Last month’s unauthorized release of a list of hundreds of supposed undocumented immigrants by two DWS employees has raised a whole host of concerns about the confidentiality of information entrusted to the state by families seeking public assistance.  Recognizing that the impact of the “List Incident” runs deep, involving issues like privacy, immigration, racism within state government, we discussed: 

1. How could this happen?  What impact has the department seen thus far?
2. How does the department protect confidential data?  What type of training are employees given about privacy?  What type of cultural competency training is provided?
3. How are the departments reaching out to mixed status and minority households to help rebuild trust?  What things should the departments/state be doing?

 Minutes from the meeting can be read here.  A news article covering the meeting can be read here.

 Dave Lewis, Communications Director for DWS, represented DWS at the meeting.   He committed the department to do the following:

1. Explore developing and seeking community input on a written plan to address the alienation of immigrant and Latino families caused by the release of the list;
2. Continue to meet with the public to discuss how DWS can repair the harm caused. 

Kristen Cox, Executive Director of DWS, will be hosting two meetings with the public regarding list on Wednesday, August 25^th 9:00-10:00 AM. If you would like to attend, please RSVP to lincoln@healthpolicyproject.org.

Utah Health Policy Project has prepared a new report outlining the challenges of enrolling mixed status families in Medicaid and policy solutions to help enroll citizens in these programs. The report can be found here.

To help states maintain their Medicaid programs and avoid laying off teachers, last week the U.S. House of Representatives passed legislation extending the enhanced federal match states have received for Medicaid through July 2011 and provided additional funds.  For Utah this means the federal government will resume paying 80% of the cost of Medicaid vs. the normal match of 72%.  This increase will provide an additional $57 million in federal Medicaid funds to the state.  With Utah Medicaid rolls growing by 75,000 individuals since the beginning of the recession, this is much needed relief.

Please thank Congressman Jim Matheson for helping pass this critical support for states.  Congressman Matheson can be reached by calling 1 (877) 677-9743 or visiting https://forms.house.gov/matheson/contact.shtml

To make the most of this federal investment however, the state should use a portion of the funds to jump start family planning services for low-income families, a proven tool that will bring significant and ongoing savings.  By spending $778,600 today to provide family planning services to families earning less than 133% of poverty (the income threshold for the state’s Baby Your Baby Program) the state will save an estimated $830,100 every year through a reduction in unwanted pregnancies and improved health outcomes. 

Read UHPP’s factsheet about family planning here.

Department of Workforce Services Executive Director, Kristen Cox, will be on hand to discuss a new rule change, UT Admin Code R986-900 Food Stamps, that reduced the amount of assistance mixed immigration status families can receive under the program.  (Click for agenda)  As a result, 2,200 families are seeing a reduction in food stamps assistance, and food pantry demand has increased.  Read news article here.

The Health and Human Services committee will be looking at one of the quality improvement components of federal health reform:  incentives to reduce costly healthcare-associated infections. (Click here for agenda)

The Committee will be briefed by the Department of Health about current hospital reporting requirements, the prevalence of infections acquired in the hospital, and how federal reform legislation may impact both reporting and prevention of these infections.

As discussed in earlier blogs, health reform calls for significant upfront investments in Medicaid.  To help meet this need while limiting cost growth, the Utah Health Policy Project will be taking a closer look at state taxation and fiscal policies. 

This month the Revenue and Taxation Interim Committee will be looking at, among other things, Tax Commission data matching (click for agenda). This issue is important for public health coverage programs because data matching can help simplify the eligibility process for programs like Medicaid and CHIP.  For example, thanks to passage of HB260 (Children’s Health Insurance Plan Simplified Renewal by Rep. Newbold), the state of Utah is now exploring ways to verify income for the CHIP program via tax returns.

This is the place to track the state’s progress implementing federal and state health reform—and how these two processes interact. This meeting features (click for agenda) :

• an update on the new federal high-risk pool (going well, though the waiting list is not very long, etc.)
• reports from the Task Force’s 2 workgroups: Implementation/Oversight (the first August 5 meeting went well: but must be there to follow how leaders are handling the early federal reform opportunities and sometimes awkward interface between federal and state health reform) and Cost Containment (this group will have its first meeting on August 17th 4-6 PM in room 250. Note that neither workgroups will be generating any minutes—we’re working on changing this.
• Update on the Utah Health Exchange from the new Exchange Director Matt Spencer.
• Update on the payment and delivery system reform demo projects.

Executive Appropriations Committee will be looking at two significant issues. (Click here for the agenda)

1. The feasibility of privatizing the state hospital and developmental center.

Privatizing the state hospital and development center could have a serious impact on the care that Utahns with disabilities receive.   The question of privatization of these programs has been of interest to legislators for many years.  However, each time the Legislature has taken a closer look at detailed privatization proposals, claims about expected cost-savings and quality improvements have proved dubious.  Rather than spending resources privatizing the hospital and developmental center, people with disabilities and taxpayers would be better served by improving access to home and community based services in the state.  These services are proven to reduce the need for institutional care, thus saving the state money.  And Utahns with disabilities also benefit by not having to choose between staying in their community and entering an institution. 

2. Medicaid Management Information System Replacement Options

Utah’s Medicaid Management Information System (MMIS), the computer system used to process payments to Medicaid providers, is antiquated, cumbersome, and lacking in critical fraud detection capabilities. However, this may not be the best year funding-wise to replace MMIS with a more sophisticated system.  New MMIS systems are very expensive, costing the state tens of millions of dollars.  Further, with health reform pushing states to move away from fee-for-service payment systems to new payment methodologies for Medicaid, it is not clear at this time what capabilities Utah will need in a new MMIS system. 

Given the grim revenue outlook and uncertainty about future data collection needs, an expensive MMIS may not be a top priority for Utah at this time. 

To learn more about the challenges of replacing our MMIS system in the near term, please see UHPP’s new paper on Medicaid fraud prevention.  

A special invitation…

MAKING HEALTH REFORM WORK FOR UTAH:
A STRATEGY CONVERSATION W/ EXPERTS FROM FAMILIES USA*

Why now? Many of you have asked for a gathering to strategize on early reform implementation activities, including preparation for the coming changes to Medicaid…Your wish is our command.

To help us get implementation on the right footing, we are pleased to bring out 3 experts from Families USA for a special visit.

ANYONE INTERESTED IN MAKING SURE REFORMS SUCCEED IN UTAH
SHOULD ATTEND.

When: Tuesday August 17th  9:00 AM-3:30 PM
Where: Location given with RSVP

Note: SPACE IS VERY LIMITED to ensure productive discussion
MUST RSVP by August 13th for a seat.
Suggested Donation: $20-50 (sliding scale.  Donate here using the method you prefer; please note “FAMILIES” with your donation.)
To register contact Wendy Knowles: wendy@healthpolicyproject.org
801-433-2299 ext. 26

Tentative Agenda

9:00 AM Morning Session: Utah Medicaid in Reform
Understand the important role Medicaid will play in reform & what changes are needed to ensure Medicaid is ready to play its part.
• What Medicaid expansions are in store?
• How much will the expansions cost and how do we pay for them? Messaging on the ‘woodwork effect’ and the perceived cost shift to states
• Making the connection between public program eligibility and exchanges

12:00-1:00 Lunch—from Caputo’s Deli!
1:00-3:30 PM Afternoon Session: Reform and the Private Market
• Strengthening the infrastructure for consumer health assistance/navigation (CHAP) and outreach to new populations; encouraging the state to apply for the CHAP grants
• Aligning Utah reforms with federal reform, messaging and strategies for:
-Exchange
-Rate Review process
-more provisions in year 1
-Implementation legislation in other states + next steps for Utah

*Since 1982, Families USA has worked to promote high-quality, affordable health care for all Americans. Check out their new website: Health Reform Central.

With ever-increasing costs and concerns about quality and efficiency within Medicaid, Senate President Michael Waddoups and House Speaker David Clark, have asked the community for input on how Utah’s Medicaid program can be improved. Please note: Input will be collected through a survey tool through July 31. The Utah Health Policy Project has prepared a report, Improving Medicaid in Utah, Controlling Costs while Improving Health Outcomes  to help answer the legislature’s concerns and guide the community in their response.    

Utah Medicaid is in desperate need of ideas to control costs and improve health outcomes.  Currently, the program is severely underfunded.  Enrollment has grown by over 70,000, to 225,000 over the last two years.  All of this growth has been funded using one-time resources, and no ongoing tax revenue has been identified to pay for these enrollees in future years.  Compounding Medicaid’s funding challenges is federal health reform’s requirement that Medicaid provide coverage to everyone with household income less than 133% of federal poverty starting in 2014. This is a major change for Utah Medicaid, which has to this point primarily served children and people with disabilities.  Given the generous federal match rates set aside for the coming Medicaid expansions (the feds will pay 100% of Utah’s costs in 2014, decreasing to a perpetual base of 90% in 2019), it will never been more cost effective for the state to extend health coverage to its uninsured low-income adults; however, this expansion still comes at a significant cost.  Beginning in 2014, when the Medicaid eligibility expansion begins, Utah Medicaid is expected to grow by 110,000.  In addition to the expansion to new populations, this growth is driven by the ‘woodwork effect.’ Due to the individual mandate and the culture of coverage the reform creates, states like Utah, who have relatively low participation in their current programs, will see many of their currently eligible, but not enrolled residents’ who sign up for coverage. Utah will have to cover its usual portion of the cost (about 30¢ on every $1) for these, the estimated 60,000 “currently eligible” Utahns, who enroll due to reform. Regardless of the sudden pressure on the state budget, we view this is a worthwhile and necessary expense: these individuals should have been covered all along and it’s about time we got them into the system. The Utah Department of Health estimates the state’s share of the enrollment growth will be $37 million in 2014, increasing to $125 million by 2020. This growth in enrollment and costs demands that we do things differently. Fortunately, there are many things the state can do that will both help control costs and improve health outcomes of Medicaid clients.

State leaders should consider payment methods known to bring down costs while improving the quality of care. The Medicaid benefit package should include all medically necessary care along with services like dental and vision care that will maximize integration in the workforce and independent living. The point we should drive home in the survey is that he state has myriad options to make Utah Medicaid work better for both clients and taxpayers. 

We need your help to help make the legislature aware of what these options are! The President and Speaker’s survey is open and waiting for you to share your input.  Please read our report and provide the legislature your ideas here by July 31, 2010.

This year the Utah Medicaid Partnership has been working to help prepare the state for the significant changes in store for Medicaid due to federal health reform.   To help the public and policy leaders understand the scope of these changes and challenges those changes present, UMP is planning a series of forums focused on three main issues: 

• Medicaid and national health reform 
• Paying for and containing costs within Medicaid
• The role of Medicaid in providing long-term care

If you are interested in learning more about the UMP and helping the coalition with its important work, please attend the next UMP meeting on Tuesday, August 3rd, from noon to 1:30PM at AUCH, 860 East 4500 South, Suite 206.

For more information about UMP, including past agendas and minutes, please visit http://www.healthpolicyproject.org/UMP.html