In November 2017, an “Intra-Agency Agreement between the NH Title V sections and the NH Office of Medicaid Services, Relative to Joint Planning, Coordination and Improvement of Health Programs under Title V and Title XIX” was signed jointly by MCH, BFCS and Medicaid.
Title V has worked judiciously with Medicaid in the past year. The Medicaid Medical Care Advisory Committee (MCAC) advises Medicaid on policy and planning. As stated in the intra-agency agreement, there is a dedicated seat for a staff member of the DPHS. Members of the MCAC must be familiar with the comprehensive needs of low-income population groups and with the resources required for their care, which is consistent with the professional responsibilities of Title V staff. Duties are comprised of reviewing and recommending proposals for rules, regulations, legislation, waivers, operation and other Medicaid policies. There are three Medicaid Care Management organizations (MCOs) in the State: NH Healthy Families, Well Sense and AmeriHealth Caritas.
Medicaid has relaxed its Administrative Rules due to the COVID‑19 pandemic, increasing the types of providers able to provide current services and expanding its waivers, allowing for telehealth and enabling the origin of services to be wherever the patient is. In addition, during the Public Health Emergency (PHE), no individual was dropped from Medicaid for failure to re-determine. BFCS Health Care Coordinators have been working with families to ensure that despite this lenience, families complete their paperwork to avoid a “cliff effect” when it is lifted.
The Title V/Medicaid Agreement also reaffirms the commitment to have Title V funded contractors identify, enroll and re-enroll Medicaid eligible clients and to refer those clients to appropriate services. Seven of the funded CHCs utilize Title V for sustaining or even increasing capacity for any type of staff helping with client insurance needs. Dependent upon the CHC, approximately 1-29% of the clients coming in for the first time are uninsured.[1]
RSA 167:68-a[2] enacted in September of 2019 states that “Home visiting programs for children and their families…shall be made available to all Medicaid eligible children and pregnant women without restriction…. The commissioner shall adopt rules…relative to administering this section.”[3] Previously, the rules stated that agencies providing home visiting would receive Medicaid reimbursement for covered mothers 21 and under either with a first pregnancy and/or an infant up to the age of one. Agencies also had to be under contract with either MCH, BFCS and/or the Division Children, Youth or Families (DCYF). This rule dated back to the early days of voluntary home visiting provided by DHHS contract agencies, prior to MIECHV and the implementation of Healthy Families America. MCH currently has oversight over the MIECHV program and provides Title V funding for home visiting services under Comprehensive Family Support Services, a family support contract jointly run with DCYF and the DHHS Division of Economic and Housing Security.
MCH and BFCS staff started work with their Medicaid colleagues to revise the current Administrative rule He‑W‑549.[4] Regular meetings have been taking place for the past year and a half, including a coordinated stakeholder meeting, seeking input from provider agencies on how best to support rewriting the Medicaid rule to loosen restrictions and expand access to home visiting services. Title V staff met with stakeholders and gathered information for the conversations such as current and anticipated utilization of home visiting services that would be eligible for reimbursements and current billing practices utilizing the existing rule.
In more recent discussions, contemplation of an optimal strategy, for example utilization of a waiver or state plan amendment (SPA) have been considered, although it was determined that more information was needed. This recognition and a DHHS team being selected to participate in the three part National Academy for State Health Policy, State Policy Institute on Public Insurance Financing of Home Visiting Services (the Academy), allowed a facilitated space to learn of strategies, advantages and barriers that different states had faced in pursuing various paths to utilize public financing of home visiting.
Medicaid and MCH’s Family Planning Program also work together on a special SPA. This particular SPA allows presumptive eligibility for Medicaid to non-pregnant individuals 19‑64 years of age who are not otherwise eligible and who have an income at or below 133% of the FPL. Individuals must be enrolled by a qualified entity, including all of the MCH (Title V and Title X) contractors, who can facilitate presumptive eligibility. The SPA allows clients to receive coverage for family planning medical visits, contraceptive devices or drugs, both prescription and some non-prescription, pregnancy tests and screening for sexually transmitted infections when performed routinely as part of an initial, regular, or follow-up family planning visit, as well as sterilization. In State Fiscal Year 20, 669 people used this SPA.
NH MCO contracts include a requirement that each develops and makes available provider support services, which include but are not limited to training curriculum, to be developed in coordination with DHHS, that addresses clinical components necessary to meet the needs of CYSHCN. In June 2020, the Health Services Advisory Group (HSAG) notified DHHS that they had not been able to confirm that any of the MCOs had such a training curriculum. One MCO indicated that they were waiting for guidance from DHHS and the other two did not furnish any information or explanation.
BFCS’ Clinical Program Manager, CYSHCN Director, and NH Family Voices (NHFV) staff developed a strategy for working with the MCOs on the curriculum requirement. NHFV Associate Director led the work, which began with convening an informational meeting with a representative from each of the three MCOs. The initiative has progressed, albeit slowly due to COVID-related restrictions, and two training sessions have been scheduled for late-spring/early summer 2021.
The BFCS and the MCOs have maintained a working partnership to address access and coverage. In November 2020, a vendor providing feeding and swallowing services/consultation under contract with BFCS submitted a formal request for a rate increase from NH Medicaid. This is currently under review. This is in addition to an across-the-board 3.1% rate increase for all Medicaid services in 2020 and 2021.
DHHS’s Bureau of Quality Assurance and Improvement (QAI), which primarily works with NH Medicaid, has continued its partnership with MCH by routinely sharing data, such as monthly birth linkages (linked births and Medicaid delivery claims), for routine querying and matching for programs such as newborn screening and newborn hearing screening. This linkage enables more in-depth analyses than are possible with either dataset alone and has been used to examine issues such as early elective deliveries and severe maternal morbidity.
NH has been focusing on National Performance Measure #10, the percent of adolescents, ages 12‑17, with a preventive medical visit in the past year, which aligns with the CMS/HEDIS measure which increases the age to 21. MCH, the QAI and MCOs have worked together with their respective partners, to increase this through a variety of different mechanisms. This past year, Medicaid’s External Quality Review Organization facilitated interviews, with questions determined by the QAI and MCH, with caregivers of adolescents to discuss overall healthcare, with an emphasis on the importance of annual visits. Most interviewed understood the importance of a well visit and had adolescents who were up-to-date on their regular vaccinations.[5] DHHS’s Chief Medical Officer published a letter to Medicaid clinical providers about the importance of the adolescent well care visit, irrespective of the COVID‑19 pandemic. Starting on January 1, 2021, New Hampshire has included adolescent well visits to the MCO Quality Withhold and Incentive Program. MCOs will be required to reach specific thresholds for the measure or risk losing a percentage of their capitation payments. High performing MCOs have the potential to receive incentives.
In January of 2021, NH Medicaid also included timely postpartum care to the MCO Quality Withhold and Incentive Program. MCH staff are working with their contractors such as the Community Health Centers to inform them about both MCO incentives.
[1] UDS Tables (2020).
[2] Retrieved from http://www.gencourt.state.nh.us/rsa/html/xii/167/167-68-a.htm on 04/12/21.
[3] Ibid.
[4] Retrieved from http://www.gencourt.state.nh.us/rules/state_agencies/he-w500.html on 04/13/21.
To Top
Narrative Search