Apple Health Core Connections Managed Care for Foster Children MaryAnne Lindeblad, BSN, MPH Medicaid Director Washington State Health Care Authority NAMD Fall Conference - November 13, 2018

Background HCA contracted with a single statewide Managed Care Organization (MCO) based on: Unsuccessful past experience with enrolling to multiple MCOs – difficult for child welfare and foster parents to navigate multiple systems Child Welfare staff and Foster Parent desire for a single plan to work with Single MCO provides continuity of care across placements and provider changes Enrolling foster children into multiple managed care MCOs resulted in confusion for foster parents and social workers, as each MCO had different administrative procedures and differing provider networks. Having a single MCO enables the MCO to oversee continuity of care when children change placements, especially if the change requires the child to change providers – the MCO has the ability to track prescriptions, treatment plans and services provided and ensure new provider has this information

Contracting Apple Health Core Connections (AHCC) 2014 Legislative mandate directed the Health Care Authority (HCA) to issue a competitive procurement for a managed care program for foster children Coordinated Care of Washington (CCW) was the single Managed Care Organization awarded a statewide contract for this program Health Care Authority set up a work group to develop the overarching plan for a managed care program for foster children that included: All physical health benefits covered by Apple Health Managed Care Mild to moderate mental health benefit Robust care coordination activities, including 90 day continuity of care provision for new enrollees that requires the MCO to maintain enrollee’s treatment plan, prescriptions and providers until the enrollee has received an evaluation. Treatment plans, medications and provider relationships are maintained wherever possible. Team comprised of Health Care Authority, Dept of Children, Youth and Families, Children’s Behavioral Health and Developmental Disabilities staff.

Populations Served Voluntary Program for: Children in Foster Care (enrolled as wards of the state) Children in Adoption Support Foster Care “Alumni” - Young Adults aged 18-26 who have aged out of the foster care system, but remain eligible for services under the Affordable Care Act Because foster care program is relatively small and might not present a financially viable population for an MCO, HCA included children in adoption support and those young adults aged 18-26 who have aged out of foster care. Current population mix is approximately 11,000 foster children, 12,000 adoption support and 1,200 alumni.

Program Challenges Ensuring network adequacy – some providers decline to contract with CCW Child Welfare staff turnover presents training challenges CCW provides ongoing web-based and in-person training and updates. CCW has had challenges contracting with providers for this program because of previous administrative issues; however, they are working to overcome these hurdles and many providers will contract for foster children even if they don’t want to contract for all populations. (NOTE: when CCW first implemented their programs in 2012, they had a number of issues including long delays for authorizations, confusion as to what services required auth, and delays in paying for services) Turnovers in social workers and other child welfare staff presents a huge challenge – the need for ongoing training and information is something we have been working on for years. CCW does a good job of going around to foster parent events and to regional DCYF meetings but working with the social work staff is probably the biggest challenge to program success.

Program Opportunities Single statewide MCO provides continuity for children who change placements: Provider Portal - Electronic Health Record enables new PCP to review what previous PCP did Reduces duplication of services such as immunizations Ensures greater coordination and fewer delays in getting needed services in a new placement (especially if placement is in another service area) The single MCO provides continuity of care for children in out of home placement, and is a valuable resource for foster parents and social workers, who can call a single number for help in accessing services for the children in their care. The Provider Portal allows Dr. Jones to review the services Dr. Smith provided so they aren’t duplicated or missed. Especially for children with multiple needs, including Behavioral Health, having the single point of contact regardless of where they are placed is crucial – their care coordinator can track their care through multiple locations and ensure they are set up with new providers if necessary.

Program Opportunities Single statewide MCO provides continuity for children who change placements: Provider Portal - Electronic Health Record enables new PCP to review what previous PCP did Reduces duplication of services such as immunizations Ensures greater coordination and fewer delays in getting needed services in a new placement (especially if placement is in another service area) The single MCO provides continuity of care for children in out of home placement, and is a valuable resource for foster parents and social workers, who can call a single number for help in accessing services for the children in their care. The Provider Portal allows Dr. Jones to review the services Dr. Smith provided so they aren’t duplicated or missed. Especially for children with multiple needs, including Behavioral Health, having the single point of contact regardless of where they are placed is crucial – their care coordinator can track their care through multiple locations and ensure they are set up with new providers if necessary.

Questions? More Information: http://www.hca.wa.gov MaryAnne Lindeblad, BSN, MPH Medicaid Director MaryAnne.Lindeblad@hca.wa.gov Tel: 360-725-1863 Questions about any Washington State Medicaid Managed Care Program: mcprograms@hca.wa.gov