Application for State Child Health Plan under Title XXI of the Social Security Act State Children's Health Insurance Program APPLICATION FOR STATE CHILD HEALTH PLAN UNDER TITLE XXI OF THE SOCIAL SECURITY ACT STATE CHILDREN’S HEALTH INSURANCE PROGRAM (Required under 4901 of the Balanced Budget Act of 1997 (New section 2101(b))) State/Territory:___________________ NEBRASKA______________________________ (Name of State/Territory) As a condition for receipt of Federal funds under Title XXI of the Social Security Act, ________________________________________________________________________ (Signature of Governor of State/Territory, Date Signed) submits the following State Child Health Plan for the State Children’s Health Program and hereby agrees to administer the program in accordance with the provisions of the State Child Health Plan, the requirements of Title XXI and XIX of the Act and all applicable Federal regulations and other official issuances of the Department. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0707. The time required to complete this information collection is estimated to average 160 hours (or minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: HCFA, P.O. Box 26684, Baltimore, Maryland 21207 and to the Office of the Information and Regulatory Affairs, Office of Management and Budget, Washington, D.C. 20503. Section 1. General Description and Purpose of the State Child Health Plans (Section 2101) The state will use funds provided under Title XXI primarily for (Check appropriate box): 1.1. ? Obtaining coverage that meets the requirements for a State Child Health Insurance Plan (Section 2103); OR 1.2. X Providing expanded benefits under the State’s Medicaid plan (Title XIX); OR 1.3. ? A combination of both of the above. Section 2. General Background and Description of State Approach to Child Health Coverage (Section 2102 (a)(1)-(3)) and (Section 2105)(c)(7)(A)-(B)) 2.1. Describe the extent to which, and manner in which, children in the state including targeted low-income children and other classes of children, by income level and other relevant factors, such as race and ethnicity and geographic location, currently have creditable health coverage (as defined in section 2110(c)(2)). To the extent feasible, make a distinction between creditable coverage under public health insurance programs and public-private partnerships (See Section 10 for annual report requirements). Children Below 200% of Poverty Population: Based on 1990 U.S. Census data, there are 429,012 children under 18 residing in Nebraska with a total population of 1,578,385. This is 30.3% of the state’s population. Projections estimate there will be 478,286 children in year 2000. Of the total children, it is estimated that 167,519 children under age 18 live in homes with incomes below 200% of the federal poverty level (FPL). The number of children under age 18 living in homes with incomes below 185% of the federal poverty level is estimated at 150,088. The 1990 Census also reports that of the 429,012 children under 18, there are 107,811 children in families with income under 150% FPL, and 58,474 children in families with income under 100% of FPL. Children in families with income at or below the poverty level represent 12.3% of total children. This is essentially constant in comparison to 12.1% in 1980. Children in families with income at or below 150% of poverty represent 23.8% of total children. In 1992 the percentage of children in poor and near poor families with incomes below 150% was 24.7%. A Kids Count (Annie E. Casey Foundation publication) analysis of Current Population Survey (CPS) data since 1990 does not show a statistically significant change in poverty in Nebraska. U.S. Census Data for Children by Age < 18 and Federal Poverty Level AGE: 125%-149% 150%-174% 175%-184% 185%-199% 200% Tot. All Income Under 5 7,886 8,965 3,418 4,949 65,551 118,312 5-11 11,083 13,085 5,254 7,457 102,713 173,521 12-17 7,005 8,085 3,470 5,025 88,504 132,454 Total 0-17 25,974 30,135 12,142 17,431 256,768 424,287 According to data from the Nebraska Department of Education, approximately two-thirds of Nebraska’s school children participated daily on the average in the school lunch program in December 1997. Of that two-thirds, almost 69,000 children were eligible for free lunches and another 26,000 children were eligible for reduced-price lunches. One third of the total school enrollment are eligible for free or reduced lunches. Total number eligible for reduced price lunches (between 130 and 185 % FPL)--- 25,953 Total number eligible for free lunches (less than 130% FPL)------------------------ 68,930 Total avg. daily participation in school lunch ---------------------------------------- 202,023 Total school enrollment in NE ---------------------------------------------------------- 299,852 Race : Of the children under 18 residing in Nebraska in 1990, approximately 89.6% of the children were white and 10.4% were non-white. Of the children who are currently Medicaid-eligible, approximately 69.1% of the children are white and 30.9% are non- white. Applying those race percentages to the number of children under 100% of FPL, 40,406 are white and 18,068 are non-white. Of children under 185% of FPL, 103,711 are white and 46,377 are non-white. White children comprised the majority of births in 1996. Of the 23,271 births in 1996, 21,200 (91.1%) were white and 2,071 (8.9%) were non-white births. The 1995 Kids Count report (using data from the Health and Human Services System) shows 9% of children age 19 and under were non-white. Geographical Distribution: Over one-half of all children (age 18 and under) in Nebraska reside in rural areas according to the 1990 Census. 223,355 children live in the six metropolitan counties (based on U.S. Census definitions) of Dakota, Washington, Douglas, Sarpy, Cass and Lancaster counties. 228,253 children reside in all other counties. Number of Uninsured Children Although private insurance and public sector coverage efforts have helped expand health coverage of children in Nebraska, some children still have no coverage. Based on Census Bureau estimates for 1993-95, 7.0% of Nebraska’s children have no public or private coverage; for 1994 -96, the estimate was 6.8%. The percent has remained constant over years 1989-1993. Those children are apt to have 38% fewer medical visits than children with insurance (National Center for Children in Poverty, 1991: Waterman and Woodford, 1993). Medicaid expenditures for children newly eligible for the program have significant dental costs partially due to lack of regular dental care while in an uninsured status. Preventive and delayed care due to lack of coverage leads to higher treatment costs. The American Hospital Association Health Statistics & EBRI analysis of March 1995 Current Population Survey of Nebraska estimated that of 463,683 children in Nebraska, 45,689 were covered by Medicaid and 43,397 have no health insurance. 2.2. Describe the current state efforts to provide or obtain creditable health coverage For uncovered children by addressing: (Section 2102)(a)(2) 2.2.1. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in public health insurance programs (i.e. Medicaid and state-only child health insurance): The Nebraska Comprehensive Health Insurance Pool (CHIP) program is a state-only insurance program that was created in 1985. There is some potential for confusion with the State Children’s Health Insurance Program (Title XXI), because it is frequently referred to as CHIP or SCHIP. However, Nebraska’s Title XXI program will be known as Kids Connection. Children who qualify for Medicaid are not eligible for Nebraska’s CHIP program since persons are supposed to be “uninsurable” and CHIP losses are covered by a reduction in state insurance premiums taxes owed by companies who participate in the pool. Individuals in the CHIP pay premiums that are currently 125 percent of the average of the five highest volume plans in the state, and premiums have been as high as 150 percent of the average premium - the Insurance Commissioner sets the rate. The children, fewer than 300, who are CHIP policy holders are from families with incomes that exceed the 200 percent threshold so it is unlikely that there will be any substitution with Kids Connection. In addition to Medicaid, there are other programs and service delivery systems that (1) provide selected services and/or (2) work toward linking families with health services whether it be Medicaid coverage or other community resources. To promote and provide children and youth with comprehensive services and a full continuum of care through Medicaid, the following direct and indirect outreach efforts are utilized: * Employee newsletters are used to relay updates, changes, and information about initiatives to HHSS employees statewide. Internal electronic mail is used as a vehicle to notify all central and field staff of changes and updates on eligibility and services. * Provider bulletins that contain policy changes and clarification and claims processing updates are issued. * Brochures are distributed in local offices and to groups when presentations are made to community groups, other agencies, and professional organizations. * News releases are issued regarding new initiatives and reports as well as when public hearings will be held. Several news releases regarding Kids Connection have been issued to date. * The Health and Human Services System employs a full-time system advocate accessible through an 800 number to assist individuals with questions or concerns. * The agency communicates with client advocacy groups, the Medicaid Medical Care Advisory Committee, the Client Advisory group, and the Physician/Office Staff Advisory group during the rulemaking process to address and obtain input regarding policy issues and agency procedures that impact clients and providers. * A number of educational/promotional materials are utilized such as HEALTH CHECK posters, HEALTH CHECK video, provider training materials, local office training, and managed care enrollment materials. * The Health and Human Services System has developed a web page that has information about the various programs and services provided by the System. The web page now has information on Kids Connection with plans to update the information as needed. The web site also has basic information about Medicaid program service coverage and application sites. * The 800 numbers for agency access for information and for applications are currently listed on HCFA’s web site. * The local HHSS offices accept mail-in applications for Medicaid eligibility. * The agency utilizes outstationed eligibility sites in a number of hospitals where hospital staff complete the eligibility applications with patients and send them to the local HHSS office for eligibility determination. The local office staff liaisons with the outstationed eligibility providers regarding training and information and contract payment. * There are currently thirteen presumptive eligibility providers statewide where pregnant women can apply for presumptive Medicaid eligibility. Staff from these sites have ongoing communications during the presumptive eligibility process with local office staff and are familiar with Medicaid and how it can be accessed for other family members. These include the state’s two FQHCs and the two teaching hospitals and several community action agencies. Approximately 2,000 PE applications for pregnant women were completed annually at these qualified provider sites. Medicaid applications are available at most sites. * Of the 13 presumptive eligibility providers, ten are recipients of Title V/Maternal and Child Health Block Grant funds. These providers, then, are given the collaborative support of Nebraska’s Medicaid program and Title V program in order to provide health care services to women and children, as well as to seek out those who are uninsured and provide care to them. In receiving Title V funds, these providers have the resources to identify and support uncovered women and children, whether they are Medicaid eligible or not. * In addition, all Title V grantees in Nebraska are provided state-level support to identify and refer potentially eligible families to the Medicaid program whenever possible. Services for prenatal health care, preventive and primary care for children, health education, lead screening, and adolescent pregnancy prevention and support are all provided to low-income and other at-risk populations in Nebraska through Title V funds. A large proportion of recipients of these services are identified as uninsured and are provided the support necessary to pursue health care coverage. * Children with special health care needs who do not have health care coverage are often identified through the Medically Handicapped Children’s Program (MHCP), which is Nebraska’s Title V program dedicated specifically to providing specialty and subspecialty services to this population of children. MHCP services are commonly promoted by communities as a means for getting children with special health care needs into the publicly-funded health care system, particularly Medicaid. All children referred to MHCP clinics or services are screened for Medicaid eligibility. * In addition, the hospitals, schools, and community-based organizations that provide Early Intervention (EI) services to children with special health care needs up to three years of age are an excellent resource for identification and enrollment into Medicaid. The EI services coordinators are very familiar with Medicaid rules and regulations, and are able to advocate on behalf of the children with whom they work to get them enrolled. * MHCP works collaboratively with Shriners Hospitals and the CHOICES (Children’s Healthcare Options Improved Through Collaborative Efforts and Services) program to provide seamless support to families in their communities after receiving hospital care. As a child is released from Shriners Hospital in Minneapolis and returns home to Nebraska, the MHCP and CHOICES care coordinators work together to assure that the child not only has health care coverage - often through Medicaid - but also to assure that there is an established medical home for continuous care once the child is settled at home. * Currently the second largest county health department in the state, Lancaster County Health Department, through the Medicaid Access Coordination project and two rural county health departments and one community action agency through the CATCH project, have Medicaid administration contracts to perform outreach and provide centralized nurse- staffed phone access, triage, and referral for potential Medicaid eligible children and their families. They also encourage preventive care and link families with other community health resources and other public health programs. * The agency provides training and information to the Title V Healthy Mothers/Healthy Babies 800 Helpline which links families with Medicaid and Title V providers. The Helpline also has information on the locations where families can apply for assistance. In the last year, the Helpline received almost 1,000 calls, and 64% of referrals were for medical/prenatal care and social services, including Medicaid. * The Medicaid agency, as part of the WIC/Medicaid interagency agreement, provides information on coverage and eligibility to WIC staff as tools for them to outreach to families currently receiving WIC benefits. Through collaborative efforts, Medicaid eligible families are contacted and provided with WIC information. * Through a cooperative interagency agreement with the community action agency covering 22 central Nebraska counties, outreach efforts are being performed to connect EPSDT eligible children and potential Medicaid eligible children with well child care and home visitation services provided by the community action agency with the support of Title V/MCH Block Grant funds. An additional cooperative agreement between the Medicaid and Title V programs at the state level is in negotiation, which would allow for a proportion of the Title V “overmatch” to be used to support further Medicaid outreach efforts throughout the State. * Many of the state’s schools have been enrolled as Medicaid providers of therapy services (physical, speech, and occupational) and, thus, have become more aware of Medicaid coverable services for their families. School health nurses periodically receive information on the HEALTH CHECK (EPSDT) program, and they often refer youth for assistance. School nurses receive ongoing information from the state’s School Health Consultant regarding their role in providing outreach for Medicaid to uninsured children, including updates on rules and regulations, brochures, and information on EPSDT rates for the counties served by their school districts. * With the support of their state-level grantors, immunization clinics and reproductive health clinics encourage recipients of their services who are potentially eligible to pursue enrollment into Medicaid. * Medicaid staff serve on a tribal advisory board to provide technical assistance setting up a clinic facility for members of the tribe who are Medicaid-eligible. Staff are also working with tribally-owned and leased clinics to meet the IHS/HCFA Memorandum of Agreement terms and provide training and information on services and billing. Presentations and technical assistance have been provided to the Northern Plains Healthy Start staff. * HHS System staff are in the process of meeting with Tribal representatives, including the Ponca tribe (April 17 meeting), the Santee Sioux tribe (April 28 meeting), the Omaha tribe (May meeting to be scheduled), and the Winnebago tribe (May meeting to be scheduled). In addition, HHS staff are scheduled to participate in an Indian Affairs Commission meeting in May in South Sioux City to discuss Kids Connection. Staff are also consulting with the Director of the Indian Affairs Commission to develop appropriate outreach plans. 2.2.2. The steps the state is currently taking to identify and enroll all uncovered children who are eligible to participate in health insurance programs that involve a public-private partnership: Currently there is no public-private partnership providing coverage for Nebraska children. 2.3. Describe how the new State Title XXI program(s) is (are) designed to be coordinated with such efforts to increase the number of children with creditable health coverage so that only eligible targeted low-income children are covered: (Section 2102)(a)(3) Phase 1 of the Title XXI plan will be focused on expanding eligibility to youth ages 15 through 18 and the outreach efforts currently employed by the agency will be continued or enhanced. Also refer to Section 9.9. A more proactive approach to enrolling eligible children will be used. Children ages 15 through 18 in families currently in households receiving public assistance will be identified to eligibility workers to activate Medicaid eligibility for them along with their younger siblings. Local office eligibility workers will be provided procedural information regarding the expansion of eligibility. Promotional materials will be developed and provided to community agencies, schools, and local offices to use to outreach to families. Several options are being considered for a toll-free helpline for this program. Other health/medical helplines will be targeted to receive Kids Connection information to include in their inventory of information on financial resources. Title V/MCH Block Grant community-based grantees are planning their programs for the upcoming year with Kids Connection in mind. As providers of services geared toward low-income and uninsured families, these grantees want to assure they are able to do their part to recruit uninsured children where they live, play, and go to school and church. Dialogue regarding Kids Connection has been ongoing between state-level Title V staff and their grantees since last fall to help educate community-level programs on this new program and their role in it. Three grantees have even held community forums to begin discussing and educating themselves on the impact this program can have on their community. Title V grantees have also contacted each other to find out strategies that they will be using to reach out to this growing uninsured population of children to assure the success of Kids Connection. State-level Title V staff have also been involved since last fall in the planning of Kids Connection as well. Current sites of presumptive eligibility for pregnant women will be recruited and trained to take applications for children ages 15 through 18 years. In order for children to access Medicaid/Kids Connection through a ‘single entry’ point, the presumptive eligibility form will be changed to accomplish two purposes. It will be changed to a two-page application for presumptive eligibility and can be, if the family so chooses, the application for Medicaid/Kids Connection. Current outstationed eligibility sites will also receive the eligibility information to enable them to take applications on 15 through 18-year old children. Because many of the current presumptive eligibility providers are Title V-funded, they are already aware of Kids Connection and are preparing to broaden the marketing of their program to find uninsured children where they live. Mail-in applications will continue. The feasibility and cost/benefit of phone-in applications, extended hours at eligibility offices, and other open access strategies will be explored with the local office eligibility workgroup which has representatives from all six service areas of HHSS. Outreach and promotional efforts will also be extended to providers of services. Pediatric physicians who are not enrolled in the Medicaid program will be contacted to encourage enrollment. This will be done in collaboration with the Nebraska Chapter of the American Academy of Pediatrics, Nebraska Chapter of the American Academy of Family Practice, and the Nebraska Medical Association. Efforts will continue to identify dental providers not enrolled or who have a very limited number of Medicaid clients, and who practice in underserved dental areas. Dentists will receive personal invitations to participate or to increase participation. This has begun in collaboration with the Nebraska Dental Association. Coverage information will be extended to visual care providers and/or their professional organizations. School health nurses will be contacted and provided Kids Connection packets to facilitate outreach to high school youth and their families that have been identified as having unmet needs and no health care resources. Children with special health care needs will continue to be identified and enrolled in Medicaid/Kids Connection through the same avenues as are currently being used. Staff within the Medically Handicapped Children’s Program, Early Intervention, and CHOICES (Children’s Healthcare Options Improved Through Collaborative Efforts and Services) program will be informed of the new rules and regulations surrounding Kids Connection, as well as the additional locations within communities that can be accessed for enrollment. Focus groups and key informant interviews will be utilized to obtain the customers’ and providers’ input and assistance in communicating with hard-to-reach populations, to identify needs specific to this group, and to determine methods and resources to address those needs. Head Start and Early Head Start providers in Nebraska are eager to assist in providing outreach to families with uninsured children. Representatives from the Head Start community have been involved with the planning of Kids Connection since last fall, and these programs will play an integral role in identifying and enrolling children of all ages in Kids Connection. Section 3. General Contents of State Child Health Plan (Section 2102)(a)(4)) X Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 4. 3.1. Describe the methods of delivery of the child health assistance using Title XXI funds to targeted low-income children: (Section 2102)(a)(4) _________________________________________________________ 3.2. Describe the utilization controls under the child health assistance provided under the plan for targeted low-income children: (Section 2102)(a)(4) __________________________________________________________ Section 4. Eligibility Standards and Methodology. (Section 2102(b)) X Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 5. 4.1. The following standards may be used to determine eligibility of targeted low-income children for child health assistance under the plan. Please note whether any of the following standards are used and check all that apply. If applicable, describe the criteria that will be used to apply the standard. (Section 2102)(b)(1)(A)) 4.1.1. ? Geographic area served by the Plan:___________________ 4.1.2. ? Age:____________________________________________ 4.1.3. ? Income:_________________________________________ 4.1.4. ? Resources (including any standards relating to spend downs and disposition of resources):___________________________ 4.1.5. ? Residency:_______________________________________ 4.1.6. ? Disability Status (so long as any standard relating to disability status does not restrict eligibility): _______________________________ 4.1.7. ? Access to or coverage under other health coverage:_______ 4.1.8. ? Duration of eligibility _______________________________ 4.1.9. ? Other standards (identify and describe): __________________________________________________ 4.2. The state assures that it has made the following findings with respect to the eligibility standards in its plan: (Section 2102)(b)(1)(B)) 4.2.1. ? These standards do not discriminate on the basis of diagnosis. 4.2.2. ? Within a defined group of covered targeted low-income children, these standards do not cover children of higher income families without covering children with a lower family income. 4.2.3. ? These standards do not deny eligibility based on a child having a pre- existing medical condition. 4.3. Describe the methods of establishing eligibility and continuing enrollment. (Section 2102)(b)(2)) ____________________________________________________________________________ 4.4. Describe the procedures that assure: 4.4.1. Through intake and follow up screening, that only targeted low-income children who are ineligible for either Medicaid or other creditable coverage are furnished child health assistance under the state child health plan. (Section 2102)(b)(3)(A)) ____________________________________________________________ 4.4.2. That children found through the screening to be eligible for medical assistance under the state Medicaid plan under Title XIX are enrolled for such assistance under such plan. (Section 2102)(b)(3)(B)) ____________________________________________________________ 4.4.3. That the insurance provided under the state child health plan does not substitute for coverage under group health plans. (Section 2102)(b)(3)(C)) ____________________________________________________________ 4.4.4. The provision of child health assistance to targeted low-income children in the state who are Indians (as defined in section 4© of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c). (Section 2102)(b)(3)(D)) ____________________________________________________________ 4.4.5. Coordination with other public and private programs providing creditable coverage for low-income children. (Section 2102)(b)(3)(E)) ____________________________________________________________ Section 5. Outreach and Coordination (Section 2102(c)) Describe the procedures used by the state to accomplish: 5.1. Outreach to families of children likely to be eligible for assistance or under other public or private health coverage to inform them of the availability of, and to assist them in enrolling their children in such a program: (Section 2102(c)(1)) Outreach efforts for Phase 1 of Kids Connection include: 1. Using a one-page simplified Medicaid application form; 2. Allowing mail-in application forms; 3. Improving access by not requiring a resource test for this group of children; 4. Working with advocacy agencies in disseminating information on Medicaid eligibility, the application process, etc. to the low income community; and 5. Using informational pamphlets. For additional information on outreach efforts, please refer to sections 2.2.1 and 2.3. 5.2. Coordination of the administration of this program with other public and private health insurance programs: (Section 2102(c)(2)) Since Nebraska’s Title XXI chosen option is a Medicaid expansion and there are no other state-only or public-private partnership insurance programs enrolling only children, there will be no need for a referral mechanism at this time. Coordination with outstationed eligibility services has already been addressed in Sections 2.2.1 and 5.1. Section 6. Coverage Requirements for Children’s Health Insurance (Section 2103) X Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 7. 6.1. The state elects to provide the following forms of coverage to children: (Check all that apply.) 6.1.1. ? Benchmark coverage; (Section 2103(a)(1)) 6.1.1.1. ? FEHBP-equivalent coverage; (Section 2103(b)(1)) (If checked, attach copy of the plan.) 6.1.1.2. ? State employee coverage; (Section 2103(b)(2)) (If checked, identify the plan and attach a copy of the benefits description.) ___________________________ 6.1.1.3. ? HMO with largest insured commercial enrollment (Section 2103(b)(3)) (If checked, identify the plan and attach a copy of the benefits description.) ___________________________ 6.1.2. ? Benchmark-equivalent coverage; (Section 2103(a)(2)) Specify the coverage, including the amount, scope and duration of each service, as well as any exclusions or limitations. Please attach signed actuarial report that meets the requirements specified in Section 2103(c)(4). See instructions. 6.1.3. ? Existing Comprehensive State-Based Coverage; (Section 2103(a)(3)) [Only applicable to New York; Florida; Pennsylvania] Please attach a description of the benefits package, administration, date of enactment. If “existing comprehensive state-based coverage” is modified, please provide an actuarial opinion documenting that the actuarial value of the modification is greater than the value as of 8/5/97 or one of the benchmark plans. Describe the fiscal year 1996 state expenditures for “existing comprehensive state-based coverage.” _______________________________________________________ 6.1.4. ? Secretary-Approved Coverage. (Section 2103(a)(4)) 6.2. The state elects to provide the following forms of coverage to children: (Check all that apply. If an item is checked, describe the coverage with respect to the amount, duration and scope of services covered, as well as any exclusions or limitations) (Section 2110(a)) 6.2.1. ? Inpatient services (Section 2110(a)(1)) 6.2.2. ? Outpatient services (Section 2110(a)(2)) 6.2.3. ? Physician services (Section 2110(a)(3)) 6.2.4. ? Surgical services (Section 2110(a)(4)) 6.2.5. ? Clinic services (including health center services) and other ambulatory health care services. (Section 2110(a)(5)) 6.2.6. ? Prescription drugs (Section 2110(a)(6)) 6.2.7. ? Over-the-counter medications (Section 2110(a)(7)) 6.2.8. ? Laboratory and radiological services (Section 2110(a)(8)) 6.2.9. ? Prenatal care and pre-pregnancy family services and supplies (Section 2110(a)(9)) 6.2.10. ? Inpatient mental health services, other than services described in 6.2.18., but including services furnished in a state-operated mental hospital and including residential or other 24-hour therapeutically planned structural services (Section 2110(a)(10)) 6.2.11. ? Outpatient mental health services, other than services described in 6.2.19, but including services furnished in a state-operated mental hospital and including community-based services (Section 2110(a)(11) 6.2.12. ? Durable medical equipment and other medically-related or remedial devices (such as prosthetic devices, implants, eyeglasses, hearing aids, dental devices, and adaptive devices) (Section 2110(a)(12)) 6.2.13. ? Disposable medical supplies (Section 2110(a)(13)) 6.2.14. ? Home and community-based health care services (See instructions) (Section 2110(a)(14)) 6.2.15. ? Nursing care services (See instructions) (Section 2110(a)(15)) 6.2.16. ? Abortion only if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest (Section 2110(a)(16) 6.2.17. ? Dental services (Section 2110(a)(17)) 6.2.18. ? Inpatient substance abuse treatment services and residential substance abuse treatment services (Section 2110(a)(18)) 6.2.19. ? Outpatient substance abuse treatment services (Section 2110(a)(19)) 6.2.20. ? Case management services (Section 2110(a)(20)) 6.2.21. ? Care coordination services (Section 2110(a)(21)) 6.2.22. ? Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a)(22)) 6.2.23. ? Hospice care (Section 2110(a)(23)) 6.2.24. ? Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services. (See instructions) (Section 2110(a)(24)) 6.2.25. ? Premiums for private health care insurance coverage (Section 2110(a)(25)) 6.2.26. ? Medical transportation (Section 2110(a)(26)) 6.2.27. ? Enabling services (such as transportation, translation, and outreach services (See instructions) (Section 2110(a)(27)) 6.2.28. ? Any other health care services or items specified by the Secretary and not included under this section (Section 2110(a)(28)) 6.3. Waivers - Additional Purchase Options. If the state wishes to provide services under the plan through cost effective alternatives or the purchase of family coverage, it must request the appropriate waiver. Review and approval of the waiver application(s) will be distinct from the state plan approval process. To be approved, the state must address the following: (Section 2105(c)(2) and (3)) 6.3.1. ? Cost Effective Alternatives. Payment may be made to a state in excess of the 10% limitation on use of funds for payments for: 1) other child health assistance for targeted low-income children; 2) expenditures for health services initiatives under the plan for improving the health of children (including targeted low-income children and other low-income children); 3) expenditures for outreach activities as provided in section 2102(c)(1) under the plan; and 4) other reasonable costs incurred by the state to administer the plan, if it demonstrates the following: 6.3.1.1. Coverage provided to targeted low-income children through such expenditures must meet the coverage requirements above; Describe the coverage provided by the alternative delivery system. The state may cross reference section 6.2.1 - 6.2.28. (Section 2105(c)(2)(B)(I)) 6.3.1.2. The cost of such coverage must not be greater, on an average per child basis, than the cost of coverage that would otherwise be provided for the coverage described above; and Describe the cost of such coverage on an average per child basis. (Section 2105(c)(2)(B)(ii)) 6.3.1.3. The coverage must be provided through the use of a community-based health delivery system, such as through contracts with health centers receiving funds under section 330 of the Public Health Service Act or with hospitals such as those that receive disproportionate share payment adjustments under section 1886(d)(5)(F) or 1923 of the Social Security Act. Describe the community based delivery system. (Section 2105(c)(2)(B)(iii)) 6.3.2. ? Purchase of Family Coverage. Describe the plan to provide family coverage. Payment may be made to a state for the purpose of family coverage under a group health plan or health insurance coverage that includes coverage of targeted low-income children, if it demonstrates the following: (Section 2105(c)(3)) 6.3.2.1. Purchase of family coverage is cost-effective relative to the amounts that the state would have paid to obtain comparable coverage only of the targeted low-income children involved; and (Describe the associated costs for purchasing the family coverage relative to the coverage for the low-income children.) (Section 2105(c)(3)(A)) 6.3.2.2. The state assures that the family coverage would not otherwise substitute for health insurance coverage that would be provided to such children but for the purchase of family coverage. (Section 2105(c)(3)(B)) Section 7. Quality and Appropriateness of Care X Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 8. 7.1. Describe the methods (including external and internal monitoring) used to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan. (2102(a)(7)(A)) ____________________________________________________________ Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.) 7.1.1. ? Quality standards 7.1.2. ? Performance measurement 7.1.3. ? Information strategies 7.1.4. ? Quality improvement strategies 7.2. Describe the methods used, including monitoring, to assure access to covered services, including emergency services. (2102(a)(7)(B)) ____________________________________________________________ Section 8. Cost Sharing and Payment (Section 2103(e)) X Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 9. 8.1. Is cost-sharing imposed on any of the children covered under the plan? 8.1.1. ? YES 8.1.2. ? NO, skip to question 8.5. 8.2. Describe the amount of cost-sharing and any sliding scale based on income: (Section 2103(e)(1)(A)) 8.2.1. Premiums:_______________________________________ 8.2.2. Deductibles:______________________________________ 8.2.3. Coinsurance:______________________________________ 8.2.4. Other:___________________________________________ 8.3. Describe how the public will be notified of this cost-sharing and any differences based on income: _____________________________________________ 8.4. The state assures that it has made the following findings with respect to the cost sharing and payment aspects of its plan: (Section 2103(e)) 8.4.1. ? Cost-sharing does not favor children from higher income families over lower income families. (Section 2103(e)(1)(B)) 8.4.2. ? No cost-sharing applies to well-baby and well-child care, including age- appropriate immunizations. (Section 2103(e)(2)) 8.4.3. ? No child in a family with income less than 150% of the Federal Poverty Level will incur cost-sharing that is not permitted under 1916(b)(1). 8.4.4. ? No Federal funds will be used toward state matching requirements. (Section 2105(c)(4)) 8.4.5. ? No premiums or cost-sharing will be used toward state matching requirements. (Section 2105(c)(5) 8.4.6. ? No funds under this title will be used for coverage if a private insurer would have been obligated to provide such assistance except for a provision limiting this obligation because the child is eligible under the this title. (Section 2105(c)(6)(A)) 8.4.7. ? Income and resource standards and methodologies for determining Medicaid eligibility are not more restrictive than those applied as of June 1, 1997. (Section 2105(d)(1)) 8.4.8. ? No funds provided under this title or coverage funded by this title will include coverage of abortion except if necessary to save the life of the mother or if the pregnancy is the result of an act of rape or incest. (Section 2105)(c)(7)(B)) 8.4.9. ? No funds provided under this title will be used to pay for any abortion or to assist in the purchase, in whole or in part, for coverage that includes abortion (except as described above). (Section 2105)(c)(7)(A)) 8.5. Describe how the state will ensure that the annual aggregate cost-sharing for a family does not exceed 5 percent of such family’s annual income for the year involved: (Section 2103(e)(3)(B)) __________________________________________________________ 8.6. The state assures that, with respect to pre-existing medical conditions, one of the following two statements applies to its plan: 8.6.1. ? The state shall not permit the imposition of any pre-existing medical condition exclusion for covered services (Section 2102(b)(1)(B)(ii)); OR 8.6.2. ? The state contracts with a group health plan or group health insurance coverage, or contracts with a group health plan to provide family coverage under a waiver (see Section 6.3.2. of the template). Pre-existing medical conditions are permitted to the extent allowed by HIPAA/ERISA (Section 2109(a)(1),(2)). Please describe: ________________________________________________ Section 9. Strategic Objectives and Performance Goals for the Plan Administration (Section 2107) 9.1. Describe strategic objectives for increasing the extent of creditable health coverage among targeted low-income children and other low-income children: (Section 2107(a)(2)) Strategic objectives, performance goals, and measures are listed together in item 9.3. 9.2. Specify one or more performance goals for each strategic objective identified: (Section 2107(a)(3)) Strategic objectives, performance goals, and measures are listed together in item 9.3. 9.3. Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to determine the state’s performance, taking into account suggested performance indicators as specified below or other indicators the state develops: (Section 2107(a)(4)(A),(B)) Nebraska’s strategic objectives, performance goals, and measures for Kids Connection include: Phase I is defined as expanding Medicaid program eligibility for uninsured youth who are under 19 years of age, born on or before September 30, 1983, and who have incomes equal to or less than 100% of the federal poverty level. It is estimated that an additional 950 children will be added to the Medicaid program. STRATEGIC OBJECTIVE #1: Reduce the number of uninsured children in Nebraska by providing health care coverage through Medicaid/Kids Connection Program. Performance Goal 1.1: Market the Medicaid/Kids Connection Program. Measure 1.1.1: By July 1, 1998, 10 informational sessions will be delivered to targeted groups of clients, health care providers, and community partner/client advocates. Measure 1.1.2: By August 1, 1998, an ongoing distribution system for education/marketing materials will be implemented by Nebraska HHSS. Performance Goal 1.2: Determine children eligible for Medicaid/Kids Connection under the new income eligibility guidelines. Measure 1.2.1: By December 31, 1998, eligibility will be determined for 25% of the estimated group of 950 children who may qualify for Medicaid/Kids Connection. Measure 1.2.2: By July 1, 1999, eligibility will be determined for 100% of the estimated group of 950 children who may qualify for Medicaid/Kids Connection. STRATEGIC OBJECTIVE #2: Create the HHSS infrastructure for determining and tracking those children eligible under Medicaid/Kids Connection. Performance Goal 2.1: Make needed systems changes in the N-Focus Eligibility Data System. Measure 2.1.1: By September 1, 1998, systems changes related to the new income eligibility guidelines for Medicaid/Kids Connection will be functioning. Performance Goal 2.2: Hire needed eligibility staff to implement this program. Measure 2.2.1: By September 1, 1998, 2 additional eligibility staff will be hired in the HHS System. Performance Goal 2.3: Train eligibility staff on the new eligibility guidelines and systems changes. Measure 2.3.1: By September 1, 1998, training will have been offered in all six HHSS service delivery areas. STRATEGIC OBJECTIVE #3: For those children participating in Medicaid Managed Care, provide clients with a medical home through a primary care provider under Managed Care. Performance Goal 3.1: Clients mandatory for Medicaid Managed Care will be actively enrolled on a priority basis by the Access Medicaid. Measure 3.1.1: By September 1, 1999, 70% of the children identified as mandatory will be enrolled into managed care within 90 days following the date they are found eligible for Medicaid. STRATEGIC OBJECTIVE #4: Increase children’s access to primary care providers. Performance Goal 4.1: Recruit new Medicaid health care providers. Measure 4.1.1: By December 31, 1998, develop a plan to exceed the current participation rate (83.7%) of physicians serving Medicaid-eligible children. STRATEGIC OBJECTIVE #5: Improve children’s health outcomes through proxy measures of well child visits, dental care, and visual care. Performance Goal 5.1: Increase access of previously uninsured children to well child care through EPSDT/Health Check. Measure 5.1.1: By July 1, 1999, newly eligible children will have equal or more well child care visits per 1000 eligibles compared to previously eligible children in this same age group. Performance Goal 5.2: Increase children’s access to dental services. Measure 5.2.1: By July 1, 1999, newly eligible children will have equal or more preventive dental care visits per 1000 eligible children compared to previously eligible children in this same age group. Measure 5.2.2: By July 1, 1999, newly eligible children will have equal or more treatment dental care visits per 1000 eligible children compared to previously eligible children in this same age group. Performance Goal 5.3: Increase children’s access to visual care. Measure 5.3.1: By July 1, 1999, newly eligible children will have equal or more visual care checkups per 1000 eligible children compared to previously eligible children in this same age group. Measure 5.3.2: By July 1, 1999, newly eligible children will have equal or more prescriptive lenses per 1000 eligible children compared to previously eligible children in the same age group. STRATEGIC OBJECTIVE #6: Expand to Phase II by September 1, 1998. Phase II is defined as expanding Medicaid program eligibility for uninsured children who are under 19 years of age and who have incomes equal to or less than 185% of the federal poverty level. LB 1063 which provides funding for phase II was signed in law on April 13, 1998. Performance Goal 6.1: Obtain federal approval of Phase II plan. Measure 6.1.1: Submit Phase II plan in June 1998. Performance Goal 6.2: Enhance strategic objectives, performance goals and performance measures as needed, to include for example: 1. Marketing to clients, health care providers, community partners/client advocates; 2. Outreach to clients, health care providers, community partners/client advocates; 3. Presumptive Eligibility changes; 4. Continuous Eligibility for 12 Months; 5. Streamlined Single Method of Entry for Medicaid/Kids Connection; 6. Multiple Points of Entry (e.g., community sites, phone, mail, etc.); 7. Improve Access to Quality Comprehensive Health Care; 8. Improve health outcomes for children with Special Health Care Needs (e.g., asthma, diabetes: increase office visits and decrease emergency room visits and inpatient admissions). Applicable suggested performance measurements listed below that the state plans to use: (Section 2107(a)(4)) 9.3.1. ? The increase in the percentage of Medicaid-eligible children enrolled in Medicaid. 9.3.2. X The reduction in the percentage of uninsured children. See Strategic Objective #1 and #2. 9.3.3. X The increase in the percentage of children with a usual source of care. For children mandatory for Nebraska Medicaid Managed Care, see Strategic Objective #3. 9.3.4. ? The extent to which outcome measures show progress on one or more of the health problems identified by the state. 9.3.5. ? HEDIS Measurement Set relevant to children and adolescents younger than 19. 9.3.6. X Other child appropriate measurement set. List or describe the set used. See Strategic Objective #4 and #5. 9.3.7. ? If not utilizing the entire HEDIS Measurement Set, specify which measures will be collected, such as: 9.3.7.1. ? Immunizations 9.3.7.2. ? Well child care 9.3.7.3. ? Adolescent well visits 9.3.7.4. ? Satisfaction with care 9.3.7.5. ? Mental health 9.3.7.6. ? Dental care 9.3.7.7. ? Other, please list: __________________ 9.3.8. ? Performance measures for special targeted populations. 9.4. X The state assures it will collect all data, maintain records and furnish reports to the Secretary at the times and in the standardized format that the Secretary requires. (Section 2107(b)(1)) 9.5. X The state assures it will comply with the annual assessment and evaluation required under Section 10.1. and 10.2. (See Section 10) Briefly describe the state’s plan for these annual assessments and reports. (Section 2107(b)(2)) The State will comply with the required annual assessments and the evaluation required by March 31, 2000. HHS Finance and Support staff will support this program and will develop any evaluations and reports required by HCFA. If outside services are required for any of these reports, the agency may be required to obtain these services through the RFP process, and cannot, at this time, identify who would perform the services. 9.6. X The state assures it will provide the Secretary with access to any records or information relating to the plan for purposes of review of audit. (Section 2107(b)(3)) 9.7. X The state assures that, in developing performance measures, it will modify those measures to meet national requirements when such requirements are developed. 9.8. The state assures, to the extent they apply, that the following provisions of the Social Security Act will apply under Title XXI, to the same extent they apply to a state under Title XIX: (Section 2107(e)) 9.8.1. X Section 1902(a)(4)(C) (relating to conflict of interest standards) 9.8.2. X Paragraphs (2), (16) and (17) of Section 1903(I) (relating to limitations on payment) 9.8.3. X Section 1903(w) (relating to limitations on provider donations and taxes) 9.8.4. X Section 1115 (relating to waiver authority) 9.8.5. X Section 1116 (relating to administrative and judicial review), but only insofar as consistent with Title XXI 9.8.6. X Section 1124 (relating to disclosure of ownership and related information) 9.8.7. X Section 1126 (relating to disclosure of information about certain convicted individuals) 9.8.8. X Section 1128A (relating to civil monetary penalties) 9.8.9. X Section 1128B(d) (relating to criminal penalties for certain additional charges) 9.8.10.X Section 1132 (relating to periods within which claims must be filed) 9.9. Describe the process used by the state to accomplish involvement of the public in the design and implementation of the plan and the method for insuring ongoing public involvement. (Section 2107(c)) The State of Nebraska involved the public in the design and implementation of Kids Connection in the following manner: Kids Connection Committee: The State Medicaid Director convened a committee to address design and implementation of Kids Connection, Nebraska’s Children’s Health Initiative. This group was composed of Health and Human Services System staff as well as representatives of United Health Care, Mutual of Omaha, HMO Nebraska (Blue Cross/Blue Shield of Nebraska), a marketing advisor, Polk County Health Department, Lincoln/Lancaster County Health Department Access Medicaid, Blue Valley Community Action, Primary Care Services, University of Nebraska Medical Center Pediatrics, Indian-Chicano Health Center, Association of Community Action Agencies, Governor’s Office, Department of Administrative Services’ Budget Office, Nebraska Association of Hospitals and Health Care Systems, Nebraska Medical Association, Voices for Children, Iowa/Nebraska Primary Care Association, Appleseed Association, State Senator Chris Beutler, Head Start, Wellness Option, Children’s Hospital and Health Center, Nemaha County Health Department, CATCH Program, Winnebago Maternal and Child Health; and the Urban Indian Health Center. The Health and Human Services System staff represent a broad spectrum from the three agencies, Services, Regulation & Licensure, and Finance & Support. The team has met on the following dates: October 2,9, 16, 30, November 6, 13 and 20, December 4 and 18, 1997; January 15, February 5 and 19, March 5 and 19, and April 2, 16, and 30, 1998. On-going twice-monthly meetings are planned to continue work on development and implementation of the State’s Children’s Health Insurance Program. The team identified work groups for the following areas: 1. Marketing and Outreach 2. Presumptive Eligibility 3. State Eligibility 4. Systems 5. Managed Care and Rural Nebraska 6. Federal Plan 7. Local Office The activity level of these groups will vary throughout the planning and implementation phases of the Children’s Health program. News Release On October 2, 1997: Governor Ben Nelson announced that he would propose during the next legislative session development of a health care plan for Nebraska's low-income children. Nebraska will take advantage of federal funding of approximately $14.8 million during fiscal year 1998 to create expanded health insurance coverage for uninsured children under the federal Balanced Budget Act of 1997. The plan will - *improve access to quality health care and promote continuity of care; *cover as many young Nebraskans as possible in a cost-effective manner; and *improve the health of children by providing preventive care and treatment. Expanding health care services for uninsured children is a significant component of Governor Nelson's Success 2000 program. It builds on the Governor's Nebraska Good Beginnings program, which emphasizes improved access to community-based services that promote the development of strong families and healthy children from birth to age two. First Lady Diane Nelson has been the honorary chair of the Good Beginnings program since its inception in 1992. Legislative Hearing on 10/31/97: The Nebraska Legislature held a hearing to consider Legislative Resolution 186, introduced in the 1997 Legislative session. The purpose of this resolution is to study health care availability for uninsured children. Because of the ensuing passage of the Balanced Budget Act of 1997, including the State Children’s Health Insurance Program (SCHIP), this hearing became a forum to consider the proposed Children’s Health Initiative in Nebraska. Individuals testifying at this hearing included: Senator Chris Butler; Jeff Elliott, Director of Finance & Support - who described the framework for expanding Medicaid to include targeted low income children under Title XXI; Steve Frederick, HHS Finance & Support; Marcia Spilker, Nebraska Association of School Nurses; Allen Dvorak, M. D., president of the Nebraska Medical Association; Kris Morrissey, Director of Policy with Voices for Children in Nebraska; David Corbin, Ph.D., President of the Nebraska Public Health Association; Ric Compton, Medicaid Administrator; Lorrie Benson, Executive Director of Nebraska Community Action Agencies; Randy Boldt, Blue Cross/Blue Shield of Nebraska; Stacie Bleicher, M.D., president of the Nebraska chapter of the American Academy of Pediatrics; Dick Netley, parent of a consumer; Father Val Peter of Boys Town; Bill Arfman, Director of NAPE/AFSME; Mike Zgud, Chair of the Board of Directors of NAPE/AFSME; Sister Norita Cooney, chair of the Board of Alegant Health; Donna Polk, Executive Director of Nebraska Urban Indian Health; Dennis DeRoin, M.D., Nebraska Academy of Family Physicians; Natalie Clark, Executive Director of the Lancaster County Medical Society; Earl Brown, member of the Nebraska Medicaid Client Advisory Group; Ann Oertwich, Executive Director of the Nebraska Nurses’ Association; Roger Keetle, Nebraska Association of Hospitals and Health Systems; Merv Riepe, Executive Director of the Children’s Health Network; Jay and Peggy Chasen, citizens; and Tom Bassett, Executive Director of the Nebraska Dental Association. The testimony presented at this hearing was generally supportive of the proposed Children’s Health Initiative. Joint Statement On Children’s Health: On December 15, 1997, Governor Ben Nelson announced the release of a Joint Statement on Comprehensive Health for Nebraska Children and Youth. The statement was developed over the past 18 months by the Nebraska Health and Human Services System, Nebraska Chapter of the American Academy of Pediatrics, Nebraska Academy of Family Physicians, and Voices for Children in Nebraska. The statement called for a partnership with families, health care providers, businesses, insurers and government to ensure the health and well-being of children and their families. Public Hearing On December 18, 1997: The Health and Human Services System held a public hearing on proposed rules that would expand Medicaid eligibility for children age 15 to 18 years old up to 100% of federal poverty level (phase 1 of the Children’s Health Initiative). This is the initial phase of Nebraska’s plan to implement Title XXI of the Social Security Act. A notice of rulemaking was published on November 17, 1997 in the Omaha World Herald. News Conference On January 8, 1998: The Governor held a news conference on the Children’s Health Plan on January 8, 1998, at Beals School in Omaha. The purpose of this news conference was to announce his plan to provide health care coverage to Nebraska children who are not insured because of low income. The program, named Kids Connection, is part of the Governor's Success 2000 agenda, and one of his initiatives for the 1998 session of the Nebraska Legislature. Kids Connection would improve access to quality health care and promote continuity of care, cover as many young Nebraskans as possible in a cost-effective manner, and improve the health of children by providing preventive care and treatment. State of the State Address on January 12, 1998: In his state of the state address, Governor Nelson emphasized the importance of making sure Nebraska’s children are growing up healthy. With a focus on children and families, the Governor proposed the Kids Connection program (under Title XXI of the Social Security Act) to provide Nebraska’s children with basic health coverage by using existing state funds to match new federal funding. The state funding for Kids Connection is part of a new health trust fund, another Success 2000 initiative. This fund is designed to slow the rapid rise in health care costs by making sure appropriate care is available across the state. News Conference on April 13, 1998: Governor Nelson signed LB 1063, which expands health care coverage for children up to 185 % of the federal poverty level under a new program called Kids Connection. Governor Nelson signed the legislation surrounded by children at the University Child Care program housed at Lincoln’s YWCA. Outside Meetings: Health and Human Services System staff have been involved in the following meetings or presentations to discuss Kids Connection (this is not an all-inclusive list): The Policy Secretary has participated in the following meetings, appearances, etc. regarding Kids Connection: December 11 - Kids Count December 15 - Access Medicaid December 17 - Meeting with Governor Nelson December 18 - Nebraska Partnership Council December 23 - Meeting with Senators Beutler, Landis and Wesely, and Tim Becker, Governor’s Chief of Staff January 8 - Governor's Press Conference on SCHIP January 9 - Governor's Committee for Protection of Children January 14 - Lincoln Bridge Team January 14 - Nebraska Health Care Association January 24 - Southeast Nebraska Rural Physicians Association (SERPA) January 28 - CAP and Local Health Directors January 28 - CAP and Local Health Directors January 28 - Report to Senator Butler January 29 - Legislative Hearing on Children’s Health Insurance February 9 - Meeting with Natalie Clark, Lancaster Co. Medical Association. Steve Frederick, Strategic and Financial Planning (in addition to public hearings and other meetings): August and September: Three meetings were held with Blue Cross/Blue Shield, Don Macke, and Don Leuenberger (Policy Secretary at the time) and Nebraska Community Development about developing a Caring Program in light of Title XXI. September 18: Health and Human Services System Partnership Meeting in Chadron October 16: HHS Partnership Health and Well-Being Subcommittee Meeting November 5 and 19: Children’s Health Clinic Meeting in Omaha February 11: Meeting with Northeast Area Hospital Administrators in Norfolk to discuss Title XXI proposal (Note: Four other meetings were held in Scottsbluff, North Platte, Geneva, and Kearney where Dennis Mohatt and Dave Palm presented on Title XXI.) Tom Ryan, Project Manager for Kids Connection, participated in the following: March 23: Presentation to approximately 600 members of the Nebraska Rural Community Schools Association in Kearney April 17: Meeting with representatives of the Ponca Tribe April 17: Conference call with approximately 12 Nebraska WIC directors April 21 and 22: Area meetings with the Nebraska Association of Hospitals and Health Systems in Lincoln and Norfolk (in addition, Ric Compton participated in similar meetings in Ogallala (in person) and in Kearney (via video) April 28: Meeting with representatives of the Santee Sioux Tribe This is not an all-inclusive list; other HHSS staff have also participated in meetings related to Kids Connection that are not listed in this document. Staff in the Governor’s Policy Research Office have also participated in outside meetings related to Kids Connection. Jennifer Williams participated in the following meetings: 9/11-9/12 - National Governor's Association Children's Health Insurance Program Conference in Washington, D.C. 9/19 - Meeting with Senators Chris Butler, Don Wesely and David Landis, Tim Becker, Don Leuenberger, Steve Frederick 11/07 - Commission for the Protection of Children 11/14 - Child Care and Early Childhood Education and Coordinating Committee (CCECECC) 11/17 - Meeting with Randy Boldt of Blue Cross/Blue Shield 11/20 - Head Start State Collaboration Team 1/9 - HHS Regional Conference on Children's Health Insurance Program in Kansas City, MO 2/3 - NGA Title XXI Conference Call 9.10. Provide a budget for this program. Include details on the planned use of funds and sources of the non-Federal share of plan expenditures. (Section 2107(d)) Phase 1 of Kids Connection will add an estimated 950 children when full participation is reached. Based on average costs for children per month, projected to FFY 1999, $1,309,800 is estimated in program costs ($943,000 FFP). Since applications will not be taken and acted on for every child on the effective date, it is estimated that May 1998 through September 1998 costs would be $318,000 ($229,000 FFP). Because of the phase-in of 100 % of poverty eligibles, children will move out of this program and into Title XIX. The amount of enhanced funding through Title XXI is estimated as follows: FFY 1998 $ 318,000 FFY 1999 $1,309,000 FFY 2000 $1,011,000 FFY 2001 $ 694,000 FFY 2002 $ 357,000 Administrative activities and outreach that will be claimed at the enhanced match rate would be about 6 percent of program costs. That is, $19,080 the first FFY; $78,500 the second fiscal year, and so on. State general funds will be used as the source of matching funds for the non-federal share. Section 10. Annual Reports and Evaluations (Section 2108) 10.1. Annual Reports. The state assures that it will assess the operation of the state plan under this Title in each fiscal year, including: (Section 2108(a)(1),(2)) 10.1.1. X The progress made in reducing the number of uncovered low- income children and report to the Secretary by January 1 following the end of the fiscal year on the result of the assessment, and 10.1.2. X Report to the Secretary, January 1 following the end of the fiscal year, on the result of the assessment. Below is a chart listing the types of information that the state’s annual report might include. Submission of such information will allow comparisons to be made between states and on a nationwide basis. Attributes of Population Number of Children with Creditable Coverage XIX OTHER CHIP Number of Children without Creditable Coverage TOTAL Income Level: 0-17 (1990) < 100% NA NA 58,474 < 133% NA NA 81,837 < 185% NA NA 150,088 < 200% NA NA 167,519 > 200% NA NA 256,768 Age 1996 Data 1996 Estimates 1996 Estimates 0 - 1 12,014 1,151 23,024 1 - 5 29,640 7,300 121,680 6 - 9 15,477 6,432 98,948 10 - 14 15 - 18 15,637 9,028 8,447 6,584 129,949 101,287 Race and Ethnicity 1998 Estimates American Indian or Alaskan Native NA NA 6,192 Asian or Pacific Islander NA NA 7,171 Black, not of Hispanic origin NA NA (B-25,956) 25,000 Hispanic NA NA 26,843 White, not of Hispanic origin NA NA (W-439,451)413,263 Location MSA NA NA 223,355(1990) Non-MSA NA NA 228,253(1990) 10.2. X State Evaluations. The state assures that by March 31, 2000 it will submit to the Secretary an evaluation of each of the items described and listed below: (Section 2108(b)(A)-(H)) 10.2.1. X An assessment of the effectiveness of the state plan in increasing the number of children with creditable health coverage. 10.2.2. A description and analysis of the effectiveness of elements of the state plan, including: 10.2.2.1. X The characteristics of the children and families assisted under the state plan including age of the children, family income, and the assisted child’s access to or coverage by other health insurance prior to the state plan and after eligibility for the state plan ends; 10.2.2.2. X The quality of health coverage provided including the types of benefits provided; 10.2.2.3. X The amount and level (including payment of part or all of any premium) of assistance provided by the state; 10.2.2.4. X The service area of the state plan; 10.2.2.5. X The time limits for coverage of a child under the state plan; 10.2.2.6. X The state’s choice of health benefits coverage and other methods used for providing child health assistance, and 10.2.2.7. X The sources of non-Federal funding used in the state plan. 10.2.3. X An assessment of the effectiveness of other public and private programs in the state in increasing the availability of affordable quality individual and family health insurance for children. 10.2.4. X A review and assessment of state activities to coordinate the plan under this Title with other public and private programs providing health care and health care financing, including Medicaid and maternal and child health services. 10.2.5. X An analysis of changes and trends in the state that affect the provision of accessible, affordable, quality health insurance and health care to children. 10.2.6. X A description of any plans the state has for improving the availability of health insurance and health care for children. 10.2.7. X Recommendations for improving the program under this Title. 10.2.8. X Any other matters the state and the Secretary consider appropriate. 10.3. X The state assures it will comply with future reporting requirements as they are developed. 10.4. X The state assures that it will comply with all applicable Federal laws and regulations, including but not limited to Federal grant requirements and Federal reporting requirements. Nebraska's Phase I Plan