Colorado’s Title XXI Section 1115 Waiver Adult Prenatal Coverage in Child Health Plan Plus (CHP+) Post Award Forum Presented by: Jeffrey Jaskunas, MS , MBA May 27, 2020 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Introduction and Background The Adult Prenatal Coverage in CHP+ The state has targeted this demonstration was last renewed from population to achieve three August 1, 2015 - July 31, 2020. key obj ectives: The demonstration expanded income 1. Decrease uninsurance rate for eligibility for pregnant women who pregnant women. would have been covered under CHP+ FPL expansion of 142% to 195% . 2. Increase prenatal and postpartum care for pregnant women. 3. Increase the number of healthy babies born to pregnant women. 3
Population Women ages 15-44 years between 142% -195% FPL with a service date between 08/ 01/ 2015 and 07/ 31/ 2019. S ervice codes indicating delivery, prenatal, and postpartum care. 4
Enrollment Members Who Maintained Medicaid Eligibility During the Demonstration Period Average Tot al member Member Unique mont hs/ Mont hs Client s client Aug Sept Oct Nov Dec Jan Feb Mar Apr May June July Demonstration Year 1 22578 2772 8.1 1784 1901 1951 2077 2122 2088 2047 1968 1847 1752 1593 1448 Demonstration Year 2 23691 2875 8.2 1957 2046 2151 2161 2161 2136 2052 1999 1921 1820 1716 1571 Demonstration Year 3 24745 2970 8.3 2027 2147 2244 2267 2233 2185 2149 2098 2025 1924 1780 1666 Demonstration Year 4 24134 2996 8.1 2075 2154 2256 2248 2214 2158 2057 1994 1932 1803 1674 1569 5
NUMBER OF BIRTHS 100 150 200 250 300 350 50 0 August September October 08/01/2015-07/31/2016 November December Demonstration Births January February March April May June July August September October 08/01/2016-07/31/2017 Demonstration Births by Month November December August 2015 - July 2019 January February March April May June July August September October 08/01/2017-07/31/2018 November December January February March April May June July August September October 08/01/2018-07/31/2019 November December January February March April May June July 6
Hypotheses Hypothesis 1: The proportion of Hypothesis 2: The proportion of pregnant women enrolled in the babies born to women enrolled CHP+ demonstration will have a in the CHP+ demonstration and statist ically significant increase admitted to the NICU will in prenatal care visits and a decrease over the five years of statist ically significant increase the demonstration proj ect. The in postpartum car e visits from proportion of babies born to S FY 2015 to S FY 2020. women enrolled in the CHP+ demonstration that weigh under 2,500 grams will decrease by 10 percent from S FY 2015 to S FY2020. 7
Measures Measure 1: Number of pregnant women receiving prenatal care will increase compared to baseline. Measure 2: Number of pregnant women receiving postpartum care will increase compared to baseline. Measure 3: Percentage of births weighing < 2,500 grams will decrease by 10% or more from baseline to demonstration year 4. 8
Results: Prenatal & Postpartum Care Percent of Eligible Clients Receiving Prenatal Care by Year Percent of Eligible Clients Receiving Postpartum Care by Year 60 62 50 60 40 58 Percent Percent 56 30 54 20 52 50 10 48 0 46 Baseline Year DY 2015-16 DY 2016-17 DY 2017-18 DY 2018-19 Baseline Year DY 2015-16 DY 2016-17 DY 2017-18 DY 2018-19 Study Year Study Year % Baseline % Baseline The st udy findings did not support our prenatal hypot hesis— finding a pot ent ial decreasing t rend across all years for women receiving prenat al care. The st udy did support our postpartum hypot hesis— 11.9% year-t o-year increase comparing baseline t o demonst rat ion year 4. 9
Results: Low Birth Weight Percent of Eligible Clients with Healthy Birth Weight Data shows improvement in the number Infants (>2500 grams) of low birth weight babies. After an 96 initial decrease of 63.8% from 94 92 baseline to demonstration year 1, Percent 90 subsequent year-to-year percent 88 86 change was minimal. 84 82 80 Challenges: 78 Concerns about data collected and 76 Baseline Year DY 2015-16 DY 2016-17 DY 2017-18 DY 2018-19 further baseline data analysis needed Study Year % 10% Goal Increase Birth certificate match requirement The study findings did support our hypothesis. Need to set a goal rather than expect year after year improvement. 10
Discussion and Looking Ahead Future Design Opportunities Unclear if or how the • What should this demonstration population program and evaluation might vary from the greater Medicaid or CHP+ populations. look like in the future? Difficult to complete a • How will we know it’ s scientific evaluation from the design. working? Performance and outcomes are • not marked to national benchmarks. 11
Demonstration Finance COLORADO FFY 2015 FFY 2016 FFY 2017 FFY 2018 FFY 2019 Adult Prenatal Coverage in CHP+ COST PROJECTIONS OF 1115 DEMONSTRATION PROPOSAL Demonstration Population (pregnant women 142% - 195% FPL) Insurance payments Managed care $524,592 $2,128,650 $983,044 $1,762,913 $4,365,192 per member/per month rate @ $845.35 @ 1,707 avg $830.82 @ 1,819 $605.72 @ 2,039 $605.72 @ 2,265 $854.06 @ # of eligibles elig/mo avg elig/mo avg elig/mo avg elig/mo 2,259 Fee for Service $16,791,651 $16,006,395 $13,837,743 $16,926,428 $18,786,784 Total Benefit Costs for Waiver Population $17,316,244 $18,135,045 $14,820,787 $18,689,341 $23,151,976 Total Benefit Costs $17,316,244 $18,135,045 $14,820,787 $18,689,341 $23,151,976 (Offsetting beneficiary cost sharing payments) * Premium Payments will be net of cost sharing Net Benefit Costs $17,316,244 $18,135,045 $14,820,787 $18,689,341 $23,151,976 $20,373,738.9 Federal Title XXI Share $11,551,666.09 $16,049,514.52 $13,043,774.57 $16,446,619.65 2 State Share $5,764,577.48 $2,085,530.14 $1,777,012.35 $2,242,720.86 $2,778,237.12 TOTAL COSTS FOR DEMONSTRATION $17,316,244 $18,135,045 $14,820,787 $18,689,341 $23,151,976 12
Questions or Comments 13
Contact Information Jeffrey Jaskunas CHP+ Program Manager Jeffrey.Jaskunas@ state.co.us 14
Thank You! 15
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