Alaska continues to be a Medicaid expansion state. This began in September 2015 by Executive Authority of the Governor. By May 2021, 63,539 Alaskans were covered through Medicaid expansion. This “newly eligible” population includes all childless adults between 100% and 133% FPL.

Children currently represent 41% of Medicaid/CHIP enrollment, and Title V involvement in promoting well child visits and outreach as outlined in Section 504 of the Social Security Administration Act is critical to work by the Division of Public Assistance (DPA) and the Division of Healthcare Services to reduce the eligibility backlog. As of February 2021, there were 100,499 Alaska children ages 18 or less who rely on Medicaid and Denali KidCare (CHIP) to access the care they need to be healthy.

In January 2018, the State of Alaska applied to the Centers for Medicare and Medicaid Services (CMS), for approval of an 1115 behavioral health waiver at the Direction of Alaska Legislature through Senate Bill (SB) 74. This has been led by the Division of Behavioral Health, and Title V was a partner in that effort. Data from the MCH Epi Unit was key in ensuring that children were covered under this waiver. The goal was to create a data-driven, integrated system for behavioral health for people who experience serious mental illness, severe emotional disturbance, substance use disorder (SUD), co-occurring SUD and mental illness, and at-risk families and children. The SUD component was approved in November 2018, and the behavioral health component in September 2019. This waiver allows for expansion of services for children and adults.

WCFH last updated the MOU with Medicaid in 2019. Much like the Division of Public Health, Medicaid was also greatly impacted by COVID-19 and the ability to focus on other work. Medicaid had to create emergency regulations, such as the provision of telehealth, emergency refills, and travel guidelines. While WCFH needs to add more content to the 2019 MOU, the past year has seen increased and more consistent partnership between Title V and Medicaid, despite the challenges of COVID-19.

Medicaid Collaboration:

Maternal Depression Screening – The Maternal, Infant & Early Childhood Home Visiting (MIECHV) 2020 Needs Assessment served as a catalyst for policy change related to maternal depression screening. This was a partnership between the EPSDT Director and the MIECHV Program Manager. Current policy has Medicaid coverage ending for pregnancy at 60 days postpartum. While coverage ends, children often stay on Medicaid. This change allows for a provider to bill the child’s Medicaid for the mother’s maternal depression screening. WCFH will now work with Medicaid and the Public Information Team to raise awareness about the change through social media posts, presentations, Public Health ECHOs, and through the PQC and other provider networks.

Outreach/Promotion of Well-Child Visits – During the COVID-19 pandemic, Alaska experienced a decrease in our rate of well-child visits and childhood immunizations. To help mitigate this challenge, WCFH, Medicaid, the Immunization Program, and the Public Information Team have partnered on outreach strategies to promote preventive health visits for children. Title V dollars were used to create new rack cards to be distributed to schools for the start of the school year. The Title V-funded school nurse consultant help create the rack cards. WCFH will also be working with Medicaid on public service announcements on well-child visits for the upcoming school year. This will also be supported by Title V dollars.

Long Acting Reversible Contraception (LARC) - Alaska Title V staff have long been working on the issue of access to and reimbursement for LARC. This included prior partnership with Medicaid on a LARC workgroup and creation of a clarification paper on LARC reimbursement. While Medicaid was headed in the direction of de-bundling LARC from the global maternity fee, COVID-19 halted this work. Additionally, the Department began to work with a contractor to explore the use of DRG methodology for hospital payments. With the support of the Chief Medical Officer and Director of Public Health, WCFH staff, including the Title V Director, were a part of this workgroup to ensure LARC reimbursement was not missed during this process. Title V staff wrote a white paper which was submitted to the Office of Rate Review, the DRG contractor, and Medicaid on the health and financial reasons to do a carve-out and incentivize this process. Meetings took place which allowed Title V to be a part of this important policy discussion. A set of 4 options will be given to the Commissioner for review and consideration, two of which involve a separate payment to hospitals for immediate postpartum LARC insertion. Medicaid did acknowledge that LARC reimbursement needs to be done differently, which had not been the case in prior years’ discussion. WCFH has the support of the Chief Medical Officer in voicing support for the two options which follow CMS recommendations, along with the recommendations of national organizations like ACOG.

Extending Postpartum Covering to 12 Months – Based on the new opportunity through the American Rescue and Recovery Act, WCFH has a goal of actualizing the extension of postpartum coverage to from 60 days to 12 months, The Title V MCH Director has been meeting with Medicaid staff, including the CHIP Director, Medical Director, and other representatives from the Commissioner’s Office on this topic. The Title V MCH Director had been working with an intern on a white paper proposal which will be submitted to the administration for consideration. The intern unfortunately had to discontinue work on this project, and the paper remains in draft form. WCFH will need to articulate the cost-benefit of this policy change. Many organizations such as the Alaska Children’s Trust and the AKPQC are very interested in supporting this effort.

Genetic testing - One of the key reasons Providence Children’s Hospital ended their pediatric genetics clinic was concern related to reimbursement of genetic testing. Providence provided data related to denials from Medicaid and the subsequent costs their lab had to absorb. To help mitigate this challenge, and hopefully pave the way to reestablishing these services in Alaska, the Title V Director has participated in workgroup that includes the MCH Director at the Alaska Native Medical Center, a genetic counselor, healthcare providers, and Medicaid to help inform and improve this process. The group has finalized a guidance which would improve reimbursement for genetic testing. To date, this document has not yet received final approval by DHSS.

CHIP Work Plan – The Title V MCH and CYSHCN Directors and the MCH Epidemiology Unit Manager collaborated with the CHIP Director and Medicaid team on revising the Alaska CHIP Work Plan.

Telehealth - Title V has been partnering with Medicaid on the transition of pediatric clinics to telehealth services. Due to COVID-19, Alaska Medicaid relaxed some rules related to telehealth and billing. Telehealth will continue to be a key part of the healthcare delivery system after the pandemic. Title V continues to partner with Medicaid regarding billing procedures related to telehealth. Medicaid was able to provide technical assistance over the past year related to the transition to telehealth services.

Pediatric Sub-Specialty Care - The continued shortage of pediatric specialists remains a concern in terms of healthcare access for CYSHCN. The All Alaska Pediatric Partnership leads a statewide effort to revise the plan for pediatric specialty care. The Title V Director was part of planning and facilitating a convening in November 2019 that brought together hospitals, healthcare providers, and Medicaid to begin a strategic plan. This will include increased access to telehealth, workforce development, creating additional partnerships with universities, and provider recruitment. The Medicaid Medical Director and CYSCHN Program Manager continue to work on this initiative and corresponding work groups.

Oral Health – The Oral Health Program Manager and the Dental Consultant continue to partner with Medicaid related to oral health data analysis. The Oral Health Program Manager, Medicaid, and a researcher at the University of Alaska-Anchorage are also collaborating on reviewing Medicaid claims data related to oral health.

Developmental Screening – The WCFH Early Childhood Systems program manager continues to partner with Medicaid on reimbursement for evidence-based developmental screening.

Perinatal Quality Collaborative - Alaska Medicaid has started to become more involved in the AKPQC. The Medicaid Medical Director participated in the neonatal QI workgroup for universal screening of substances. It is anticipated that Medicaid will become more involved as the PQC becomes more established. Medicaid staff attended the 2021 Alaska PQC and Maternal Child Death Review Annual Summit.