1. DMAS Updates
CHIPAC Full Committee Meeting September 14, 2017

2. DMAS Updates New Division Children’s Enrollment Managed Care Changes
Response to JLARC
Cover Virginia
Outreach and Consumer Communications

3. Eligibility and Enrollment
Services Division
A new Division has been created within DMAS to focus on the following areas:
Eligibility Policy
Enrollment Services
Cover Virginia
Performance Management
Introduce Cindy Olson as Director

4. Governor’s Healthy Virginia Goal
In September 2014, Governor McAuliffe launched his Healthy Virginia goal to enroll 35,000 additional children into the FAMIS and Medicaid programs
On September 1, 2017, DMAS not only reached the goal, but exceeded it by 3,365 for a total of 38,365 enrolled children
This is equal to 110% of the original goal
Took a little longer than expected

5. You’re Invited - Please note the revised time. Event is now at 9 am

6. Strategic Transition to Managed Care
Two managed care programs
CCC Plus
Medallion 4.0
Serving older adults and disabled
Includes Medicaid-Medicare eligible
216,000 individuals
Serving infants, children, pregnant women, parents
760,000 individuals
Long-term services and supports in the community and facility-based, acute care, pharmacy
Incorporating community mental health
Births, vaccinations, well visits, sick visits, acute care, pharmacy
Incorporating community mental health
Implementation started Aug 2017
Implement statewide by Jan 2018
New procurement 2017
Building on two decades of managed care experience
Implement statewide 2018
Approximately $30B over 5 years
Estimated $10B - $15B over 5 years

7. Managed Care Alignment
CCC Plus and Medallion 4.0 managed care programs are aligned in many ways
Regions
Services (where possible)
Integrated behavioral health models
Common core formulary
Care management
Provider and member engagement
Innovation in managed care practices including VBP
Quality, data and outcomes
Strong compliance and reporting
Streamlined processes and shared services

8. CCC Plus Regional Launch
CCC Plus has a phased in approach
August 2017 – January 2018
August
September
October
November
December
January
Tidewater
Effective
8/1/17
Central
Effective
9/1/17
Charlottesville
Effective
10/1/17
Roanoke Alleghany & Southwest
Effective 11/1/17
Northern & Winchester
Effective 12/1/17
CCC and remaining ABD
Effective 1/1/18

9. Charlottesville/ Western Region
Medallion 4.0 Timeline
Medallion 4.0 has a phased in approach
2017–2018
August
2018
September
2018
October
2018
November
2018
December
2018
Tidewater Region
Effective 8/1/18
Central Region
Effective 9/1/18
Northern / Winchester
Effective
10/1/18
Charlottesville/ Western Region
Effective
11/1/18
Roanoke / Alleghany /
Southwest Region
Effective
12/1/18

10. JLARC Project Functional Categories
Projects fit into one of more of the following categories:
Uniform Assessment Instrument (UAI)
Recommended efforts to improve UAI reliability for children; UAI training and screening; ensure timely screening; and strengthen oversight of UAI process
Rates
Adjust rates to: account for expected savings; allow negative historical trends to carry forward; rebase administrative rates for enrollment changes and deduct unallowable administrative expenses from rate setting
Financial Oversight
Strengthen oversight by requiring: detailed MCO financial and utilization reporting; control of related party spending; excessive related party spending is not included in capitation; and underwriting gain returns above three percent
Programs
Administer compliance review and sanctions, report on MCO performance and incentivize MCO performance improvement. Additionally, strengthen oversight of behavioral health and LTSS service delivery
Trend Impact
Monitor MCO spending and utilization trends and analyze what is driving those trends. To include: identifying inefficiencies and adjusting rates accordingly, and monitoring MCO utilization control methods and evaluating their impact
Policy
Submit for CMS review, a proposal requiring cost-sharing based on family income for LTSS eligible individuals eligible through the optional 300 percent of SSI
12 FTES and $3,046,792 appropriated to DMAS over the next two years

11. JLARC Project Implementation Work to Date
Issued and reviewed responses from MCO Trend Analysis RFI
Organized projects across different areas of DMAS
Began process of hiring contractors and staff, including a Chief Health Economist, to complete JLARC projects

12. Medicaid Expansion
Nearly 400,000 Virginians could get coverage if Virginia expanded Medicaid.
There are slightly fewer uninsured Virginians now than in years past because of the Governor’s efforts to promote the New Virginia Economy and people gaining coverage through the Affordable Care Act.
Expanding Medicaid would save Virginia at least $138 million GF over the next biennium.
The state’s cost of Medicaid Expansion for FY19-20 would be $351 million.
The state would also save $489 million over the same time period.
The state could seek assistance from the private sector to cover the state’s cost.
Virginia has foregone $10.5 billion in federal funds.
Looking back, the legislature’s refusal to expand Medicaid has cost Virginia $10.5 billion since 2014.
Going forward, Virginia will continue to forego more than $2 billion in federal funds each year.

13. Cover Virginia

14. Status of Backlog
Cleared?

15. Cover Virginia Call Volume

16. Telephonic Applications Submitted by Call Center

17. CPU Applications Received
By the State Fiscal Year Quarter starting with January 2015
Apr 17 – Jun 17 = 11,771 Apps Received.

18. Application Processing at Cover Virginia
Source
Application Period
Volume
Federally Facilitated Marketplace (FFM) Transferred Applications
1st Federal OPE & 2014 special enrollments
10/1/13 – 6/30/14
46,828
Additional 2014 backlog
7/01/14 – 11/14/14
4,573
2nd Federal OPE ( )
11/15/14 – 2/15/15
35,998
2015 (non OPE) special enrollments
2/16/15 – 10/31/15
15,035
3rd Federal OPE ( )
11/01/15 – 1/31/16
26,540
Ongoing FFM Applications (outside OPE)
2/1/16 – 10/31/16
50,062
4th Federal OPE ( ) in process
11/01/16 –1/31/17
27,229
2017 (non OPE) special enrollments
02/1/17 –7/31/17
12,298
Telephonic & CommonHelp Applications
Telephonic applications
4/13/15 – 7/31/17
113,901
CommonHelp applications (began 7/1/16)
7/01/16 – 7/31/17
17,786
Specialty Applications
GAP applications (total received)
1/12/15 – 7/31/17
27,451
State Employee FAMIS applications
4/20/15 – 11/19/15
732
Total apps received 8/18/14 – 7/31/17
378,433
Expedited Enrollments
Hospital Presumptive Eligibility
1/01/14 – 07/31/17
4,088
Electronic “Deemed” Newborns
53,977

19. Outreach and Consumer Communications

20. Back to School Campaign
1.5 million FAMIS flyers sent to every public school in the state for inclusion in first day packets
450,000 Free and Reduced Lunch inserts included with acceptance letters
Dedicated Back to School page on coverva.org
Attendance at events throughout the state
The BTS campaign is now complete. Web page will remain through November.

21. Cover Virginia Social Media
FAMIS and Cover Virginia Facebook pages at:
Please like us!
And follow us
Cover Virginia Twitter account

22. Questions?