HEALTHY AND WELL KIDS IN IOWA (HAWK-I)
November 20, 2000
|BOARD MEMBERS:||LEGISLATIVE BOARD MEMBERS:|
|Eldon Huston, Chair||Senator Johnie Hammond (absent)|
|Terri Vaughan, Vice-Chair (absent)||Senator Kenneth Veenstra (absent)|
|Susan Voss (for Terri Vaughan)||Representative Brad Hansen (absent)|
|Stephen Gleason, D.O. (absent)||Representative Bob Osterhaus (absent)|
|Edward Schor, MD (for Stephen Gleason)|
|Ted Stilwill (absent)|
|DEPARTMENT OF HUMAN SERVICES:||ATTORNEY GENERAL'S OFFICE:|
|Anita Smith||Marne Woods|
|Deb Van Den Berghe|
|Carla Beneke||Iowa Department of Public Health – Covering Kids|
|Alice Benge||SIEDA Outreach Worker|
|Sonni Vierling||Iowa Department of Public Health – Covering Kids|
|Sara Schneider||Iowa Department of Human Services, HAWK-I|
|Lisa Kincaid||John Deere Health|
|Mike Coverdale||Iowa Community Action Association|
|Denise Hill||Iowa Medical Society|
|Bill Brand||Iowa Department of Human Rights|
|Mary O’Brien||Visiting Nurse Services|
|Tawanna Morris||Polk County - Center for Healthy Communities|
|House Democratic Staff|
WELCOME & INTRODUCTIONS:
The Healthy and Well Kids in Iowa (HAWK-I) Board met on Monday, November 20, 2000, in the Oak Room, Des Moines Botanical Center, 909 E. River Drive, Des Moines, Iowa. Eldon Huston, Chair, called the meeting to order at 12:40 p.m.
Anita Smith took the roll call, a quorum was present. Audience members introduced themselves. Mr. Huston informed the guests that there would be an opportunity for public comment later in the agenda and if someone would like to address the Board, they should notify him.
APPROVAL OF THE OCTOBER 16, 2000, MEETING MINUTES
Susie Poulton made a motion to approve the October 16, 2000, minutes as written. Barry Cleaveland seconded the motion. Unanimous approval was made by Eldon Huston, Diane Briest, Susie Poulton, Susan Voss, Barry Cleaveland, and Edward Schor.
Ms. Smith discussed the various items of correspondence with the Board. The first item was a November 7, 2000, letter from Mr. Huston to Stephen Gleason, Director of the Iowa Department of Public Health. This letter outlines the Board’s response to the HAWK-I-related action steps that appear in the "Healthy Iowans 2010" report. Mr. Huston asked if all the Board members had received a copy of the report. Several Board members had not. Mr. Huston asked if Dr. Schor could see that additional reports could be provided to these Board members.
Ms. Smith shared an October 20, 2000, letter from Theodore J. Boesen, Jr., Executive Director of the Iowa/Nebraska Primary Care Association. Mr. Boesen’s letter was addressed to Elvira Jarka of HRSA’s Kansas City’s office. Ms. Smith said that when a state plan amendment is submitted to HCFA it is circulated among other departments for review and comment. Mr. Boesen’s letter is a result of that review. In his letter, Mr. Boesen wants the Iowa DHS to agree to contract with an independent research organization to identify barriers causing the number of children enrolled in HAWK-I to be substantially less than the estimated eligible children. He requested that this be a part of the state plan and this contract be a part of the state plan amendment. Ms. Smith said that Brenda Jackson from HCFA indicated that HCFA has been getting a lot of questions about Iowa and why Iowa’s CHIP enrollment is ranked 28th when the other 3 states in this region are all in the top 10. Ms. Smith said she believes the ranking cited comes from a Children’s Defense Fund report of CHIP enrollment as of June 30, 1999. HAWK-I did not go statewide until March 1, 1999, so even though Medicaid expansion was implemented July 1, 1998, Iowa’s full program had only been up and running three months at the time of the report. Ms. Smith told the Board that she has requested data to find out where Iowa is ranked in the region as well as nationally, but has not received the information as of today’s date. Ms. Smith said that this region is unique in that all four states took a different approach. Nebraska just expanded Medicaid, Missouri expanded Medicaid with a waiver and went to 300 percent of poverty and are covering families. Kansas did a combination approach like Iowa, but they did not do a Medicaid expansion so they still have the old stair step Medicaid levels and their "Health Waves" program.
A letter was sent to Iowa’s Congressional delegation by George Appleby, Chair of the Medical Assistance Advisory Council (MAAC). This letter is similar to the one the Board previously sent requesting support from Iowa’s Congressional delegation regarding reversion of the CHIP funds. MAAC is an advisory council to the Medicaid program and they wanted to also express their support for allowing states to keep these funds.
On November 3, 2000, Ms. Smith sent a letter to Jane Condon, Calhoun County Department of Health. Ms. Smith said that the Family Physicians and Communities Partnering for Kids Program applied for and received a grant from HRSA to help families in Calhoun County find medical homes for children. Their goal is to get 100 percent of the children in Calhoun County into some type of medical home, whether it is HAWK-I, Medicaid, or private insurance. This letter asks that HAWK-I outreach coordinator Deb Van Den Berghe be HAWK-I’s representative on this committee.
Ms. Smith reminded the Board that last month they were told that Physicians Clinic of Iowa (Cedar Rapids) was no longer going to participate with Wellmark under their universal contract. An October 11, 2000, letter from Frann Otte of Wellmark indicates a resolution has been reached and PCI will continue to participate in Wellmark. Negotiations are continuing with the Iowa Clinic, P.C. (Des Moines).
Also included with the correspondence is an October 17th letter from Anna Ruggle to Frann Otte. The Iowa Foundation for Medical Care (IFMC) conducted a site visit at Wellmark during the last week of September. Although IFMC’s final report has not been received, all indications are that the site visit went very well.
Ms. Smith told the Board that the functional health assessment survey contains a "comments page". Ms. Smith shared copies of the comments received with the Board. The comments, for the most part, were very positive.
A report from the Center on Budget and Policy Priorities discusses the importance of family-based insurance expansions. One of the points the article makes is that family-based Medicaid expansion that includes parents can increase Medicaid enrollments among children who are already Medicaid-eligible but not enrolled. The articles says that families are more likely to apply if the entire family can be covered as opposed to just the children. Ms. Smith said she believes this carries over to CHIP as well.
There were several articles relating to the drop in the uninsured rate, which is attributed to the robust economy and also the implementation of the CHIP programs. Although experts are starting to see a decrease in the uninsured rate, they are also warning that this trend is not likely to continue as the economy is not likely to remain as robust. More employers are offering health insurance because the labor market is so tight and the insurance is an incentive to retain employees.
The Iowa City Press Citizen did an article about a Sudanese family in Iowa City who applied for HAWK-I and wasn’t eligible. Ms. Smith said the article was pretty negative, but the fact of the matter is the family entered the United States after August 22, 1996, and simply is not eligible. This is an issue that HAWK-I does not have any control over. Ms. Smith said currently there is a ban on immigrants participating in federal means-tested programs for five years after date of entry and Congress is considering a bill that would reduce the time limit to two years.
Mr. Huston said the Press Citizen article states that out of the more than 1,600 uninsured children in Johnson County, 83 are enrolled. Mr. Huston noted that this could be due to low enrollment or the estimate in Johnson County is too high. Ms. Poulton said she has worked with the outreach coordinator there who indicated difficulty in getting the word out through schools. They have had more success this year, so that may help. Ms. Poulton said she does think the estimate is high because a lot of people in the Iowa City area are from other countries and have come here after 1996.
Ms. Smith told the Board it is still fairly early in the year to see any trends, however, the HAWK-I premiums and administration budget show the program is on target. Interest earned on the trust fund to date is $92,029.
Ms. Smith discussed a cost comparison for Medicaid expansion kids vs. non-expansion kids for FY 99. Ms. Smith said when the Medicaid budget was prepared this year, management saw a dramatic difference in the cost and researched the causes. The big difference is in the inpatient hospital charges. The comparison shows the average cost for the non-Medicaid expansion group is $8,692 and for the expansion group is $2,753. This could be because the waiver kids are falling into the regular Medicaid group. The physician charges are a little less for the Medicaid kids as opposed to the expansion kids. One could argue that maybe they are getting more preventive services and seeing physicians and maybe that’s why the hospital is less as well. Medical supplies were significantly higher for the expansion group, but again that could be due to waiver services. This comparison is based on actual claims data. Ms. Smith said she is not sure if any conclusions can be drawn from this data at this point in time.
Dr. Schor wanted to know how the expenditures per child match up with the premium cost per child. Dr. Schor said when the program started the Board didn’t have any idea what these kids were going to cost and, therefore, had to rely on actuarial analysis. Dr. Schor said he thinks the Board is getting close to actually having some data to be able to assess whether they are paying an appropriate premium or not given the experience with this particular population. Dr. Schor said if comparing these kids to previous Medicaid kids is the basis for actuarial analysis, then these kids are coming out cheaper and HAWK-I may be overpaying for the premium. Dr. Schor wondered if the inpatient hospital included mental health services.
Ms. Smith said she believed the Iowa Plan would be paying for mental health services. Ms. Smith said she too had questions about the totals and would have to ask for clarification of the totals.
Mr. Huston asked Ms. Smith to get the clarification and report back to the Board next month.
Enrollment & Statistics:
Ms. Smith told the Board there was a significant increase in CHIP enrollment again this month. Current enrollment is at 7,626 (up from 6,900 last month) for an increase of over 11 percent.
When reviewing the Medicaid Expansion Combination Chart Ms. Smith said she decided to take a look at counties where the enrollment goals were 1,000 children or greater. There were 11 counties and those counties represent about 63 percent of the total enrollment. Ms. Smith said that Story and Johnson Counties have significantly lower percentages of their enrollment goal than some of the other counties. This could be because they are more affluent counties, or there could be some other reason. Ms. Smith also noted that Linn County is only at 18 percent of their enrollment goal. Again, this could be because it is a more affluent county that may have fewer uninsured children. Ms. Smith said staff will continue to monitor, particularly since Linn County has increased their outreach activities.
For the month of October 2000, 1,185 applications were received. Ms. Smith said that enrollment in managed care has been increasing. Current enrollment in indemnity is at 36 percent and it had generally been right at 40 percent. The referral reports did not reveal any big changes. Many of the referrals remain from nurses and teachers, but friends and "word-of-mouth" are taking off as to how people have heard about the program.
The Applications Pending by County report shows that the majority of the applications in a pending status are those that have been referred to Medicaid and are awaiting additional information. There were 44 disenrolled in October for failure to pay their premium. Mr. Huston asked if 44 disenrollments was above average or if that was a constant number. Barbara Fox-Goldizen from MAXIMUS stated that number is fairly normal and noted that just because they are disenrolled it doesn’t mean they cannot be reinstated.
Call Center Hours:
At the last Board meeting the Department recommended changing the call center hours at MAXIMUS from 6:00 a.m. to 8:00 p.m. to 7:00 a.m. to 7:00 p.m. The reason for the change is because of the few number of calls received between 6:00 and 7:00 a.m. and between 7:00 and 8:00 p.m., as well as staffing issues and the difficulty MAXIMUS is having finding staff to work those hours. The Board had asked to see the October call history and MAXIMUS was asked to provide a financial impact statement.
Ms. Fox-Goldizen said their review showed during the last five months an average of 21 calls per month were received between 6:00 and 7:00 a.m. An average of 58 calls per month were received between 7:00 and 8:00 p.m. With one staff person early in the morning, that works out to $1.32 per call and about $.42 per call received between 7:00 and 8:00 p.m.
Mr. Huston asked how MAXIMUS proposes handling the calls that come in when the call center is not staffed. Ms. Fox-Goldizen responded that they are contractually obligated to have voice mail messaging. Additionally, the message the Board requested last month has been installed. MAXIMUS is required to return all calls before 10:00 a.m. and will return calls at particular times of the day as requested by callers. Ms. Fox-Goldizen said they do maintain a log and it is available for Ms. Smith’s review if she requests.
Ms. Smith said that MAXIMUS has had significant staff turnover and hopefully the change in hours will make is easier to not only retain staff, but will allow more staffing during peak hours. The change in call center hours will require a contract amendment with MAXIMUS.
Susan Voss made a motion to change the call center hours to 7:00 a.m. to 7:00 p.m. Barry Cleaveland seconded the motion. Unanimous approval was made by Eldon Huston, Diane Briest, Susie Poulton, Susan Voss, Barry Cleaveland, and Edward Schor.
Evaluation of Systems and Processes:
Ms. Smith told the Board that after the news article appeared in the October 16th Des Moines Register about the difficulty the woman experienced getting into the HAWK-I program, she wrote a letter to MAXIMUS asking them to do a complete analysis of all the processes to find out where the system is breaking down. Ms. Smith received a response to her letter on October 23rd from Jan Ruff, Project Manager. MAXIMUS sent a team to Iowa to analyze every step of the process and make recommendations. They looked at systems, customer service, mailroom filing issues, routine processing issues, and encounter data. Within the system issues they looked at problems with ESI data as well as problems with the systems design and problems with letter processing.
For example, for a while the computer indicated people were getting notices and they weren’t. The team found there were not enough edits in the system design to prevent counselor error. These are in the process of being fixed or have already been fixed. Ms. Smith said MAXIMUS has been asked to have checks and balances in place so that if an application is transferred to Medicaid there is something in place to make sure that it gets there and someone follows up. The team looked at customer service and quantity of staffing, and again there was the issue of almost a complete staff turnover in a very short period of time. They looked at the quality of counselor performance and have implemented telephone monitoring, telephone etiquette training, and telephone scripts. Temporary employees were hired to get everything filed and backlogs taken care of in the mailroom. Quality monitoring is being performed on all projects and performance standards are being put in place. In addition to all of those recommendations, Ms. Smith met with the team who came in and they made additional recommendations on changing some processes. One, for example, is instead of mailing a notice to a family every month saying you owe a premium, they will receive all their monthly payment slips up front. Then, if necessary, a reminder will be mailed if the premium isn’t sent in. This will save on postage costs and systems issues. There have also been recommendations about wording on notices and timing.
Ms. Fox-Goldizen told the Board that MAXIMUS has established daily monitoring reports that she reviews daily. These cover the call center as well as the call room and system issues. These reports are also forwarded to Jan Ruff for her review. Scripts have been provided to the counselors to use as well has a "help sheet" about the program. Quality monitoring is taking place on a daily basis so if management is queuing a phone call and discovers a difficult situation, they can provide information immediately to the counselor. Ms. Fox-Goldizen said the mailroom is all caught up with the filing so that is running smoother. Processes are in place so that notices of decisions and files can go to Medicaid when a referral takes place.
Ms. Smith said she has received very positive feedback to these processes. Ms. Smith said that the problems stemmed from the fact that the transition was a lot more difficult and so much time was spent on transitioning that a lot of the procedures and the checks and balances that should have been put in place had not been. The systems staff at MAXIMUS corporate headquarters went through the entire system to see if there were problems in the system and to ensure things were happening the way they were suppose to.
Mr. Cleaveland asked if this would become an annual review. Ms. Fox-Goldizen said that it would probably be more often than annual, perhaps quarterly. In the meantime all the processes are being monitored and will continue to be. Time studies will be done to see if there is a need for additional counselors. Mr. Huston asked if outreach staff have made comments about the process. Outreach coordinator Deb Van Den Berghe said that these changes have all been fairly recent, but from conversations she has had with outreach workers, many of the concerns have been alleviated.
SWAT Team Update:
Ms. Smith is participating on a "SWAT Team" sponsored by the National Academy of State Health Policy (NASHP), along with CHIP directors from 6 other states. The team will look at retention and enrollment and the barriers to enrollment. Ms. Smith said the team held their initial meeting in Washington D.C. in November to design how they believe this should be approached. NASHP is going to contract with Lake, Snell, Perry and Associates to develop a work plan for review by the SWAT team. That review is scheduled for November 21 and will lay out a strategy to conduct statistically valid surveys in each of the 7 states to try to identify barriers to enrollment. Initially NASHP indicated they could fund the entire project, but given the scope they might not be able to. The 7 states agree that they should create a comparable baseline, so they will be looking at CHIP enrollment between September of 1999 and September of 2000. Ms. Smith said that this is one of two projects being done on a national level that she is aware of.
Dr. Schor asked if there had been any discussion extending the study to look at those people we don’t enroll due to Medicaid referral or those who choose not to go into the program? Ms. Smith said that she thinks the study will include all of those people. The team is going to look at stigma of Medicaid as well as some other issues. One of the reasons they want Iowa included in the study is because Iowa is the only Midwestern state, and one of the components is the difference between urban and rural. For example, in a rural area the stigma may not be with the program but it might be that when families go to the local office they would have to talk to their neighbor. In a more urban area families can apply more anonymously so the stigma may not be as great.
COVERING KIDS UPDATE:
Denise Hill of the Covering Kids Now Task Force spoke to the Board. Ms. Hill said that the task force has been charged with specifically looking at barriers to Medicaid, CHIP enrollment, and other coverage for kids in the State of Iowa and many of the things the Board has discussed. Ms. Hill said the task force is available to the Board if they would like them to serve as a "think tank" for issues the Board identifies.
The task force last met on October 18th in conjunction with the Covering Kids Coalition to further identify how they can work together and to aid the Board and the Departments. The task force talked about the need to ensure that DHS is aware of operational issues that are identified so they can be resolved. The task force also discussed issues relating to the lack of medical homes in Iowa and feels this is a key part in making sure children have coverage. Ms. Hill said that the task force heard about a child who had abnormal test results and when the child arrived in the office for follow-up couldn’t be seen and was referred on because the child was no longer Title XIX-eligible. The task force feels that these situations are probably happening a lot as kids go in and out of programs so that will be one of the issues the task force will focus on.
The task force also revisited continuous eligibility. Ms. Hill said that in the past the task force made legislative recommendations to provide continuous eligibility for the Medicaid program. Upon further discussion the task force determined they want to monitor the data on the elimination of monthly reporting and see if it impacts the need for continuous eligibility. Several members of the task force think there still may be a need due to continuity of care issues.
At their next meeting the task force will discuss expansion to cover parents and will revisit presumptive eligibility. The task force feels that there needs to be communication to the public concerning the reversion of CHIP funds to let the public know that this is not an indication of the program not working, but rather a timing of funds. Ms. Hill said that the task force thinks the program message needs to emphasize that HAWK-I coverage begins the first day of the month after the month other insurance is dropped. The program also needs to emphasize that if families are spending more than 5 percent of their income on insurance premiums that they may be eligible, even though they may already have insurance. The task force believes that is a key message that doesn’t seem to be reaching some of the potential enrollees. Ms. Hill said this goes to an issue the Board asked the task force to look at, which was the national statistic that 6 out of 10 parents with eligible children do not know that they are eligible. The task force thinks this is a key piece as to why that may be happening. Ms. Hill said that identifying uninsured kids remains the key barrier to enrolling children and it has been consistently discussed that schools can play a key role. One of the Covering Kids task force members is looking into a concept of actually mandating insurance for all children in the State of Iowa. This is in development stages and the task force has not taken a position on it. However, there was discussion about having schools identify kids by adding questions to a form that is mandated by state government. At this point the Iowa Department of Education is not willing to add those types of questions because the only questions the currently ask are mandated questions.
The task force also looked at physician-targeted packets. They found in the State of Florida the likelihood of families staying enrolled in the program was greater if the suggestion was made by a physician.
Mr. Huston asked how the task force’s recommendations are implemented. Ms. Hill said that last year and again this year they will put forth some legislative recommendations, but because the task force is under a Robert Wood Johnson grant there are restrictions on lobbying. Therefore, they bring the recommendations to the Board or to the Departments for support. The meeting highlights, which include their recommendations, are sent to the Governor, the Directors of Human Services and Public Health, and the HAWK-I Board.
Ms. Poulton suggested clarifying with the Department of Education their stand on adding the question about insurance on the mandated form. Ms. Poulton said that she finds that the schools have no problem asking the question about insurance coverage, but it’s what to do with that information and the resources to follow up on the answer to the question.
Ms. Hill said there had been discussion about having an intra-governmental conversation where the Governor would convene Department heads or other key decision makers and remind them about what HAWK-I is and to discuss ways that they can promote the program by utilizing existing systems of communication to provide outreach to people.
Bill Brand spoke to the Board to provide an update on the four outreach pilot projects. Mr. Brand said it is key that these projects are coordinated with other outreach efforts in place. Mr. Brand and Deb Van Den Berghe met with representatives of each of the four agencies to discuss reporting requirements and to have the opportunity for the groups to share information and experiences. These pilot areas will be reporting information to the Departments of Human Rights and Human Services that is consistent with the information that is currently being collected from the outreach coordinators in the rest of the counties. This will enable staff to be able to look at information on a consistent basis: numbers of applications being accepted, the kinds of collaborations going on within the community, the kinds of barriers being identified, and best practices.
Mr. Brand said there is a special project in Marshalltown to target non-English speaking populations and that agency has hired a bilingual coordinator to head up the project. Contacts have already been made with the different agencies and organizations that specifically deal with Hispanic populations to help introduce HAWK-I. Mr. Brand reiterated the importance of all agencies working together so there is not a duplication of services and making the most of the outreach sources. Mr. Brand said there are challenges in terms of communication and coordination between the agencies, but he is committed to addressing those.
Deb Van Den Berghe told the Board that she has received the first quarter reports from 46 of the 99 counties and has identified some of the key issues and barriers the counties have identified. Customer Service was an issue and Ms. Van Den Berghe feels that this has been addressed. Ms. Van Den Berghe has been working with Sara Schneider, the on-site Income Maintenance Supervisor located at MAXIMUS, to identify specific cases and issues that are critical to the ease in enrolling in HAWK-I. With the assistance of outreach workers, specific cases were monitored and tracked as they went through the system. Ms. Van Den Berghe said these cases were very successful.
Another issue identified from the first quarter reports is there has been significant outreach coordinator turnover. Linn County had some turnover and there has been a lot of success in Black Hawk County, unfortunately they are now losing their coordinator. Ms. Van Den Berghe said on the upside, she is able to step in and make referrals to someone able to help during the transition period.
The coordinators for Johnson and Story Counties have identified some very specific issues they are concerned about, mostly surrounding the universities. They will be working together to address these issues.
Ms. Van Den Berghe said she recently attended two different conferences, each of which specifically addressed the Latino population.
Ms. Van Den Berghe told the Board that one of the things she will focus on in the upcoming months are ways to address the undocumented alien population that are not eligible for the HAWK-I program. The outreach workers need to let these families know they are not eligible for the program and refer them to places that can help them. Another area Ms. Van Den Berghe will be addressing is when families attempt to purchase insurance from a private insurance agent and are turned down. Families who have been turned down for legitimate reasons can get help elsewhere and HAWK-I staff can assist these families by making appropriate referrals.
Dr. Schor said that even though the enrollments in HAWK-I have been slow, it does appear that people are increasingly aware of the program. Dr. Schor suggested some kind of intra-governmental process could be structured so that there could be a single point of contact to assist families and ensure they are directed to the right place. Ms. Van Den Berghe said that this is an area that Covering Kids has been addressing. This suggestion would tie in with what Ms. Hill just referred to in her update, asking the Governor to form an intra-agency group. Not only would this streamline the process for families applying, but would help the outreach efforts directed towards the 150 to 200 percent of poverty population.
REPORT TO THE LEGISLATURE:
Shellie Goldman presented the final draft of the 3rd Annual Report to the Legislature. This draft incorporated the changes the Board suggested at their last meeting, and is updated to include the actions from the October Board meeting.
The Board gave their approval of the draft report, asking that it be updated to include Board activities for November and December, 2000. The report will be distributed to the Iowa Legislature in January, 2001. The Board said it was not necessary for them to review the report again before its release.
Tawanna Morris, Polk County HAWK-I outreach advocate, requested to address the Board.
Ms. Morris told the Board that she works at the Center for Healthy Communities. Ms. Morris said that she and other outreach workers feel they take the blame for things associated with HAWK-I, as well as other issues associated with the Department of Human Services or the State of Iowa.
Ms. Morris described a recent outreach effort at McKinley school in Des Moines. Ms. Morris said that when they made referrals elsewhere the people would just look at them with an expectation of, "please tell me that you’re going to give me insurance before I leave here". Ms. Morris told the Board it would be very useful to have an intra-agency program as described earlier. That way, rather than simply referring families on, someone would be able to explain the entire process and offer some kind of alternative.
Ms. Morris expressed some frustration with the HAWK-I reports she has been receiving.
Ms. Smith said that MAXIMUS is in the process of putting together an index of all the reports that are available on the website, a description of the report, where the data comes from, and a description of all the fields. The "other" categories are currently being used due to conversion of the ESI data so many of these categories will go away at the end of the calendar year.
APPROVAL OF MAXIMUS CONTRACT AMENDMENT:
Anna Ruggle submitted the MAXIMUS contract amendment to the Board. This amendment is for the provider network evaluation the Board approved at their October meeting. From the provider files MAXIMUS receives from the health plans they will map out where the providers are located in the State of Iowa and provide the report to the Department.
Dr. Schor asked if it was possible to plot by providers who actually submitted a bill during the period as opposed to just a "pure provider count". Dr. Schor said that part "d" states 10 random phone calls will be made, but feels it would be more interesting to make phone calls to those in the provider panel who have not had any patients in HAWK-I billed to see if those providers are not taking patients. Dr. Schor said that MAXIMUS ought to be able to run an analysis that maps out not just who was in the panel, but who was in the panel and active in HAWK-I based on the billing results. Dr. Schor said if the Department wants to find out if contractual obligations are being met and ensure there is access then it is necessary to know who is actually seeing kids, not just where they live.
Ms. Goldman said the provider panel listing indicates whether or not physicians have an open or closed panel, but it would be difficult to do what Dr. Schor suggested and base it on claims extracted. If they have a closed panel and indicate they are seeing one child it doesn’t indicate they are open to the whole population. To be able to do that would take a tremendous amount of systems changes. Ms. Goldman said this evaluation will give staff a general feel of those providers who are open within 30 miles/30 minutes but if more detail were requested maybe the Quality Committee should make recommendations. Ms. Goldman said based on the way the program is set up, she felt it would be complicated statistically to put something together as Dr. Schor has suggested.
Dr. Schor said he was concerned that the information would not be very useful. These providers may indicate they are open when, in fact, they are not. Dr. Schor suggested randomly calling from the list of providers who indicate they are open to verify that they indeed are.
Mr. Huston suggested that Dr. Schor and staff work together to explore Dr. Schor’s question. Ms. Smith said her suggestion would be to see what kinds of reports and data the Department receives before considering further contract amendments.
Barry Cleaveland made a motion to approve the MAXIMUS contract amendment. Susan Voss seconded the motion. Unanimous approval was made by Eldon Huston, Diane Briest, Susie Poulton, Susan Voss, Barry Cleaveland, and Edward Schor.
MASS MEDIA PROPOSAL:
Ms. Smith told the Board that a representative from Greer, Margolis, Mitchell, and Burns had planned on attending today’s meeting, however, bad weather had caused delays in his flight and he would not be able to attend. However, Jeanette O’Connor, of the same firm will make the presentation via telephone conference and the Board will be able to view the Powerpoint presentation simultaneously. Greer, Margolis, Mitchell, and Burns is the company that developed the commercials for Covering Kids.
Ms. Smith told the Board that she is suggesting a mass media campaign for HAWK-I for several reasons. CHIP directors of other states have indicated to Ms. Smith they are putting significantly higher amounts of money towards their outreach efforts than Iowa is, specifically towards mass media. For example, Utah’s media budget is $2 million, and doesn’t include printed materials or other outreach efforts. Ms. Smith said that given all the bad press recently regarding the reversion of CHIP funds and the fact that enrollment still isn’t where we want it to be, she felt the Board should revisit the mass media issue.
Ms. Smith said research shows the families that aren’t being reached are between 150 and 200 percent of poverty. Local grassroots outreach efforts are in place working through WIC, Title V, schools, and other public organizations, however, many of the people HAWK-I is trying to reach are families who may not be accessing these services. This goes back to the statistic that 6 out of 10 parents don’t realize that they are eligible. Ms. Smith said that recent studies show the four key components to include in commercials are:
Ms. Smith said HAWK-I’s previous commercial did not contain any of those components. However, Covering Kids has pre-produced commercials available that can be adapted for HAWK-I.
Ms. O’Connor told the Board that her company was hired as the communications consultant to the nationwide Covering Kids efforts. Their focus was to build on what has been going on at a local level and to increase awareness through communications efforts. Ms. O’Connor described for the Board the communications approach that was used, which was comprised of research, advertising, a coordinated communications wave, earned media, overall results, and looking forward.
The research phase included 114 one-on-one interviews, which were an hour and a half to two hours long, and discussed motivations and strategies that would encourage families to make the call. Surveys were conducted of 2,888 income-eligible people who had someone 18 or under in the household, and target markets were chosen which included two African-American markets, two Latino markets, and 2 general audience markets. The survey found that communications must tap into parents wanting to do good for their child and piece of mind was the key motivator. It is important to communicate specific benefits, for example, that the plan covers prescription drugs and immunizations; that families can apply over phone; and they would have an insurance card similar to an employer’s plan. Another thing that was important was that the program is sponsored by the government and wasn’t just a gimmick out there by an insurance company that was too good to be true.
Ms. O’Connor said that 9 test spots were created for breakout discussion sessions and focus groups were conducted in Fresno, California and Baltimore, Maryland. This testing revealed the ads needed to draw attention to eligibility; give a specific dollar amount; emphasize working families/working class; include more shots of teenagers; show phone number as often as possible; and use "low cost" or "free".
The Board then had the opportunity to view the advertisements that ran in Illinois and New Mexico, as well as the Spanish version.
In conjunction with the commercial Ms. O’Connor said they developed Hispanic/Latino outreach kits, back-to-school action kits containing media materials and programmatic information, and back-to-school posters, fliers, banners and bookmarks. During the advertising blitz the number of calls received by the national 1-877-KIDS-NOW hotline dramatically increased. The pre-campaign average was 15,000 calls per month, during August (the kick-off month) 58,000 calls were received, and in September 33,000.
Ms. O’Connor said future efforts will include a spring communication wave, probably in March; outreach to national organizations; reaching out to corporate offices to get assistance in filtering down to the local level; and a Back-to-School 2001 outreach program.
Ms. O’Connor told the Board if they wanted to use the pre-produced advertising and use it for non-paid public service announcements, they have talent "buyouts" through July 2001 so the ads can be used for public service announcements anywhere across the country. For paid advertising the cost is for a 13-week window. The talent buyout would be anywhere from $600 to $800 depending on which ad is chosen and how often the advertising was run. For changing the advertising such as a phone number, name of the program, income level, logo, and so forth, that would run approximately $2,000 to $5,000 per ad. Ms. O’Connor said she would need to check on that to be sure, but it would also include the dubs that are sent out to the stations. Ms. O’Connor said there is a substantial savings by using these ads which are already produced and all of the research has already been done.
Ms. Smith then discussed the CHIP budget with the Board. Ms. Smith said she asked the Department’s finance staff to put together a budget showing how close HAWK-I is to the 10 percent cap based on current enrollment projections. The current projection is $676,244 under the 10 percent cap. If the 10 percent is exceeded, those costs can be deferred and claimed the next federal fiscal year.
Barry Cleaveland made a motion for the Board to go into closed session pursuant to Iowa Code Section 21.5(1)(a) to discuss the media buy. Susan Voss seconded the motion. Ms. Smith called roll on the vote: Eldon Huston – yes; Susan Voss – yes; Ed Schor – yes; Diane Briest - yes; Barry Cleaveland – yes; Susie Poulton – yes. Mr. Huston announced that the HAWK-I Board was now in closed session and requested that those persons who are not on the Board or staff members leave the meeting.
MEETING CALLED TO ORDER AFTER CLOSED SESSION:
Mr. Huston called the meeting to order after coming out of closed session. Roll call was taken. Eldon Huston – present; Susan Voss – present; Ed Schor – present; Diane Briest – present; Barry Cleaveland – present; Susie Poulton – present.
Susie Poulton made a motion that the HAWK-I Board issue a Request for Proposal (RFP) for a media buyer for a mass media promotion. Barry Cleaveland seconded the motion. Unanimous approval was made by Eldon Huston, Diane Briest, Susie Poulton, Susan Voss, Barry Cleaveland, and Edward Schor.
MEDICAID SIMPLIFICATION INITIATIVE @ HAWK-I:
Ms. Smith said meetings with the income maintenance staff have been held to discuss why so many applications that are referred to Medicaid are denied. Approximately 40 percent of all HAWK-I applications go to Medicaid and the denial rate for those applications is very high. Ms. Smith said staff is looking for ways of changing processes that will provide a remedy. For example, under Medicaid rules child support information is requested. If this request is done during the application process and the family fails to cooperate and provide the information, the application is denied. However, if the application is approved and then the child support information is requested, the child cannot be sanctioned for the parent’s failure to cooperate. Ms. Smith said that by changing the timing of the procedure, the Department should be able to get the kids on and not have them lose eligibility if the parents fail to cooperate. This will be a pilot in the MAXIMUS office to see how it works before taking statewide. This process change would require administrative rule amendments. Ms. Smith indicated that staff has also been working with Ms. Fox-Goldizen and her staff on re-wording notices to make them more customer friendly.
Ms. Smith told the Board that the November Medicaid numbers will be out shortly and will reveal the impact of not having monthly reporting. October was the first month that monthly reported was ceased.
The third Monday in January is a state holiday so the Board will meet on the fourth Monday, January 22nd.
There was no other new business to present before the Board.
The Board’s next meeting is Monday, December 18, 2000, at 12:30 in the Oak Room at the Des Moines Botanical Center.
The meeting was adjourned at 4:20 p.m.