Healthy Kids

1. Healthy Kids Title V & Medicaid partnering to improve EPSDT in Nevada

2. Healthy Kids (EPSDT) Status • Weak levels of partnering across state agencies; low level of screening • High number of FQHC in Nevada • Due to frontier status; number of providers to residents • Lack of awareness when “green form” went away due to HIPAA initiation

3. Getting Started • Low numbers of screens and need identified by Medicaid and Title V agency • HRSA technical assistance- Sept. 2006 • Raise awareness; 26 topics identified as in need of change • Improve communication across agencies • Improve communication to families • Improve communication to community organizations • Workgroups met to address priorities (2007)

4. Workgroups formed Workgroups formed during the September Leadership Workshop (facilitated by K. Johnson & J. Resnick) • Tribal/FQHC/Co/MCO • Parent Support & Education • Auto Newborn • Cross-Linkages The groups’ progress is reported to the Maternal and Child Health Advisory Board (Title V)

5. Tribal/FQHC/County/MCO • Proposed activities: provider capacity, outreach to low-income children, MCO network; adequacy of payment for screens; Addressed: • Communication among these entities- typically did not cross paths prior to these meetings • Provider training/awareness; billing training • Work on subcontracts to be in MCO network • Work with Parent group for creative outreach

6. Parent Support & Education • Proposed activities: support parents in their role through education, motivation and knowledge of how to use the health care system; culturally appropriate materials Addressed: • Family developed brochure • Grass-root notification to parents • Review of letters sent by state system upon enrollment

7. Auto Newborn • Proposed activities: Review federal requirements and Nevada’s policy, streamline enrollment notification and reduce time since birth to receive screens; support for electronic birth certificate capacity Addressed: • Medicaid corrected computer system to allow earlier reception of screens • Electronic Birth Certificates passed legislation • Improve education to pregnant women for early enrollment process

8. Cross-Linkages • Proposed activities: Review effective data sharing, policy, and communication across agencies such as EIS, Child Welfare, Mental Health, Head Start Addressed: (this group did not meet formally, decided for staff to work within own positions and pull together administration of each division to resolve) • Ongoing activity for improved data sharing • Notification of who to contact for specialty screening • Education about Immunization as component of Healthy Kids screen (tie to existing priorities)

9. Overall Challenges • Maintaining focus on specific issues to resolve; multiple areas in need of addressing • Inadequate service infrastructure to build upon • Low level of participation by state agency determining eligibility (in NV, not by Medicaid) • Lack of data; sharing of data; timely enrollment notification • Some issues too loaded to address in a public meeting forum

10. Overall Successes • Improved communication/awareness • Strong MCO involvement in workgroups; new contract had incentives • Revival of welfare notification to families of newly enrolled children (procedure had been skipped-staff turnover) • Networking of state agencies with community-based organizations • Website – www.health.nv.gov matrix modeled after Michigan’s “EPSDT toolkit” • More providers understand the components of the screen; more billing staff code properly

11. Future Activities • Formal process to inform parents (Iowa model) • Continued monitoring of systematic notification process via welfare mailers and eligibility worker staff training • More effective data sharing agreements • Monitoring/training of coding • Return of the screening form for providers (improves consistency of screen; billing notification; data recording)

12. Q & A Judith Wright Chief, Bureau of Family Health Services, Nevada State Health Division jwright@health.nv.gov 775-684-4285