Louisiana’s Plan for DSH Flexibility: Expanding Access to Health Care for the Uninsured Madeline W. McAndrew Senior Health Care Advisor Department of Health and Hospitals May 2005 Background Louisiana has a high number of uninsured. Louisiana ranks 50th in health status. There is limited access to preventive and primary care across the state. Care for the uninsured tends to be hospital-based. Health Care Reform Activities to Reduce the Number of Uninsured Increasing enrollment in existing Medicaid programs i.e. LAChip, LAMoms, etc. Expanding eligibility through submittal of a HIFA Waiver Maximizing utilization of federal programs – Pharmacy 340B Program Collaborating with regional and local efforts to reduce the number of uninsured. What is DSH Funding? The DSH program is a state-federal program that pays for care for the uninsured. Currently DSH funding is utilized to pay for hospital-based inpatient and out-patient services. DSH funding does not pay for physician services, except in rural health clinics operated by a hospitals. What is DSH Funding? The state must put up “match” in order to draw down federal DSH dollars. Louisiana has a DSH cap that it cannot exceed. In fiscal year 2005/06, Louisiana does not have sufficient state funds identified to draw the entire DSH allotment available to our state. What is DSH Funding? The state’s match can come from: – State appropriations; – Local funds; and/or – Certified Public Expenditures - the expenditure of local public funds that are then certified (CPEs). The Plan Improve the health status and reduce the number of uninsured by amending the pending HIFA waiver to create a funding pool using disproportionate share (DSH) funding. Health Insurance Flexibility and Accountability Waiver (HIFA) Federal Waiver Opportunity which allows states to expand to health insurance coverage. Submitted to CMS November, 2004 Four components: – LaHIPP – LaChoice – Federalization of the Louisiana Health Plan The Plan Under the amended HIFA waiver, the state’s entire DSH allotment will be placed in a flexible funding pool. The funding pool will: – Continue to support hospitals that serve a disproportionate share of Medicaid and the uninsured; – Reimburse some infrastructure expenditures; The Plan The funding pool will (continued): – Reimburse physician service and certain other medical services expenditures for the uninsured population; and – Support regional and local efforts to provide health care to low-income (under 200% FPL) uninsured adults by expanding access to preventive and primary care as well as coverage. The Plan How will this plan assist regional and/or local efforts to increase access and coverage to the Uninsured? The Plan Part of the unused portion under the DSH cap will be used for the regional/local efforts. The required match for the regional/local efforts can be provided through local funds and/or certified public expenditures. The Plan The regional/local efforts portion of the waiver will provide an opportunity to: – Expanding the availability of primary & preventive care to the uninsured; – Providing health insurance coverage to the uninsured; and – Meeting the state’s disease management goals. The Plan - Increasing Access to Primary and Preventive Care Funds from the pool shall be used for activities that increase the amount of primary and preventive care for the uninsured. Examples include but are not limited to: – Developing new or expanded FQHC and RHC sites; – Expanding the services in other public or private community-based primary care clinics or physician offices; The Plan - Increasing Access to Primary and Preventive Care Examples: (continued) – Expanding the services of parish health units to include a full range of primary care services; and/or – Expanding primary care services at LSU clinics. The Plan - Increasing Coverage Regional/local efforts may want to provide health insurance coverage to the low-income uninsured in their communities. Examples: – Expand the LaChoice program – Three-Share – Public HMO The Plan - Disease Management Any regional/local approach (access or coverage) must address Louisiana’s disease management goals. Strategies for meeting Disease Management goals include: – Implementing electronic medical records; – Tracking individuals with chronic diseases; – Implementing performance measures; and/or – Monitoring and reporting on quality outcomes. Funding – Allowable Sources for Match Acceptable Not Acceptable Certified Public Expenditures Federal Dollars Medicaid Provider New or recycled Public Entity Covered Eligible within DSH Waiver Provider Donations Covered Benefit within DSH Waiver Transfer of Local Funds Governmental Entity Tax/Millage Tax/Millage generated Foundation Grant Money The Plan Each parish within a region will be allotted a capped amount of available DSH allotment to be matched with local funds. Interested applicants must submit applications to DHH for funding. – Applications must demonstrate a legitimate source of match, community need and impact, and fulfill other requirements as outlined by DHH. The Plan How much of the local match will return to the local entity? – The local entity will receive their contribution plus the federal match to be used for health care services under the waiver less DSH funds for administrative costs on the state level. Next Steps Short-term – Passage of the Framework for Health Care bill (H.B. 565 by Representative Durand) – Obtain regional/local input – Submit an updated, more detailed concept to CMS Next Steps Long-term – Gain waiver approval from CMS – Obtain additional regional/local input and provide technical assistance – Develop the details and move toward implementation – Gain CMS approval for regional/local applications Questions? Email your consortium chair with additional comments.