In 2021, FHSD executed a new Memorandum of Agreement (MOU) with the state Medicaid program to comply with Title V requirements for an interagency agreement. The agreement formalizes existing agency collaborative efforts to improve the health of mothers, children, and families and is an attachment to this report.

The new MOU does not require or direct any specific activity between the two agencies. Instead, it contains general language as suggested by the National Academy of State Health Policy to encourage ongoing collaboration to address health needs for the MCH population.

Many MCH and public health approaches are already embedded in the current state Medicaid program (QUEST) waiver plan, the Hawaii Ohana Nui Project Expansion (HOPE). HOPE is a five-year initiative (2018-2022) to develop and implement a roadmap to achieve the vision of healthy families and healthy communities that aligns government agencies and funding around a common framework: a multigenerational, culturally appropriate approach that invests in children and families over the life cycle to nurture well-being and improve individual and population health outcomes. In vison and purpose, the HOPE plan mirrored the Hawaii State Department of Health 2015-2018 strategic plan, which contained a strong MCH focus. The following guiding principles describe the overarching framework used to develop a transformative healthcare system focusing on healthy families and healthy communities:

• Assuring continued access to health insurance and healthcare
• Emphasis on whole person and whole family care over their life course
• Address the social determinants of health
• Emphasis on health promotion, prevention, and primary care
• Emphasis on investing in system-wide changes

To accomplish the vision and goals, HOPE activities are focused on four strategic areas:

• Invest in primary care, prevention, and health promotion
• Improve outcomes for high-need, high-cost individuals
• Payment reform and alignment
• Support community driven initiatives to improve population health

In addition, HOPE activities are supported by initiatives that enhance three foundational building blocks:

• Health information technology that drives transformation
• Increase workforce capacity and flexibility
• Performance measurement and evaluation

Given Medicaid and DOH shared values and vision, collaboration between MQD and FHSD is fairly common. For instance, the two MQD staff completed the MCH Navigator workforce assessment and the MQD Q/I Community Relations Nurse subscribes to AMCHP newsletter and policy updates.

Examples of Title V partnerships activities in 2021-2022 include:

Agreements

• CSHNB/Early Intervention Services (EIS) worked with MQD to amend/update the MQD-DOH MOA related to Medicaid payment for early intervention (EI) services.
  • The MOA includes appropriate coding and rates and adds the collaboration that will occur between the EIS Care Coordinator and MQD Health Plan Service Coordinator to ensure a smooth transition of clients from EIS to the next setting.
  • The MOA covers the period from January 1, 2021 through December 31, 2026.
• CSHNB/EIS collaborated with MQD on guidelines and role delineation for collaboration between EIS and QUEST Integration (QI) health plans.
  • A March 2017 MQD memo specifies a simple workflow outlining how and when information will be exchanged and a detailed side-by-side role delineation of the EIS Care Coordinator and QI Health Plan Service Coordinator.
• MQD clarified in its May 2017 memo that EIS may provide Intensive Behavioral Therapy (IBT) services to EI Medicaid children and will transition EI Medicaid children to QI health plans to cover Applied Behavior Analysis (ABA) services for Autism Spectrum Disorder (ASD).
  • An EI Care Coordinator and QI Health Plan Service Coordinator will collaborate on the transition.

Enrollment & Service Utilization

• Title V programs are supporting Medicaid efforts to prepare for redetermination of enrollment eligibility by updating addresses for Medicaid enrollees in Title V direct service programs. In June 2022, the Medicaid Public Relations Director conducted a presentation of Hawaii Medicaid’s plans for eligibility redetermination (including a prepared media messaging campaign) to rollout at the end of the public health emergency. The presentation also included training of Medicaid eligibility, the enrollment process (both online and in-person resources), a review of benefits, and Medicaid process for transitioning youth to adult health care plans if needed. Ongoing communications and updates continue.
• Medicaid health plans promote WIC services to enrollees.
• Medicaid payment for specialty formulas and medical foods:
  • WIC is expected to be the payer of last resort for specialty formulas and medical foods.
  • Depending on medical plan and diagnosis, DHS/MQD will pay for entirely tube-fed WIC clients and possibly oral feeding.
• The MQD Medical Director and QI/Member Relations RN provide input on issues that arise and are invited to participate in workgroups, including the workgroup developing a media campaign to promote child wellness visits related to the Hawaii Title V state priority.
• MQD is sharing data with the state oral health coalition to assist with planning/evaluation for messaging to promote routine preventive dental visits.
• Most Title V health service programs and contracts promote enrollment to Medicaid.

Title V Priorities

• The Medicaid RFP issued in 2021 includes the Title V priorities of child and adolescent wellness visits, development screening, and a former priority, breastfeeding promotion.
• The Medicaid QI/Community Relations Nurse serves on the new Early Childhood Comprehensive Systems (ECCS) Advisory Board to include efforts to promote development screening and build a system for follow-up care.
• Medicaid is supporting the HRSA Pediatric Mental Health Access grant and is exploring possible funding for the mental health consultation warmline since the estimated costs for the service exceeds the grant award.

Other Activities

• The MQD QI/Community Relations Nurse and Title V Women’s Health Supervisor co-chair the Hawaii Maternal and Infant Health Collaborative (HMIHC) Pre-Inter Conception monthly workgroup overseeing this work. However, the Women’s Health Supervisor position is now under recruitment.
  • HMIHC was instrumental in the issuance of a 2017 MQD policy supporting Title V evidence-based strategies: One Key Question® (OKQ) screening approach and Long-Acting Reversible Contraception (LARC). The policy also expanded access to contraception. HMIHC continues to work on implementing and evaluating the policy.
  • HMIHC was also instrumental in MQD issuing a provider policy memo supporting prenatal Screening, Brief Intervention, and Referral to Treatment (SBIRT) pilot project, requiring training and reimbursements for participating obstetricians.
• Project ECHO Hawaii is included in the MQD HOPE plan and managed care RFP. This helps to garner support and participation from the Medicaid health plans and providers for the program. Launched in 2016, Project ECHO Hawaii is a multi-organizational partnership between the Hawaii State Rural Health Association, University of Hawaii, and DOH Office of Rural Health (part of the Title V agency).
• During the legislative session, FHSD and MQD routinely coordinate on the development of policy briefs and testimony. This year included work on a bill to fund/restore adult preventive dental benefits.
• FHSD received MQD data for the Title V annual report/application including SSDI Minimum Core dataset Medicaid measures and Title V data for NPM 6 developmental screening and SPM 5 data for child wellness visits. Medicaid also provides updates on overall enrollment numbers (including enrollments for newly added eligibility for Micronesian under the Compact of Free Association) and policy plans to extend postpartum to one year
• FHSD submitted a request to provide Medicaid oral health data for inclusion in the new Oral Health Data Dashboard located in the DOH Data Warehouse. Data requested includes Medicaid provider registration by level of claims submitted, disaggregated data for EPSDT service utilization, numbers of interisland flights funded by Medicaid to access specialty care.

New Opportunities for Collaboration

• Customized letters (provider report cards) mailed to pediatric healthcare providers show how well providers are testing Medicaid recipients at 1 and 2 years of age for blood lead levels compared to other providers in the same area
  • This idea is used by other jurisdictions to make providers more aware of this federal testing requirement and increase testing rates. CSHNB/HI-CLPPP is exploring the idea and data sharing needs with MQD
• Title V hopes to meet with the Medicaid staff over the next year to discuss potential partnership efforts around Medicaid/Title V quality measures (including developmental screening, child wellness, immunizations) and the EPSDT program.