Iowa’s Title V program and the Iowa Medicaid program have a strong working relationship through a contract established yearly between IDPH and DHS, specifically Iowa Medicaid Enterprise (IME). This agreement is for six years and renewed annually through an amendment that addresses language and budget updates. This contract, the Omnibus Agreement, does not include services for children with special health care needs.

The Omnibus Agreement addresses cooperation between Title V, Title X, WIC, Title XIX, and Title XXI programs. Roles of DHS and IDPH are identified, and program descriptions are included. The purpose of each component is as follows:

• Attachment A - Informing and Care Engagement Administrative Services: This establishes parameters for Title V local contract agencies to provide and receive payment for the following:
  • Informing families of new Medicaid eligible children ages 0 to 21 years of the benefits and services within the EPSDT program.
  • Providing medical care coordination services for pregnant women and children on Medicaid who are not enrolled in a Medicaid MCO. The Medicaid MCOs hold the contractual responsibility for providing care coordination for MCO enrolled clients.
  • Providing dental care coordination for any Medicaid enrolled pregnant woman or child. This allows clients to be linked to oral health services provided by a dentist and coordinate oral health care services.
  • Providing presumptive eligibility for low income pregnant women. This service is open to the uninsured – both citizens and non-citizens. The pregnant woman is able to receive Medicaid covered maternal health services right away and establish an OB provider.

• Attachment B - Child and Adolescent Health, EPSDT: This defines staffing for program support for the following:
  • Provides IDPH staff support for quality monitoring of EPSDT services provided by Title V contract agencies. Bureau of Family Health staff provide training, consultation, technical assistance, and quality review of local contract agencies (e.g. chart audits).
• Attachment C - Maternal Health: This defines staffing for program support for the following:
  • Provides IDPH staff support for quality monitoring of maternal health services provided by Title V contract agencies. Bureau of Family Health staff provide training, consultation, technical assistance, and quality review of local contract agencies (e.g. chart audits).
• Attachment D - I-Smile™: This defines staffing for program support for the following:
  • Oral Health: Provides IDPH staff support for implementation of the I-Smile™ dental home initiative to improve access to Medicaid dental prevention and treatment services for children and pregnant women. IDPH staff provide training, consultation, technical assistance, and quality review of local contract agencies.
• Attachment E - 1st Five Children’s Healthy Mental Development: This defines staffing for program support for the following:
  • Provides IDPH staff support for quality monitoring of 1st Five sites located within Title V contract agencies in 88 of Iowa’s 99 counties
• Attachment F – Maternal and Child Health and Hawki Outreach Services: This attachment provides support for the following:
  • Maternal and Child Health Outreach Services: Supports implementation of the toll-free 1-800 phone line so that women, youth, and families can receive information and referral for questions relating to prenatal care and well child services in addition to other services the family may need.
  • Hawki Outreach: Provides support for a state level Hawki Outreach Coordinator and funding for local Title V CAH contract agencies to conduct Medicaid and Hawki outreach activities to promote enrollment.Local outreach activities are conducted with schools, faith-based organizations, medical and dental providers, special populations, and others.
• Attachment G – Medicaid and Vital Records Linked Data: Provides support for linking vital records data files and Medicaid paid claims data to evaluate health outcomes related to Medicaid services provided for pregnant women and children. It provides important information on maternal characteristics and birth outcomes used for policy development and program planning. Through this attachment, IDPH funds the MCH Epidemiologist, through an agreement with the CDC.

Program outreach and enrollment

Promoting outreach and enrollment occurs at a number of levels. Title V supports various websites and the 1-800 Healthy Families Line and Teen Line, and contracts with local community-based public or private non-profit organizations serving all counties in Iowa. Local contractors conduct outreach for Title V, Medicaid, and Hawki by linking with other programs (e.g. WIC), collaborating with local partners, participating in community events.

IDPH contracts with EveryStep, a non-profit agency in Polk County, to administer the Iowa Family Support Network or IFSN (www.iowafamilysupportnetwork.org). The IFSN serves as a coordinated intake system for home visiting/family support programs statewide, Early ACCESS (IDEA, Part C) and the Children at Home program. The IFSN also houses a statewide resource directory that includes local MCAH agencies, among many other programs.

Health care financing

Funding to support Title V is a blend of IDPH, Iowa DHS, and Medicaid matching funds. IDPH provides payments to local Title V contract agencies that provide the services. Non-direct care is considered Medicaid administrative services. Therefore, this funding is derived from a 50 -50 split of Iowa DHS and Medicaid matching funds.

Beyond Title V grant funding, Medicaid is the primary payer of client based services provided by local Title V MCAH contract agencies. Gap-filling medical direct care services provided by Title V MCAH agencies are billed to Iowa Medicaid for Medicaid fee-for-service clients (approximately 5% of the Medicaid population). Medical direct care services are billed to Iowa’s Medicaid MCOs for MCO enrolled clients (approximately 95% of the Medicaid population).

Medical care coordination is included in the MCO’s contract with DHS. As a result, local Title V MCAH contract agencies are not able to bill for medical care coordination services provided for MCO enrolled clients. This has had a significant impact on the continuity of care that Title V contract agencies are able to provide for their population.

Transportation services provided by local Title V MCAH agencies have also been impacted by the advent of Medicaid MCOs. Historically, Title V agencies have been able to arrange and bill specific types of transportation services for Medicaid clients through their Screening Center or Maternal Health Center provider types. This enabled staff to assist clients to access Medicaid covered services/appointments. This ability is now limited to Medicaid fee-for-service population, as each Medicaid MCO has a transportation broker.

Waiver Programs

Iowa currently has seven Home and Community Based Services (HCBS) Waivers that provide funding and individualized supports to allow eligible members to live in their own homes and communities. Five of these Waivers apply specifically to Iowa CYSHCN: the Health and Disability Waiver, the Intellectual Disability Waiver, the Brain Injury Waiver, the Physical Disability Waiver, and the Children’s Mental Health Waiver. DCCH provides consultation, technical assistance, planning and care coordination activities. Waivers for CYSHCN currently cover about 16,500 children. Nearly 6,000 children are on waitlists for waiver programs.

Joint Policy Level Decision Making

Over the years, the Title V Director has experienced many opportunities to meet with Iowa’s Medicaid Director on joint policy issues and problem resolution. Examples include working together to plan, pilot, and fully implement the informing and care coordination program; shifting Iowa’s care management from ‘targeted case management’ to ‘administrative care coordination’ based upon federal clarification; including interpretation for PE, informing, and care coordination as a service paid by IDPH to local MCAH agencies through DHS funding; increasing Medicaid’s reimbursement rate for certain services based upon Cost Analyses completed by local Title V MCAH contract agencies; establishing third party billing policies; and resolving some instances of lack of payment to local contract agencies from the MCOs.

Approximately 13 staff from various programs within the Bureau of Family Health and Oral Health Center meet monthly with the IME Maternal Health Center & Screening Center Project Manager, IME Oral Health Project Manager, and IME Contract Manager. The meetings provide an opportunity for staff to pose questions and concerns, provide input, and receive updates from IME on Medicaid policy and current issues. Challenges that local MCAH agency contractors have experienced are presented and discussed. IDPH staff share information on progress within Title V MCAH and other programs of mutual interest.