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

Primary Family Health/Insurance Plan

(% covered for specific services, if known)

Secondary Family Health/Insurance Plan

(% covered for specific services, if known)

Carrier/Address

Policy/Program Number

Enrolled Family Member/Employee

Phone #

1. Number of people in family:

2. Household (Gross) Earned Monthly or Yearly Income (see Appendix C, page 7-8): $ (Circle monthly or yearly)

Unearned Income Amount

Sources of Unearned Income (see Appendix C, page 7-8)

(State specific source and if monthly, annual, one-time)

3. $

4. $

5. $

6. $

7. Total Monthly or Yearly Income: Add lines # 2 through 6 $ (Circle monthly or yearly)

List below the average monthly or yearly "out of pocket" extraordinary expenses that are related specifically to the child's disability: (Identify specific purchases, expenses, modifications, and alterations that family members have made within the previous month or year to accommodate the extended/additional needs of the child’s disability. Extraordinary expenses cannot include anticipated or future costs or family’s anticipated out-of-pocket cost participation expenses.) (See Appendix C, page 9)

Expense Cost Description of Costs

8. Child Care Special Costs (Difference)

$

9. Materials, Supplies

10. Equipment

11. Medical/Health

12. Medications

13. Special Food Supplements

14. Transportation/Parking

15. Other - list specifics:

16. Add lines # 8 - 15 for total Monthly or Yearly Extraordinary Expenses: $ (Circle monthly or yearly)

17. Subtract line # 16 from line # 7: $ = Adjusted Family Income (Circle monthly or yearly)

18. Babies Can’t Wait:Using Adjusted Family Income from line #17 and # of family Members from line # 1, determine % of family cost participation using the Cost Participation Scale (see Appendix C, pages 4-5). Family Cost Participation = %

19. Children's Medical Services:To determine family cost participation, use the following formula:If line #17 is monthly, multiply Adjusted Family (monthly) Income x 12 = Adjusted Family Income (Adjusted Family Income – Baseline) x .10 = Annual Cost ParticipationNote: CMS Baseline is 150% of Federal Poverty Level. (See Appendix C, page 6) Family Cost Participation = $

Income 1 2 3 4 5 6 7 8 9

 AnnualMonthlyWeekly

67,2005,6001,292

35 30 25 20 15 10 5 0 0

 AnnualMonthlyWeekly

74,0006,1671,423

40 35 30 25 20 15 10 5 0

 AnnualMonthlyWeekly

80,8006,7331,554

45 40 35 30 25 20 15 10 5

 AnnualMonthlyWeekly

87,6007,3001,685

50 45 40 35 30 25 20 15 10

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.

2 Most Recent Payroll Slips

OR Income Tax Return From

Previous Year

OR W2 Form from Previous Year

$ $ $

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

• Stakeholders

• Data

• Other options

• Authority needed

Consider this as you study FCP in your state…

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