The Offices of MCH/CSHCN (Title V) have a long-standing relationship with Medicaid (Title XIX) for the purpose of improving the health of women, infants, and children and especially for CSHCN to ensure these vulnerable populations receive needed services and support. The Interagency Agreement (IAA) has been updated to more adequately reflect the partnership and working relationship of these agencies.

The IAA represents the overarching agreement between the two Divisions. Other specific program agreements are in place to ensure the MCH/CSHCN populations are receiving coordinated Title XIX and Title V care.

Program Outreach and Enrollment

CSHCN programs offer activities that include informing eligible/potentially eligible individuals about Medicaid, rural travel and telehealth in support of Medicaid activities, referring, coordinating and monitoring the delivery of Medicaid services, and activities that improve coordination of care and delivery of services.

Some specific activities CSHCN performs for Medicaid enrollees includes:

• Gathering and sending medical records
• Scheduling medical appointments
• Monitoring continued need for service
• Following up on referred medical services
• Providing translation services
• Coordinating or referring to waiver or Early Intervention programs
• Evaluating the need for Medicaid
• Identifying gaps or duplications in services
• Collaborating with Medicaid, other agencies, and advisory groups
• Participating in training on administrative requirements
• Educating the community
• Participating in or coordinating training which enhances identification, intervention, screening and referral
• Establishing goals and objectives for health related programs
• Reviewing technical literature and research articles
   

The Office of CSHCN collaboration includes regular meetings with Medicaid to discuss the variety of CSHCN issues, coverage, needs, and improvements to service and care. Historically, CSHCN has primarily coordinated and collaborated with Medicaid to ensure services and funding for Title V populations. Medicaid and MCH/CSHCN have opened communications to improve collaboration among all Title V programs for their relative populations.

The Medicaid program provides Title XIX matching funding to State dollars for several projects in the Offices of MCH/CSHCN; the Pregnancy Risk Assessment Monitoring System (PRAMS), MotherToBaby, Fostering Healthy Children, Baby Watch Early Intervention, and WIC. The Integrated Services Program, Baby Watch Early Intervention, and Fostering Healthy Children all provide administrative case management services, assistance, monitoring, coordination, referrals, and community education for Medicaid enrollees. The programs provide extensive outreach throughout the state through many health fairs, agency and transition fairs, virtual and in-person educational training, and one-on-one counseling sessions on obtaining services and how to be an advocate for your child.

The MCH/CSHCN Offices and Medicaid coordinate many committees that include stakeholders with diverse expertise who provide feedback and action to improve Utah’s health outcomes.

The MCH/CSHCN database systems do not have the capacity to collect and report on the percent of services delivered by Managed Care Organizations and Primary Care Case Management entities. MCH/CSHCN are providing Medicaid reported numbers in the following areas: pregnant women, infants < 1 year of age, children 1-22, and CSHCN.

During Utah’s 2022 General Session, House Bill 200 was passed to authorize an expansion of the Medically Complex Children’s Waiver (MCCW) program. MCCW serves children with disabilities and complex medical conditions. House Bill 200 also modified the enrollment process for MCCW to allow enrollment year-round. Enrollment in MCCW must be prioritized to the highest medical complexity and critical needs of the family. The Office of CSHCN has supported Medicaid with outreach and promoted this opportunity with its stakeholders and families we serve. The Integrated Services Program has assisted families in enrolling.

Changes to the Utah Medicaid Program

Over the past several years, Utah has expanded Medicaid coverage to include more parents and childless adults. In recent years, Utah has increased Medicaid eligibility and benefits through state legislation, as well as a statewide ballot initiative.

Increased Coverage for Parents and “Targeted Adult Medicaid” (TAM)

At the direction of Governor Herbert and the legislature, Utah Medicaid expanded coverage in July 2017 to parents from 45% FPL to 60% of the Federal Poverty Limit (FPL). Approximately 4,000 parents became eligible for coverage. In November 2017, CMS gave approval to expand coverage to adults without dependents living up to 5% FPL who are homeless, justice-involved, or have a substance use disorder and are receiving general assistance from the Department of Workforce Services. TAM enabled approximately 5,000 high-needs individuals to receive health care, including substance abuse and mental health treatment.

Medicaid and Family Planning Services

In 2018, the Legislature passed House Bill 12, which directed Medicaid to unbundle immediate postpartum Long Acting Reversible Contraception (LARC) insertion and pay for the devices separately from the inpatient hospital stay. The legislation also required Medicaid to submit a waiver to CMS to expand family planning coverage to all women at or below 95% FPL, but due to full expansion being implemented, this waiver was not submitted. Utah Medicaid expanded medical coverage to adults at or below 95% FPL in April 2019.

Medicaid and Dental Coverage

Utah has also recently expanded dental coverage to more adults. Over the course of the 2018 and 2019 Legislative Sessions, the Governor and Legislature instituted Medicaid dental coverage for the TAM populations, older adults, and disabled individuals. Medicaid does not provide dental benefits to parents/caretakers or the majority of adults without children. Children and pregnant women enrolled in Medicaid have dental benefits.

Medicaid Expansion

On December 23, 2019, the Centers for Medicare and Medicaid Services (CMS) authorized the Utah Department of Health (UDOH) to implement a full Medicaid expansion in the state. The expansion extened Medicaid eligibility to Utah adults whose annual income is up to 138% of the FPL ($17,608 for an individual or $36,156 for a family of four). The federal government covers 90% of the costs for these services with the state covering the remaining 10%. CMS has not yet approved the other items in this waiver request. The state continues discussions with CMS on these remaining items.

Integrated plans

On January 1, 2020, the Utah Medicaid Integrated Care (UMIC) plans started. These plans manage both the physical health and behavioral health benefits of members through integrated managed care plans. Members enrolled in UMIC plans are members that are in Utah’s Adult Expansion Medicaid population and that live in Utah’s top five urban counties; Davis, Salt Lake, Utah, Washington, and Weber counties. The organizations that operate the UMIC plans are Healthy U, Health Choice, SelectHealth, and Molina.

Public Health Emergency

During the federally declared Public Health Emergency (PHE), Utah Medicaid has established a Maintenance of Effort (MOE).  For the duration of the PHE, all Medicaid cases will remain enrolled unless a member passes away, moves out of state, or requests closure.  As a result, Medicaid enrollment has grown by more than 40% during the PHE.  When the PHE expires, Utah Medicaid will begin its plan to unwind cases with the goal of a smooth transition of members to any eligible Medicaid program or a referral to the Federal Marketplace when possible.