Minutes

Statewide Health Care Transition Services Task Force

For Youth and Young Adults with Disabilities

Finance and Structure Subcommittee

Teleconference Call

September 26, 2008

ATTENDEES:

Phyllis J. Sloyer, R.N., Ph.D., PAHM, FAAP,Division Director, CMS; Subcommittee Chair

Joseph J. Chiaro, M.D., FAAP, Deputy Secretary, CMS

Janet Hess, MPH, CHES, Facilitator, Early Childhood Council

Debbie Richards, MSW, Program Manager, Florida Developmental Disabilities Council

Jorge Sallent, M.D., Pediatric Pulmonologist

Gerry Smith, (for Mary Beth Senkewicz), FloridaOffice of Insurance Regulation (FLOIR)

Meg Comeau, MHA, Project Director,CatalystCenter, BU

Carol Tobias, MMHS, Co-Director, CatalystCenter, BU

Patty Hackett, M.Ed., Co-Principal Investigator (PI), Healthy Ready to WorkNationalResourceCenter

CALL TO ORDER:

Phyllis Sloyer, Chair, called the meeting to order at 11:35 AM.

APPROVAL OF THE MINUTES FROM LAST MEETING:

A motion was made by Dr. Chiaro to accept minutes fromthe September 5 meeting and seconded by Debbie Richards. The minutes were unanimously adopted.

DISCUSSION:

Dr. Sloyer introduced Meg Comeau and Carol Tobias from the CatalystCenter at BostonUniversity (a NationalFinanceResourceCenter for CYSHCN funded through the federal Maternal and Child Health Bureau) and Patti Hackett, Co-PI of the federally funded Healthy and Ready to WorkNationalResourceCenter.The three experts were asked to participate in the call to provide feedback and guidance on the financing matrix that thesubcommittee is developing.

Each guest felt that the matrix will be a valuable tool for families, providers, and other stakeholders in identifying insurance benefit options and opportunities in Florida. Ms. Hackett envisions the matrix being developed into an interactive, web-based resource that other states could adapt. Discussion items included:

Matrix Format

  • The private health insurance section should be listed first on the matrix, before publicly-funded health programs.
  • There should be a column for excluded conditions or special circumstances.
  • The matrix should include guidance/tips/clues for applicants concerning how determinations are made for particular programs. A recommendation also was made to include the statement, “It is important to work with an experienced medical team when completing the paper work for this in order to maximize opportunities for eligibility.”

Private Plans:

  • Adult Disabled Dependent Child via Family Plan (in Florida, called “Handicapped Children’s Act”) provides an option for individuals who are mentally retarded or physically handicapped.
  • A question arose about possible exclusion for children with mental health conditions and/or developmental disabilities (for example, a child with CP who has no mental retardation). Ms. Smith will investigate and report back to the subcommittee. Ms. Smith confirmed that every health insurance company doing business in Floridathat provides coverage for a dependent child must offer thisthe optionof continuing coverage for a dependent child if the child continues to be both incapable of self-sustaining employment by reason of mental retardation or physical handicap and is dependent on the policyholder for support and maintenance. The dependent child would have to meet the above criteria to be covered. If the disabled dependent meets these criteria and is covered under the policy, whatever coverage there is in the policy contract for mental health and developmental disabilities would be extended to the “disabled dependent” as well.
  • Dr. Chiaro asked whether insurance companies can alter the premium rate on individual policies based on the family’s financial history. Ms. Smith said that the answer is “no” for in-state policies, but the Florida Office of Insurance Regulationdoes not regulate rates for out-of-state policies.
  • With respect to income limits, there are income limits for the adult disabled child because the adult with disabilities can’t be gainfully employed. However, there are no limits on the disabled adult’s family income. Regarding the definition of “meaningful gainful employment,” Ms. Comeau stated that an individual who is providing at least 50% of his/her financial support for housing, food, etc., is considered a self-supporting adult. If the individual earns a small amount of money in a sheltered workshop or vocational skills program but is making less than 50% of his/her support, eligibility should not be a problem.
  • Phyllis recapped that this plan is probably a good option if the individual has a Florida-based group insurance policy (not individual policy), and assuming that the definition of “mentally or physically handicapped” includes mental health conditions and developmental disability without mental retardation.
  • Adult Dependent – Student Status via Family Plan provides an extension of coverage for studentsregardless of disability. A caution for students who are on an HMO plan and attend an out-of-state school: out-of-state providers are considered out-of-network,so pre-approval is required for services other than emergency care. The extension currently is up to age 25, but will increase this fiscal year to age 30 under the new Cover Florida law.
  • Expanded Age for Dependent Coverage via Family Plan (new Cover Florida component) provides for expansion of coverage up to age 30:
  • It allows a 63-day lapse in coverage.
  • A question arose about how families are assisted in understanding plan requirements and deadlines. Ms. Smith said the responsibility will lie with the insurance companies.
  • It was suggested that the matrix define the age range of “young adults” (ages 18-30) and that we provide references for statistics that are cited (e.g., Commonwealth Fund report).
  • A question surfaced about whether the Cover Florida law will be adopted by ERISAplans. Ms. Smith indicated it is still to be determined and noted that the Office of Insurance Regulation has very limited authority to regulate ERISA plans. Generally ERISA plans are not required to comply with state regulations. ERISA plans currently cover approximately 50% of Florida employees and sometimes offer better benefit packages than other plans. A suggestion was made to include a separate section about things to be considered with ERISA plans.
  • Court-Ordered Health Care Benefits gives courts the power to order divorcing parents to maintain their child’s health insurance regardless of the cost. It appears that there is no age limitation if dependency is due to a mental or physical handicap that began prior to age 18 - but we need to better understand what the statute says. This is not a health insurance plan, so should beadded to commentary at the end of the matrix.
  • The Self-Employed option provides a tax break on insurance coverage for individuals who own their own business. It should be included in the commentary section.
  • Some state Title V programs use their block grant dollars to pay for COBRA, i.e., extend health insurance benefits for children who have lost private insurance coverage. It is a very expensive option and many state Title V programs are not using resources to pay for direct services or insurance coverage.

Public Plans:

  • Consensus was reached to organize this section by highlighting Medicaid benefits for those under age 21 versus benefits for those age 21 and older.
  • It is noted that SSI beneficiaries automatically receive Medicaid benefits.
  • It was suggested that the Ticket to Work option be moved to a “considerations” section since it is not really a health insurance benefit. It does, however, impact access to Medicaid coverage by allowing individuals to remain SSI beneficiaries while working.
  • Under the Medicaid Buy-In option, individuals must have a disability that would qualify them for SSI except for income. The SSI disability criteria may limit those who could use this option.It is important to note that SSI eligibility under age 18 is based on functional status while SSI eligibility over age 18 is based on employment impact status.
  • Medicaid Waivers should be included in the section with adult benefits. We might consider an additional attachment that itemizes the services, eligibility criteria and caps for each waiver. Waivers include Cystic Fibrosis; Aged and Disabled Adult;Consumer Directed Care:Developmental Disabilities (e.g., includes behavior analysis, respite; large waiting list);Familial Dysautonomia (limited to a very small number of children; no waiting list right now); and others. There are multiple waivers available in Florida.
  • The Medically Needy program, Vocational Rehabilitation, Community Health Centers, and Voluntary programs should be moved to another section because they do not provide continuous coverage.

Prior to the next teleconference, Dr. Sloyer recommended that we add Medicare to the matrix, make corrections discussed today, and resend the matrix to subcommittee members for feedback.

ADJOURNMENT

The meeting was adjourned at 1:10 P.M.