Title V – Title XIX Inter-Agency Agreement

The Minnesota Department of Health (MDH) upholds an ongoing, collaborative relationship with the Minnesota Department of Human Services (DHS), which houses the state’s Medicaid program (called Medical Assistance).

Minnesota’s Medicaid Program

Minnesota’s Medicaid program is the third largest insurer in the state, covering nearly one out of every five Minnesotans. Minnesota Medicaid covers a broad group of people and services beyond the minimum standards set in federal law. This includes expanding coverage to higher-income children and adults and covering long-term care in the home and community instead of an institutional setting. Minnesota also covers many special populations in need of services who would otherwise be ineligible for Medicaid because of their income level. This includes providing access to Medicaid for parents of children with disabilities by paying a parental fee, for women diagnosed with breast or cervical cancer through the state’s cancer screening program (Sage), and for families in need of family planning services.

Most Minnesotans enrolled in Medicaid receive services through the state’s contracted managed care organizations (MCO), which include both health maintenance organizations and county-based purchasing plans. The remaining enrollees receive services through the traditional fee-for-service system. Enrollees who remain in fee-for-service primarily consist of those who are not required to enroll in managed care or who have chosen to opt out of managed care. In general, this includes:

• People with disabilities
• People who are eligible through using a spenddown
• People with “cost-effective” health insurance
• Children receiving adoption assistance
• American Indians who live on a federally recognized reservation.

Title V – Medicaid Memorandum of Understanding (MOU)

Updated last in 2017, the Title V – Medicaid MOU (attached to this application) includes information on the responsibilities of both parties inherent in this collaboration. The MOU outlines requirements of both MDH and DHS in coordinating and enhancing efforts related to MCH populations, which include:

• Participate in advisory or work groups (sponsored by each agency) that focus on topics related to MCH
• Participate in one annual joint meeting to:
  • Coordinate departmental policies/procedures that impact health services or delivery of health services to MCH populations.
  • Identify how departments can work together to identify at-risk women of child bearing years, pregnant women, children, and youth in need for support or services that promote optimal health.
  • Identify areas where the departments could enhance or maximize efforts targeting the MCH population.
  • Share appropriate and relevant data, through separate data use agreements,  affecting health status or the delivery of health care services to MCH populations, including children with special health needs.

The MOU is reviewed every five years to determine if any changes are required.

MDH and DHS Coordination

Beyond the MOU, MDH and DHS collaborate with one another to address needs within MCH populations and help improve the health care delivery system.

Many children and youth with special health needs (CYSHN), especially those with complex medical conditions, are not enrolled in managed care – as it is not mandatory in Minnesota. In addition, there are no specific quality measures in the managed care contracts related to those with special health care needs who are under the age of 18 years old. This means that MCOs may not have effective mechanisms in place to assess the quality and appropriateness of care for CYSHN. The CYSHN program collaborates with Medicaid and MCOs to resolve this gap in the system – possibly by introducing language to incorporate into MCO contracts specifically related to CYSHN.

Minnesota received federal approval to use Medicaid dollars to pay for services through its home and community-based services waiver programs. These services became a Medicaid state plan option in 2005. Waivers cover services for people who need the level of care provided at a hospital or nursing facility but choose to receive such care in home or community-based settings. For CYSHN, this can include receiving personal care assistance or respite care in the home or community. Home and community-based waivers are coordinated within DHS in the Disability Services Division. Title V CYSHN staff partner with Disability Services staff on projects related to transition to adulthood and children with medical complexity.

The CYSHN program also partners with DHS related to the delivery of services and supports for children identified with autism spectrum disorder (ASD). In 2013, the Minnesota Legislature passed a law to create an Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit. The federal Centers for Medicare and Medicaid Services approved a revised State Plan Amendment for the EIDBI Benefit in 2017. The purpose of the EIDBI Benefit is to provide medically necessary early intensive intervention for children and youth with ASD and related conditions, as well as:

• Educate, train, and support their parents and families;
• Promote people’s independence and participation in family, school and community life; and
• Improve long-term outcomes and the quality of life for people and their families.

CYSHN staff actively collaborate with DHS in the development, implementation, and promotion of the EIDBI Benefit. CYSHN staff serve on various advisory committees related to ASD and the benefit, which has a policy-level impact on the services and supports accessible for children with ASD and their families.

Two other examples of partnerships with DHS include the state’s C&TC program and a CoIIN project aimed at helping children with medical complexity. Both are described in further detail in the Health Care Delivery System – Public and Private Partnerships Section.