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                     GRANT #P-91478/3
        Quarterly Report (April through June 30, 2002)


  A. Buy-In Programs

           1) DMAS continued meeting with the Northern Virginia Workforce Investment
              Board's OneSource Project on a subcommittee to develop a pilot project to
              address issues relating to education/communication between Social Security
              Administration (SSA) and Virginia Department of Social Services (DSS)
              offices regarding Section 1619(b) of the Social Security Act.

               Background: During the course of evaluating potential target populations for
               a future Medicaid Buy-In program, the Virginia Department of Medical
               Assistance Services (DMAS) concluded that there was an apparent statewide
               problem with under-enrollment of SSI recipients who were eligible for
               Medicaid coverage under Section 1619(b) of the Social Security Act.
               Further, this under-utilization appeared to result from confusion or lack of
               knowledge about 1619(b) eligibility and Medicaid enrollment on the part of
               consumers, providers and the agencies and organizations that serve them. As
               a result of discussions with technical experts, DMAS agreed to establish a
               pilot project to address the issues. Given the multitude of stakeholders
               (consumers, state and federal agencies, public, private and non-profit entities),
               the smaller scale of a pilot would better lend itself to gaining cooperation and
               direct participation by these individuals and organizations, especially since the
               basic problem(s) seemed to be insufficient communication/education across
               the board.

               A pilot in Northern Virginia was determined to be a logical geographic-
               demographic option due, in part, to the area's higher average income level.
               The rationale being that working SSI participants in Northern Virginia,
               therefore, would be more readily able to exceed the earnings' ceiling for SSI
               and would want to retain their Medicaid by participating in the State's Buy-In
               program. Two employment support organizations readily agreed to
               participate in a pilot. Subsequent meetings with the potential partners led to
               an opportunity to work with the members of the OneSource Project of the
               Northern Virginia Workforce Investment Board, which brought numerous
               other players and perspectives to the discussion and greatly expanded the
               opportunity for success that will then be replicated statewide. The pilot will
   be further enhanced and tested by the inclusion of communities that are urban,
   suburban and rural. This pilot will serve a working model that can be
   replicated statewide, lays the groundwork for future Medicaid Buy-In testing
   and will further expand the public-private partnership that is so important to
   the success of a Medicaid Buy-In program. Educational efforts are already
   underway at local DSS offices in the region. Agreement was also reached
   with SSA and 1619(b) training will be included in their upcoming Ticket to
   Work training. The pilot team is now preparing/designing an educational
   component for benefits specialists and other professionals as the next phase of
   the project. Consumer education will then follow to complete the process.
   The pilot is expected to be completed by year's end.
2) The Medicaid Buy-In (MBI) Workgroup planned and conducted an Employer
   Leadership Forum breakfast on June 18, 2002. The meeting was hosted by
   SunTrust Bank and held in their Board Room. Lieutenant Governor Kaine,
   who also chairs the Virginia Disability Commission, facilitated the meeting
   and the previous Lieutenant Governor, John Hager, also participated in
   meeting facilitation. The meeting was intended to solicit input from a select
   group of small, medium and large employers on the Medicaid Buy-In as an
   economic and workforce opportunity for Virginia businesses. The forum
   included a brief video about the MBI in New Hampshire and several speakers
   who elaborated on disability issues and the potential benefit of a MBI. The
   meeting was attended by approximately 30 employers from throughout the
   state and they expressed a great deal of interest in the concept of a Medicaid
   Buy-In program. Attendees offered advice on program design as well as
   describing how this type of opportunity could assist existing employees at
   their companies.
3) DMAS finalized arrangements for a "listening tour" that will be conducted
   throughout the state during the summer. The purpose of the listening tour will
   be to gain input, advice, and recommendations from a broad array of
   stakeholders who are interested in and/or would be impacted by a Medicaid
   Buy-In program in Virginia. DMAS has contracted with Virginia
   Commonwealth University Survey and Evaluation Research Laboratory
   (VCU SERL) to organize and conduct this activity. The “listening tour” will
   solicit ideas and concerns about a Virginia Medicaid Buy-In from individuals
   with disabilities, healthcare providers, advocates, government agencies and
   other key stakeholders. VCU will provide a professional facilitator who will
   report on each session’s proceedings in an individual report and a cumulative
   report. DMAS staff will be present at each session which will take place in
   following cities:
                       Richmond, July 22
                       Virginia Beach, July 24
                       Manassas, July 26
                       Abingdon, July 31
                       Roanoke, August 1
   Each site will have two meetings with the afternoon sessions consisting of
   consumers and providers and the morning sessions involving advocates and
   agency (state & local) representatives. Each session are expected to last from
   two to three hours.
4) The Medicaid Infrastructure Grant Advisory Committee was established
   following statewide solicitation of consumer, consumer advocate, provider
   and employer nominations for membership. The Commonwealth's Secretary
   of Health and Human Resources, Jane H. Woods, addressed the inaugural
   MIG Advisory Committee Meeting on May 28th and emphasized that
   Virginia is very interested in implementing a MBI. The meeting was attended
   by more than 60 individuals representing providers, advocacy groups,
   individuals with disabilities, and State agencies. Key speakers were Mike
   Cheek, American Public Human Services Association (APHSA), and Susan
   O’Mara, Virginia Commonwealth University RRTC. The speakers addressed
   the audience on the history of Buy-In, design and program parameters, and
   what is going on in other states. Following a morning session of
   introducing/educating the group on Medicaid Buy-In, a breakout session was
   held consisting of three subcommittees: technical design;
   communication/education; and coordination of services. Committee members
   actively participated in discussions and regrouped later in the afternoon to
   share their initial efforts and discussions with the other members.

   Subsequent separate meetings of the subcommittees were conducted and will
   continue during the summer to outline specific issues and possible solutions
   for a Virginia MBI in developing recommendations for the full Committee's
   consideration. DMAS staff will be at each meeting to supply information and
   support. DMAS will use the Advisory Committee’s recommendations as part
   of the DMAS report to the Virginia Disability Commission in November
   2002. A list of participants in included as Attachment A. The committee and
   subcommittee agendas are Attachment B.
        On June 20th, staff participated in a meeting of the Coordination
           Subcommittee of the MIG Advisory Committee. The subcommittee
           discussed services like housing, transportation, and food stamps that a
           MBI could affect and the need for additional information before the
           group could make recommendations. Members of the group will
           attain more information and meet on August 9th to discuss how to
           coordinate services with associated government agencies.
        On June 24th, staff participated in a meeting of the
           Communication/Education Subcommittee of the MIG Advisory
           Committee. The group will meet again on July 16th after the group
           has had a chance to compile more background information.
        On June 25th, staff facilitated a meeting of the Technical Design
           Subcommittee of the MIG Advisory Committee. During a discussion
           on the “Principles for Development of a Medicaid Buy-In Program for
           Virginia,” the group recommended adding language that intends “to do
           no harm”, provide for a safety net and to reinforce the positive impact
           on the community. Income and resource eligibility criteria will be
           addressed at the next meeting on July 17.
5) Staff met with Valerie Marsh, Executive Director, of the Virginia Chapter of
   the National Alliance for the Mentally Ill (NAMI) on May 10. Ms. Marsh
   expressed interest in a Medicaid Buy-In and appreciated DMAS sharing
   information. Staff then attended and provided an informational booth on MBI
            initiatives on May 31st at the NAMI-VA Annual Convention in Richmond.
            The booth provided and opportunity to handout educational information to
            future potential participants and healthcare providers.
         6) On May 23rd, DMAS Policy Director participated in DRS Commissioner’s
            Task Force on the Ticket to Work and Work Incentive rollout in Virginia.
            DRS requested a DMAS representative to help coordinate the implementation
            of the Ticket to Work Program in Virginia with a Medicaid Buy-In program.
         7) DMAS has contracted with the VCU Survey Evaluation and Research
            Laboratory to conduct survey research involving Medicaid recipients in the
            Blind and Disabled program categories. The research will involve a mail
            survey to the Blind and Disabled Medicaid population in Virginia as part of
            the Medicaid Buy-In project. The purpose of this research is to investigate the
            health care knowledge and experience of the Blind and Disabled Medicaid
            recipients; their health insurance status and needs; their ability to work, work
            hours and earning capacity. The survey will be distributed in mid-July.

      Next Steps
         1) Continue meeting with the Northern Virginia Workforce Investment Board
             (NVWIB) to work with the OneSource Project on a pilot program.
         2) Continue with MBI Workgroup meeting soliciting information and
             participation in the development of Medicaid Buy-In options.
         3) Continue Medicaid Infrastructure Grant Advisory subcommittee meetings to
             development Medicaid Buy-In recommendations for the full committee.
             These recommendations will be part of a report to the Medicaid Infrastructure
             Grant team’s report to the Disability Commission in November 2002.
         4) Conduct the “listening tour” in the five regions of the State. The purpose of
             the tour will be to gather more information from consumer, advocates,
             providers, and other government agencies.
         5) Conduct, along with the VCU SERL, a survey of Virginia’s Blind and
             Disabled Medicaid population to determine their health insurance needs, their
             ability to work, work hours and earning capacity.

B. Personal Assistance Services (Home and Community Based Services Waivers/ HCBS)

         1) DMAS management team gave final approval for Elderly & Disabled
            Provider Manual changes. Waiver changes added personal assistant services
            in the workplace. A copy of the manual page is Attachment C.

C. Other Program Design Features

         1) Staff attended a meeting of the Employment Services Organization Advisory
            Committee at the Department of Rehabilitative Services (DRS) offices on
            April 4th. Staff gave a slide presentation updating the group on the MBI and
            its efforts on 1619 work incentives.
            2) Staff attended the conference “Supporting People with Disabilities to Build
               Careers” from April 28-30 in Washington, D.C., which was sponsored by the
               Center for Workers with Disabilities, American Public Human Services
            3) Staff attended the Employment Network Opportunity Conference regarding
               the Ticket to Work Program conducted by the SSA Ticket contractor
               MAXIMUS on May 2nd. The conference was held to advise and encourage
               potential Employment Network contractors to serve Ticket holders. Jack
               Quigley, MIG Manager, gave the afternoon conference an unscheduled update
               on the Medicaid Buy-In progress in Virginia.
            4) The Policy Director attended the State of the Science Conference on
               Workplace Supports in McLean, Virginia on June 3, 2002. Mr. David Dean
               from the University of Richmond presented on the longitudinal data he has on
               Virginia’s Vocational Rehabilitation closures.


A.   Technical Assistance State Received
     1) APHSA Conference calls:
        a) April 18: General APHSA member call
        b) May 16: Personal Assistant Services (PAS)
        c) May 30: General APHSA member call
        d) June 11: Employer Relations
        e) June 13: Employment Support Programs
        f) June 18: MBI Discussion Forum
        g) June 19: Third Party Liability
        h) June 20: PAS
        i) June 28: General APHSA member call
     2) The Virginia Commonwealth University’s (VCU) Rehabilitation Research and
        Training Center (RRTC) on Workplace Supports and Benefits Assistance Resource
        Center along with the American Public Human Services Association Center
        (APHSA) for Workers with Disabilities combined resources to produce Supported
        Employment Telecourse NETwork (SET NET) 2002. This three part series on Social
        Security work incentives and Medicaid benefits includes instruction via a live
        telecast, live question and answer sessions, and discussion. The SET NET provided
        additional information on SSA policies and how these policies may interact with a
        Virginia Medicaid Buy-In. DMAS staff participated in the following broadcasts:
        a) April 24th, “SSI and Work Incentives Overview”
        b) May 22nd, “SSDI and Work Incentives Overview”
        c) June 26th, “Developing Comprehensive Employment Supports Infrastructure”.
             During this presentation, presenter and technical consultant Michael Cheek
             (APHSA) acknowledged Virginia’s efforts in identifying 1619 (b) issues and then
             collaborating with groups on outreach and education.
     3) On June 14th, staff met with Mike Cheek (APHSA) in preparation for the MBI
        listening tour. Staff and Mike Cheek decided on key questions to pose during the

   Technical Assistance Proved to Others
      1) DMAS has exchanged technical assistance with SSA (regional and national) and the
         Department of Information Technology about Beneficiary and Earnings Data
         Exchange (BENDEX) and the State Data Exchange (SDX).
      2) DMAS has provided similar assistance to DSS.
      3) DMAS continued to provided technical assistance concerning matching former Social
         Security SSI beneficiaries to current Medicaid recipients by using Beneficiary and
         Earnings Data Exchange (BENDEX) and the State Data Exchange (SDX) information
          John Alexander, Nevada Medicaid
          Jerry Graf, Nevada Welfare Administration
          Eileen Wardle, Idaho Department of Health and Welfare
      4) Mike Cheek, APHSA – exchange of various state information.
      5) Deborah Austin, Oklahoma Disability Services Coordinator – provided regulations on
         Personal Assistant Services (PAS) in the workplace for Virginia home and
         community-based waivers on June 12th.
      6) John Alexander, Nevada MIG Project director – provided information about 1619 (b)
         consumer and provider educational materials on May 30th. 1619 (b) information
         included a consumer flyer, a provider fact sheet, an overview of 1619 (b), and referral
         letters meant to aid SSA with enrolling1619 (b) eligible individuals.

   Is there any additional assistance which CMS Central Office or your CMS Regional Office
   could provide to help your State reach the goals of your Medicaid Infrastructure Grant?

          1) CMS should share state plans, waivers and state plan amendments related to MIG
          2) It would be highly beneficial to the states if CMS can influence the SSA to share
             data. In addition, there is need for SSA to reeducate their local staff as well as the
             consumer on Section 1619 (b).


      Attachment A: Advisory Committee participants
      Attachment B: Advisory Committee and Subcommittee agendas
      Attachment C: Elderly & Disabled Provider Manual change

Reported by: Kathryn T. Kotula
             VA DMAS, Director, Division of Policy and Research
             Medicaid Infrastructure Grant - Virginia


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