HEALTHY AND WELL KIDS IN IOWA (HAWK-I)

BOARD MEETING

MINUTES

October 16, 2000

 

BOARD MEMBERS: LEGISLATIVE BOARD MEMBERS:

Eldon Huston, Chair Senator Johnie Hammond (absent)

Terri Vaughan, Vice-Chair Senator Kenneth Veenstra

Stephen Gleason, D.O. (absent) Representative Brad Hansen (absent)

Mary Weaver (for Stephen Gleason) Representative Robert Osterhaus

Ted Stilwill (absent)

Brenda Oas (for Ted Stilwill)

Susie Poulton

Diane Briest

Barry Cleaveland

 

DEPARTMENT OF HUMAN SERVICES: ATTORNEY GENERAL'S OFFICE:

Anita Smith Marne Woods

Shellie Goldman

Anna Ruggle

Deb Van Den Berghe

 

GUESTS: AFFILIATION

Sonni Vierling Iowa Department of Public Health – Covering Kids

Alice Benge HAWK-I Outreach Worker

Lisa Kincaid John Deere Health

Lucia Dhooge Child Health Specialty Clinic

Leila Carlson National Association of Social Workers

Tawanna Morris Polk County HAWK-I, Center for Health Comm.

Paul Stanfield Iowa United Professionals

Barbara Fox-Goldizen MAXIMUS

Mike Coverdale Iowa Community Action Association

Stacey T. Cyphert University of Iowa Hospitals & Clinics

Carla Beneke Iowa Department of Public Health – Covering Kids

Deb Anderson Legislative Fiscal Bureau

Steve Conway Senate Democratic Staff

Jennifer Davis Iowa Medical Society

WELCOME & INTRODUCTIONS:

The Healthy and Well Kids in Iowa (HAWK-I) Board met on Monday, October 16, 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 12:35 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 SEPTEMBER 18, 2000, MEETING MINUTES

Barry Cleaveland made a motion to approve the September 18, 2000, minutes as written. Mary Weaver seconded the motion. Unanimous approval was made by Eldon Huston, Mary Weaver, Susie Poulton, Diane Briest, and Barry Cleaveland.

CORRESPONDENCE:

Mr. Huston said that at the last Board meeting it was suggested the Chair contact Senator Grassley’s office to express support for legislative action allowing states to keep FY 98 CHIP allotments. Mr. Huston said he spoke with Senator Grassley, who indicated they were working on the issue.

Terri Vaughan arrived at the meeting at this time.

Ms. Smith acknowledged there is the Chafee bill which would allow an additional one year to spend FY 98 funds and two years to spend FY 99 funds. Ms. Smith has been in contact with Jeffrey Hood of Iowa’s Washington D.C. office. As of October 13th, there had been no movement on any of the bills. Mr. Hood indicated there is a compromise bill that would allow states to keep 60 percent of the unspent funds and revert the other 40 percent. Mr. Hood thinks the compromise bill has the best chance for passage.

Ms. Smith then shared information on activities in two other states (Arizona and Georgia) from "The Medicaid Letter".

Brenda Oas, Board designee for Ted Stilwill arrived at the meeting at this time.

Ms. Smith provided the Board with an article that appeared in the October 16th "Des Moines Register" about a Traer, Iowa, woman who "gives up efforts to enroll her daughter in Iowa’s program of health insurance for children". Ms. Smith said there were some issues with this particular application, but due to confidentiality reasons could not provide many of the details. Ms. Smith said the child was insured and the mother wanted written confirmation that her child was not just eligible, but enrolled in HAWK-I, before dropping the insurance. This could not be done because it conflicts with federal legislation. Ms. Smith said that she did call this person personally and took care of the situation.

Representative Osterhaus asked if any of the telephone calls the parent stated were made to the third party administrator were returned by MAXIMUS. Representative Osterhaus also asked about other customer service for calls that come into the 800 number. Barbara Fox-Goldizen from MAXIMUS responded that yes, some of the telephone calls were returned and documented, and Ms. Fox-Goldizen spoke with the individual herself. Ms. Fox-Goldizen stated MAXIMUS is continuing to strive to provide good customer service and have put additional steps in place. Staff has been instructed that any complaints that have not been resolved in two or three calls need to be directed to Ms. Fox-Goldizen.

Mary Weaver asked about quality assurances in place to prevent complaints in the future. Ms. Smith said that DHS is putting quality assurance measures in place externally as well as what MAXIMUS is doing internally. Ms. Smith recently met with outreach coordinators and stressed to them that staff cannot resolve problems if they are unaware of them. The outreach coordinators were asked to call Ms. Smith, or any of the DHS HAWK-I staff, directly with any problems they encounter.

Ms. Smith said that in a situation where a person has existing, private policy coverage (not employer-related), the six-month wait does not apply. If they are determined eligible they are sent a notice which indicates they would be eligible except that they currently have coverage. The applicant is advised that if they provide verification that the existing coverage has ended, they are enrolled. If this verification is not provided within a certain amount of time, then a denial notice is sent. Ms. Smith said that unfortunately in the situation described by the "Des Moines Register", this did not happen and the application remained in a "pending" status. Even though several errors occurred, the bottom line is the child was not eligible for the HAWK-I program because the child had coverage.

Ms. Smith said the "Des Moines Register" article was faxed to the MAXIMUS corporate office in Virginia so they are aware of the situation.

Ms. Fox-Goldizen outlined for the Board the quality assurance steps MAXIMUS takes and pointed out that when issues come to light their systems people have responded very quickly. Ms. Fox-Goldizen said MAXIMUS will be hiring an additional eligibility counselor who will handle these types of calls.

Diane Briest commented that there was an editorial in the Storm Lake newspaper taking issue with reversion of funds; forfeiting the $6.1 million. The editorial basically said if the state is not doing their job, they should give the money back. Ms. Briest said she has a meeting scheduled with newspaper staff to discuss some of the things that were left out of the editorial.

The "Des Moines Register" also ran several articles about the reversion of the $6.1 million. Ms. Smith said that when the reporters initially called their question was one of "what is Iowa doing wrong that we have to send money back?" Ms. Smith said that after she explained the situation, the two articles were very accurate and appropriate. Ms. Smith said this was not the case in other states. Georgia, for example, had 3,000 phone calls from people who thought the program was going to end. Ms. Smith said Iowa is trying to get the word out that there is still money, over $90 million from fiscal years 99-01, so federal funding, or its availability, is not the issue.

 

ADMINISTRATOR'S REPORT:

Budget:

Ms. Smith told the Board that the carryover amount in the HAWK-I Trust Fund was $7.7 million, $6 million of which was used for this year’s appropriation.

Enrollment & Statistics:

Ms. Smith told the Board there was a 12 percent increase in enrollment for September; 749 children were added. Ms. Smith reminded the Board that the monthly reporting for Medicaid will end this month so it will be interesting to see the impact this has on the Medicaid numbers. The average Medicaid enrollment for the last 9 months has been 8,100.

Mr. Huston asked what kind of fluctuation, if any, has been seen in enrollment among the health plans. Ms. Smith said enrollment remains constant with about 60 percent in managed care and 40 percent enrolled in indemnity. Ms. Smith said there are still questions about some of the data on the reports and some issues that need to be resolved. Some of the issues are a carry over from the previous third party administrator and may not be cleared up until the beginning of the next calendar year.

Ms. Smith told the Board that MAXIMUS had requested a change in the call center hours and provided the Board with call center activity reports from June through September 2000. Ms. Smith said when MAXIMUS bid on the contract they indicated they wanted to monitor the call center activities for three months to see if the hours were what they should be. The activity reports show the number of inbound calls for June through September. From 6:00 a.m. to 7:00 a.m. there are very few calls, an average of 19 calls per month. The time period of 7:00 p.m. to 8:00 p.m. averages only 9 calls per month. MAXIMUS has requested changing the call center hours to 7:00 a.m. to 7:00 p.m. With the labor shortage it has been very difficult to find people to work certain hours, for example, the 6:00 a.m. to 2:00 a.m. shift. The peak times are from 2:00 to 4:00 p.m. so MAXIMUS feels by changing the call center hours, they can adjust staffing to have an additional person for the peak call times. Ms. Smith said that changing the call center hours would not have any financial impact, but would resolve two staffing issues: the difficulty finding staff and being able to increase staffing level during peak call time.

Discussion followed concerning the volume of calls received and the information given in the recording callers receive when calling the 800 number after business hours.

Ms. Fox-Goldizen stated that callers receive a recording and the system takes voice mail. These calls are returned the morning of the next business day. Ms. Fox-Goldizen said the majority come in during weekends and the largest number she is aware of was eight calls. Evenings generate one or two calls. Ms. Oas asked what the impact would be on the peak hours if MAXIMUS were to add additional personnel. Ms. Fox-Goldizen said most of the time there would be three staff members receiving calls, but during peak times four are needed. For staffing purposes she recommends an additional counselor as a back-up in case someone is ill.

The Board asked to see a more specific proposal which would include the number of hours there will be live phone coverage, suggestions for the voice mail messaging when there is not live coverage, and how those calls will be returned. The proposal should include the cost of service relative to each of the call center hours and include the October activity log.

Ms. Smith then shared the September, 2000 SCHIP Enrollment by County report. This report includes Medicaid expansion enrollment, HAWK-I enrollment, and cumulative totals. The enrollment goals have been adjusted. Ms. Smith said the goals are based on 100 percent enrollment and are prorated for the numbers of kids in poverty in each county. The Medicaid expansion enrollment goal has been changed to 22,000 (from 15,500) based upon the historical percentage. 40 percent of the applications received go into Medicaid and 60 percent into HAWK-I. The HAWK-I enrollment goal has been changed to reflect the change to 200 percent of poverty level. The enrollment goal for HAWK-I is increased to 45,000 (from 39,500). The total pool is now 67,000, which is what HCFA has estimated based on the 1990 census.

Ms. Smith said that the "How You Heard of Us" report shows a variety of places that people are hearing about the HAWK-I program. County fairs, attorneys, insurance agents, and the Internet, are just a few of the examples. The outreach workers are doing a good job of getting the information out.

Ms. Smith told the Board that after the media articles about the $6 million reverting she received several calls making inquiries about what can be done to help.

Office of Civil Rights Policy Guidance:

Ms. Smith said the Department recently received guidance from HCFA in regard to Title VI, nondiscrimination, as it relates to persons of limited English proficiency (LEP). Ms. Smith provided the Board with a brief synopsis and indicated this has been referred to the Attorney General’s office for an analysis of what DHS needs to do to comply. All programs that receive funding from the Department of Health and Human Services will be affected, including HAWK-I. Ms. Smith outlined the three points which the Office of Civil Rights will use to consider a program to be in compliance with Title VI. Depending upon the population of persons eligible to be served or directly affected by a program, certain written materials will need to be translated for each eligible LEP language group. The website may have to be updated to include other languages and possibly some of the notices will have to be translated. There have already been discussions about having applications in other languages available on the website to be downloaded as needed.

Customer Focus Group Project:

Ms. Smith told the Board about a project being conducted by MAXIMUS. Two individuals from the Center for Health Literacy and Communication Technologies will be conducting focus groups in Iowa on November 2nd. The focus group participants will be either actual HAWK-I enrollees or people who could potentially enroll in the program. There will be two sessions, one in English and one in Spanish. The goal will be to evaluate HAWK-I materials, brochures, notices, and forms to make sure they are written in a manner so that people can understand them.

Legislative Recommendation re: Case Management for CSHCN:

Ms. Smith stated she had received a letter from Dr. Jeffrey Lobas, chair of the Subcommittee for Children with Special Health Care Needs. Dr. Lobas is also a member of the Clinical Advisory Committee. At the September 18th meeting, the Board adopted the Clinical Advisory Committee’s recommendations for legislative changes to the benefit package. One of the changes was case management for children with special health care needs. Dr. Lobas said it was not the intention of the Subcommittee for Children with Special Health Care Needs to have that included as one of the recommendations until further work can be done by the Subcommittee. The health plans are doing their own case management and Dr. Lobas wants that to continue until an entire package for special health care needs is presented to the Board.

Terri Vaughan made a motion to remove the recommendation for case management for special health care needs from the Board’s legislative recommendations. Barry Cleaveland seconded the motion. Unanimous approval was made by Eldon Huston, Mary Weaver, Susie Poulton, Diane Briest, Barry Cleaveland, Terri Vaughan, and Brenda Oas.

OUTREACH UPDATE:

Outreach Coordinator Deb Van Den Berghe told the Board that with the influx of press concerning the potential $6.1 million reversion, staff has been busy making clarifications and ensuring the program is still safe. Ms. Van Den Berghe said the articles have definitely increased the number of telephone calls she receives and she is able to continue making people comfortable with the program. Twenty-one outreach coordinators were in Des Moines for an update meeting and were able to attend a presentation by Ms. Smith regarding the CHIP reversion.

Ms. Van Den Berghe said it was unfortunate that out of approximately 50 outreach coordinators across the state, only 21 coordinators were able to attend the update meeting. The coordinators work anywhere from five hours a month to full-time on outreach efforts so it is particularly difficult for those who only work a few hours a month to come to Des Moines for a day. Those who attended were given a tour of MAXIMUS and had the opportunity to meet the staff and see first hand what MAXIMUS does. The outreach coordinators were given the new reporting structure for their quarterly reporting activities. Ms. Van Den Berghe said the new reports will provide more measurable information and she will be able to provide related costs, staff time, what type of outreach was conducted, and what type of follow-up was done. Ms. Van Den Berghe said she has been meeting with representatives from Covering Kids and the same report structure will be used for the Covering Kids activities.

Ms. Van Den Berghe told the Board that one of the issues with outreach budgets is the cost of having booths and doing displays. A booth has been offered to HAWK-I free of charge at the upcoming family physicians conference in Polk County. Ms. Van Den Berghe said this is the first time this has happened and was a result of media coverage concerning the $6.1 million reversion. A booth at this conference would have cost $900.

Ms. Van Den Berghe said she had looked into the possibility of having a reference to HAWK-I on the Iowa 1040 Individual Tax forms. The inquiry was too late to be considered for this year, however, there will be a computer link so anyone inquiring about insurance issues on the tax form can be referred to the HAWK-I website and directly linked. Also, more than a dozen states offer the earned income tax credit but not all eligible families in those states receive the credits to which they are entitled. The Center on Budget and Policy Priorities has made it possible for state tax administrators to receive computer tapes that include names, addresses, and taxpayer identification numbers. This information came from Legal Aid Resources and they are going to link everyone that they get to the HAWK-I program. People who are eligible for the earned income tax credit would be in the same income levels of the HAWK-I program. Since Legal Aid in Iowa will be doing the referrals there will not be confidentiality issues.

Ms. Smith told the Board that she polled other states to find out what they budget for outreach efforts. Thus far Ohio has responded that their outreach budget is $6 million. Ms. Smith said Iowa is spending $500,000. At the time the budget was established that was all Iowa could spend because of the 10 percent cap. Ms. Smith said the $500,000 doesn’t go very far so the Board may want to considering increasing the outreach budget as enrollment increases and the 10 percent cap increases.

Senator Veenstra asked if outreach expansion is necessary to develop the expansion of HAWK-I itself or is it needed to fulfill the basic program needs. In other words, what is driving the need for expansion of outreach? Mrs. Van Den Berghe said it is the low numbers. Since purchasing insurance can be very confusing, outreach workers are very effective in providing information and building a level of confidence with these individuals as well as educating physicians and provider services.

COVERING KIDS COALITION UPDATE:

Sonni Vierling of the Covering Kids Coalition addressed the Board. Ms. Vierling told the Board that the Covering Kids Coalition and the Covering Kids Taskforce are two different entities under the same umbrella grant from the Robert Wood Johnson Foundation. The Iowa Medical Society is a subcontractor of the grant and they facilitate the task force meetings.

Ms. Vierling said the Coalition’s primary responsibilities are to provide guidance for the grant activities as well as networking with agencies interested in child health insurance issues. Ms. Vierling said the Coalition has complimented the efforts of simplification of the HAWK-I application, but recommends changing or deleting language in section 7 of the application. The Coalition has received feedback that some families fear that if they check the box their application will not be referred to HAWK-I. The Coalition also recommends including language in the application to inform parents that if they are paying 5 percent or more of their income for insurance they are eligible for the six-month waiver.

Ms. Vierling said the recent national Covering Kids conference provided a lot of information on what other states are doing. National research shows that six out of ten families who are eligible for CHIP programs don’t know they are eligible. Of those, approximately 82 percent would enroll. There is no hard data to see if this holds true in Iowa. Ms. Vierling said the same research firm also did a lot of research and focus groups on social marketing public education campaigning. Part of what they found is that in creating messages for the CHIP population there are two essential messages that need to be included in the education campaign. One is to emphasize low cost and the other is that the services covered need to be included in order for parents to buy into what a great program it is. Before the Covering Kids campaign launch the national clearinghouse (1-877-KIDSNOW) received an average of 15,000 calls per month. After the campaign, over 58,000 calls were received in September, 2000. Ms. Vierling said that the Covering Kids efforts would be a nice complement to the HAWK-I outreach efforts and would welcome working with DHS staff on doing something statewide.

Ms. Smith said that the recommended changes to the application will be considered, along with some other changes, when the application is reprinted in April, 2001.

JOHN DEERE CHIROPRACTIC CARE ISSUE UPDATE:

Anna Ruggle reported that Larry Carl of the Iowa Chiropractic Society has met with John Deere concerning chiropractic coverage. Meetings are continuing and the Board will be kept updated. Mr. Huston said he, too, had talked with John Deere and Larry Carl concerning this issue.

PUBLIC COMMENT:

Paul Stanfield, Iowa United Professionals, addressed the Board. Mr. Stanfield told the Board that he had heard discussions concerning the low enrollment numbers at every Board meeting he has attended, but what he has not heard discussed is an issue he raised in the past about the amount of the premium. Mr. Stanfield says he remains convinced that the amount Iowa charges per month is too high. Mr. Stanfield said at the time the Board was setting the premium DHS had recommended $10 per child with a maximum of $30 per family. A comparison by Mr. Stanfield showed this as one of the highest premiums in the nation. Mr. Stanfield said the Department explained that Iowa does not have co-pay so he then did a comparison using co-pay states, which did not lower Iowa very much. Ultimately the maximum premium per family per month was set at $20.

Mr. Stanfield said he saw an article in the Des Moines Register which said that 41 percent of the parents of uninsured children say they have postponed because they cannot afford it. Mr. Stanfield suggested that the Board review the amount charged for the monthly premium for HAWK-I participants.

Mr. Stanfield said his research showed that some states charge $5 per month and some states did not even charge a premium. The difference between a family paying $5 per month and $20 per month is $180 per year. Mr. Stanfield said he has anecdotal evidence from caseworkers that says this is a hurdle that some families cannot clear so the Board should take another look to see whether this is a factor that prevents families for applying for HAWK-I.

Mr. Huston said he would ask staff to take a look at the issue and report back to the Board.

HEALTHY IOWANS 2010 ACTION STEPS:

Mr. Huston said he received a copy of the Healthy Iowans 2010 report and it details three or four items the HAWK-I Board is asked to report on. One of the recommendations is to increase eligibility to 300 percent of the federal poverty level by 2010. Mr. Huston said the recommendation did not come from the HAWK-I Board or the legislature, so he assumes the recommendation is what the Healthy Iowans 2010 group would like to see based on their own analysis. Mr. Huston asked if anyone could shed any light on this.

Mary Weaver said that is correct. The report comes out of the Iowa Department of Public Health and a broad array of people were involved in the report; over 500 different organizations and people. The report is a strategic plan for improving the health of all of Iowa and this suggestion/recommendation would improve health by allowing more children to enroll. Ms. Weaver said these are recommendations, not mandates, so the Board would not have to approve these action steps.

Ms. Smith said she had not seen the report until Mr. Huston forwarded Stephen Gleason’s letter which asks that the Board to document their progress in achieving the goals and action steps. Ms. Smith said one of the action steps was to expand HAWK-I to 300 percent by 2010. However, Congress authorized Title XXI only through 2007 so if Iowa were to undertake this it would be funded with 100 percent state dollars. Ms. Smith said several of the other action steps are things which are being looked at now, such as studying the feasibility of expanding eligibility to include low-income families, and to include an enhanced service package for children with special health care needs.

Ms. Weaver said a "mid-course review" of the Healthy Iowan 2010 will occur in 2005 so items and concerns identified will be rewritten at that time. Ms. Weaver said a response explaining, for example, that Title XXI only goes through 2007 should be a sufficient.

Mr. Huston asked that a response be drafted for his signature. The letter should set forth where the Board is on the three items and what, if any, progress is being made toward the Healthy Iowan 2010 goals.

 

FAMILY COVERAGE OPTION FISCAL NOTE:

Ms. Smith reminded the Board that at their last meeting, the legislative members asked staff to prepare a fiscal note of what it would cost to cover parents under both HAWK-I and Medicaid.

The Department’s Bureau of Eligibility staff prepared a document that identifies the number of parents of kids participating in the Mothers and Children’s (MAC) program. There are a total of 18,165 parents. This was multiplied by the annual cost ($3,194.15) of a parent currently receiving "FMAP" (Family Medical Assistance Program), for a total of $58 million. The state matching rate of 37.19 percent would result in $21.5 million of that total being from state dollars. In addition to providing the benefits, there would be costs associated with medical contracts, for the fiscal agent (Consultec) to process claims ($290,568); manual and pamphlet changes ($250); and data processing costs ($1,875) bringing the total state cost to the Medicaid program to $21,870,975.

Anna Ruggle gave the Board a copy of the letter and report she received from the actuarial firm, Milliman & Robertson, Inc., and a summary sheet of their report. The assumptions used to arrive at a per member/per month (pm/pm) cost of adding parents to HAWK-I were: there would be a $25 emergency co-pay (waived if admitted); $1,000 annual dental maximum; $50 limit for vision care exams; $100 for lenses and frames; no other cost sharing; and no maternity (maternity would normally be covered under Medicaid up to 200%). Indemnity would be based on a loosely managed level of care and a managed care plan would be on a moderate level of management of health care. Total pm/pm for managed care would be $234.77 and indemnity would be $271.86. Estimates are that 17,293 children will be enrolled in HAWK-I for 2002; for a rough estimate of 34,000 parents. Estimates are that 60 percent would be enrolled in managed care ($15,011,607) and 40 percent in indemnity ($11,588,805). This would be a total cost of $26,600,412 in state dollars. The total cost to cover parents under Medicaid and HAWK-I would be somewhere in the $49 to $50 million dollar range.

Ms. Smith said the estimate of 34,000 parents is based on Wisconsin’s experience that twice as many parents as children were enrolled in the program. Ms. Smith said the monthly premium cost for state employees in single coverage plans is $209 to $224 plus dental ($16). The state employees’ plan would include deductibles, co-payments, and cost sharing in addition to the premiums, therefore, Milliman & Robertson’s estimation of $234 to $271 would be on target.

Ms. Weaver asked if other states are enrolling parents. Ms. Smith said that Wisconsin’s BadgerCare program is and New Jersey just implemented a program. New Jersey’s CHIP director said it has been very successful and they are overwhelmed by applications. Ms. Smith said she hopes to get more information, including premium cost, from New Jersey soon. MAXIMUS is administering New Jersey’s program.

Representative Osterhaus asked if it would be possible to enroll these parents into the state employees’ plan, and asked Ms. Vaughan if there was anything in the Iowa Code which would prevent doing that. Representative Osterhaus said by enrolling the parents in the state employees’ plan this would increase the size of the group and may possibly be more economical to the state.

Ms. Vaughan said that several years ago the Department of Personnel was looking at the pool purchasing concept and she recalls there were several issues involved such as collective bargaining and Medicaid rules.

Ms. Smith said there was a discussion a few years ago as far as leveraging better purchasing for the state by requiring insurers who participate with state employees to also participate in Medicaid and HAWK-I. Ms. Smith said that part of the reason states want to cover parents is to keep the family in the same health plan so they go to the same providers.

COST BENEFIT ANALYSIS OF PREMIUM SURCHARGE:

At the September Board meeting there was discussion concerning whether or not the Board wanted to pay the surcharge on HAWK-I premiums to ensure that any child leaving HAWK-I does not have the pre-existing exclusion if they go into the individual market. Senator Hammond had asked about the cost effectiveness and if rather than paying the surcharge could funds could go into a pool to be used for HAWK-I children who would be affected.

Ms. Vaughan described the options. Option 1 is status quo; the kids would be treated the same as those under Medicaid, which means they have to go into a high-risk pool and they pay a surcharge. Option 2 is they opt into the health insurance reforms, in which case the children when they turn 18 would be able to move into a standard benefit plan at standard rates, but the trade off is the State has to pay the surcharge on premiums. What has been suggested is instead of paying the 1 percent assessment, the 1 percent is put aside and when a child reaches 18 and is uninsurable in the standard market for one year, the HAWK-I program pays the extra surcharge in the comprehensive health pool. After one year they go can into the standard pool. Ms. Vaughan said there is nothing in state insurance law that would prohibit this, it is essentially subsidizing a population of former HAWK-I participants in the high-risk pool. It would be a question of any constraints, such as HCFA regulations. Ms. Vaughan said it might be more cost effective to simply pay the higher fee in the Comprehensive Health Association for one year because the 1 percent assessment is on all the premiums versus the small portion of those turning 19 who would go into the Comprehensive Health Association.

Ms. Smith said Title XXI money could not be used to fund the additional per member/per month surcharge, it would have to be 100 percent state dollars unless some other funding source was available. Ms. Vaughan said if the Board decided on the option of the surcharge being part of the premium, that would be partially funded with federal dollars. Ms. Smith said federal Title XXI legislation says higher income populations cannot be given an advantage over lower income populations, so it probably would not be allowable to assess a premium on the HAWK-I population without doing the same on the Medicaid population.

Representative Osterhaus said that this should be discussed with the Legislature because he believes the Board would like to see the HAWK-I population be able to move into an adult insurance program. Representative Osterhaus made a formal request for the Fiscal Bureau to study the issue.

REVIEW OF DRAFT REPORT TO THE LEGISLATURE:

Shellie Goldman presented a draft of the "Third Annual Report of the HAWK-I Board to the Governor, General Assembly, and Council on Human Services". Ms. Goldman discussed each section of the report with the Board. The first six pages of the report summarize all of the HAWK-I Board’s activities and milestones from January 1, 2000, to the present. The budget is shown on page 7, and includes a discussion about the projected $6.1 million reversion of federal CHIP funds. The report details the addition of John Deere Health Plan on April 1st, and describes the number of health plans currently available and the number of choices in each county.

Included in the report are the second baseline survey, the Department’s telephone survey, and an overview of the Broadlawn’s focus group results and comments. Also included in the report are HCFA’s site business reports and administrative rules that became effective during FY 2000 and those currently in the Notice of Intended Action process.

Board members were asked to review the draft report and have all comments and suggestions to Ms. Goldman by October 31st. Ms. Goldman will then finalize the report for the Board’s approval at the November Board meeting.

NEW BUSINESS:

Ms. Ruggle told the Board that the current contract with Wellmark includes language that case management, care coordination, dental, physical and occupational therapy, and nutritional services will be negotiated by December 31, 2000. These were the Clinical Advisory Committee recommendations. Wellmark is asking why it is necessary to negotiate in view of the Board’s legislative recommendations regarding these services.

Discussion followed concerning the various options. Marne Woods was asked to review the contract language and report back to the Board in November.

There was no other new business to present before the Board.

The Board’s next meeting is Monday, November 20, 2000, at 12:30 in the Oak Room at the Des Moines Botanical Center.

The meeting was adjourned at 3:30 p.m.