integral to providing high-quality health care Quality measurement & reporting is required in Medicaid managed care plan contracts CMS has identified about two dozen voluntary Medicaid/CHIP quality measures through the Child Core Set, that cover 5 domains: 1. preventive and primary care (including indicator of Developmental Screenings in the first 3 years of life); 2. perinatal care; 3. behavioral health; 4. management of acute and chronic conditions; and 5. dental and oral health.
California Lags Behind in Child Health Quality Measurement
Child Health Quality Measures Over 60 organizations signed on to these recommendations: As the Department of Health Care Services (DHCS) considers the Medi-Cal quality indicators for 2017, we encourage DHCS to adopt the following indicators from the set of nationally-recognized children s measures of health care quality in Medicaid: Developmental screenings for infants and toddlers; Check-ups for babies; Regular preventive care for adolescents; Patient satisfaction for children with special health care needs; Assessment of depression and suicide risk for children and adolescents; and Screenings for depression, intimate partner violence, and substance use among pregnant women.
Consumer/Family Engagement in Children s Health Policy California Children s Services (CCS) Whole Child Model For more info: http://www.dhcs.ca.gov/services/ccs/pages/advisorygroup.aspx Medi-Cal Children s Health Advisory Panel For more info: http://www.dhcs.ca.gov/services/pages/medi- Cal_Childrens_Health_Advisory_Panel.aspx
Thank You! Kelly Hardy, MPP MPH Senior Managing Director, Health khardy@childrennow.org www.childrennow.org