Family Cost Participation in Georgia’s Part C System

Family Cost Participation in Georgia’s Part C System

Why FCP in Georgia? Precedent Initial Planning Stakeholder Involvement

GA Part C Demographics • Part C serving over 11,000 children per year • Narrow eligibility criteria (Revised Fall 2005) • 60.5% Medicaid eligible • 36.5% Private Insurance • 3.8% PeachCare (S-CHIP)

Georgia Demographics • Median Income of families with children (2004) = $46,400 ($50,800 nationally) • Percentage of Children Living in Poverty(100%): 21% (18% nationally) • Percentage of Children in Extreme Poverty (below 50% Poverty level) = 10% (8% nationally) Source: GA Kids Count

Determining Family Costs • Children with Special Needs Financial Analysis for Family Cost Participation includes review of the following: • Available funding sources (Medicaid, SCHIP, Title V, Private Insurance, etc.) • Number of family members • Gross household income • Unearned income • Out of pocket extraordinary expenses related to the child’s disability (used for "spend down”)

Please check () all programs child is currently enrolled in:  Medicaid #: ______________________ Indicate CMO, if applicable: ________________________  PeachCare for Kids #: ______________ Indicate CMO, if applicable: ______________________  Babies Can't Wait  Children’s Medical Services  High Risk Infant Follow-Up  Health Insurance Coverage

Family Size 07/01/06

VERIFICATION: (Only one form of verification is required.) CSN Staff or designee (i.e., service coordinator, care coordinator) must visually verify one of the three documents below for each parent. The document(s) verified must be those that illustrate the most accurate estimate of the family’s total gross income. Total gross income must be written in the box below. I verify that all information above is true and correct. ___/____/____ Printed Name of Parent Signature of Parent Date ___/____/____ Printed Name of CSN Staff/Designee Signature of CSN Staff/Designee Date

Determining Family Costs • Children with Special Needs Financial Analysis for Family Cost Participation: • Also used for Title V/CSHCN program cost participation • Includes standard definitions of earned income, unearned income, and resources not to be included as earned or unearned income • Includes descriptions of allowable extraordinary expenses

Determining Family Costs • Children with Special Needs Financial Analysis for Family Cost Participation includes: • Consent/Decline Access to Private Insurance form • Decline to Complete Financial Analysis for Cost Participation form

Determining Family Costs • Children with Special Needs Financial Analysis for Family Cost Participation: • Completed after eligibility determination, prior to IFSP development • Updated at least annually or more often if family financial status changes

Determining Family Costs • Children with Special Needs Financial Analysis for Family Cost Participation: • Completion of scale yields a percentage (0% - 100%) • Families are responsible for their percentage of the total cost for each unit/session of early intervention support/service

Family cost participation only applies to IFSP services that are not covered by third party fund sources (e.g. Medicaid, PeachCare for Kids, Children’s Medical Services, private insurance, etc.).

If families consent to access private insurance AND private insurance pays for any portion of a service, no additional cost is assessed to the family. The family’s contribution or cost share is fulfilled by the payment received from their private insurance.

Why does FCP Work for Georgia? • Consistent policies & procedures • Same criteria is applied to all families • Scheduled updates & revisions

Ongoing Review of Policy FCP scale is updated annually to include most current Federal Poverty Guidelines and other necessary changes

Modifications are Based on Ongoing Monitoring Local monitoring & site reviews Complaints Identification of new fund sources

Revisions that Occurred in Response to Ongoing Monitoring Revised Policies: FCP & Medicaid-eligibility - Provisions applied family cost participation to non-covered services for all families

Revisions that Occurred in Response to Ongoing Monitoring Revised Policies: “Spend Down” & Adjusted Income - Revisions to refine, clarify, and define allowable and disallowed “spend downs”

Revisions that Occurred in Response to Ongoing Monitoring Revised Criteria: For families with multiple children enrolled in Part C - Provisions to reduce FCP percentage by 5% for each child after the first enrolled child

Revisions that Occurred in Response to Ongoing Monitoring New Funding Sources & Coordination: • Private Insurance provisions • Expansion of FCP to Title V

Things previously considered but not implemented in GA • Out of pocket maximum costs per year for each family • Separate scales for families who access insurance and those who deny access

Why does FCP Work for GA? Consistent Policies: • Determination of “inability to pay” Ongoing Monitoring: • Widespread acceptance & expectations

Family Cost Participation -What’s Next in GA? Changes in Political and Economic Context: • Look at FCP fee scale, levels Infrastructure Changes: • Data system enhancements

Anticipated Possible Future Revisions • Flat fee per month for families rather than percentage of each unit of fee-for-service • Easier for families to budget monthly • Fits better with primary service provider/coaching approach to service delivery • Looking at states who have some variation of this model (CT, KY, MA, TX, VA, UT, WI)

Anticipated Possible Future Revisions • Data system changes (Central billing???) • Cannot currently report total funds collected through family cost participation system because fees are collected at the local provider level in GA

Consider this as you study FCP in your state… • Stakeholders • Data • Other options • Authority needed

Any Questions??? Georgia’s FCP forms are included in your Symposium materials. Contact Stephanie Moss at skmoss@dhr.state.ga.us or 404-657-2721

Family Cost Participation in Georgia’s Part C System