Developing and Sustaining a Part C Finance System: Connecticut

Ongoing Monitoring of: Demographics Expenditures State Economics Political Context

Demographic Information Trends in Children Served Fiscal Year 2003

Demographic Information Eligibility Moderate eligibility criteria (-2SD in one area, -1.5 SD in two areas) Children with other diagnosed conditions plus mild delays are also eligible Children with -2SD in speech only plus a biological factor are eligible List of diagnosed conditions with high probability of resulting in a developmental delay

Alaska2.21 Montana1.84 Oklahoma1.83 North Dakota1.59 D.C Missouri1.28 Arizona1.27 Nevada1.03 Massachusetts 5.29 Hawaii3.64 Indiana3.42 Delaware2.93 Wyoming2.86 New Hampshire2.63 Florida2.57 Wisconsin2.56 Arkansas2.56 Rhode Island2.51 Kansas2.41 Pennsylvania2.38 Vermont2.38 Maryland2.34 Maine2.28 South Dakota2.15 West Virginia2.26 Colorado2.26 Virginia2.07 Michigan1.78 Ohio1.70 Mississippi1.65 Minnesota1.56 North Carolina1.51 Iowa1.46 New Mexico1.41 Washington1.32 Louisiana1.21 Alabama1.18 New York4.15 Connecticut2.97 Kentucky2.39 Idaho2.15 Tennessee2.09 Illinois1.93 Utah1.93 New Jersey1.92 Texas1.86 Puerto Rico1.71 California1.67 Oregon1.42 Nebraska1.36 South Carolina1.31 Georgia0.98 IDEA Part C Percentage of children under the age of 3 receiving services as of 12/1/2001 (excludes at-risk) = 2% level Broad Eligibility Moderate Eligibility Narrow Eligibility Data Source: Westat

Funding Sources Direct Services State Funds80.8% Federal IDEA (B&C) 8.7% Commercial Insurance 10.5% Family Feesnegligible Medicaid-federal portion only (8.7%) to gen. fund

Data Source: Monthly Invoices Expenditures Funding deficits in each of previous three years covered by transfers from other department accounts

State Economics Budget Surpluses & Deficits Fiscal Years Data Source: Legislative Office of Fiscal Analysis

Political & Economic Context Democratic majorities in House & Senate but not veto-proof. No obvious champions. Republican Governor - proposes to end entitlement The state’s worst budget crisis since 1991 = chaos  layoffs - January  early retirements - June  lead agency reorganizes to 3 regions - June  no budget agreement until August Strong provider trade association. Birth to Three providers function as part of a much larger group

Redesign the Finance System Decrease expenditures for direct services by modifying some payment rules for programs Increase revenue for direct services Decrease number of eligible children (or at least prevent further increases) 1. Family cost participation 2. Shift in Part C allocation 3. Increase in insurance revenue

Change demographics through small, measurable eligibility changes Review diagnosed conditions list Revise modifications that expanded eligibility Provide safety net of enhanced developmental monitoring

Expand Funding Sources State Funds 80.8% Federal IDEA (B&C) 8.7% Commercial Insurance 10.5% Family Fees Negligible Medicaid-Federal only or other federal funds such as TANF To State General Fund only  Expand coverage to include all services Reallocate admin costs saved by reorganization Charge families on sliding scale

Change payment policies within Connecticut political and economic context Make small changes that do not affect larger overall provider community 1.Change policy on continuing to pay programs for up to 8 consecutive weeks of “no service” to no payment for any month of no service (cancellations by family less than 24-hours in advance excluded) 2.Change payment of additional fee-for-service rates for children needing intensive services. Pay for those hours over 15 instead of 13.

Infrastructure Changes Statutes - family fees, insurance coverage Regulations - family fees, credentialing Provider Contracts - modifications to payments Procedures - eligibility, family fees, provider payments, insurance Data System - eligibility, provider payments, family fees Billing contractor - for family fees

Guidance and ongoing support New materials for primary referral sources & families Two forums for program directors with follow- up New procedures - hard copies, cds, website Letter to families, phone calls from families Questions and answers - hard copies, posted on data network

Ongoing Monitoring

Percent of all eligibility determinations Families Declining Initial Evaluation

Percentage of children exiting due to withdrawal by their parents Percent of all withdrawals Letter announcing fees sent to all families