Family Cost Participation in Georgia

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Family Cost Participation in Georgias Part C
System
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Why FCP in Georgia?

• Precedent
• Initial Planning
• Stakeholder Involvement

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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)

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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

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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 childs disability (used for "spend down)

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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 ? Childrens 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
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1. Number of people in family
2. Household (Gross) Earned Monthly or Yearly Income (see Appendix C, page 7-8) (Circle monthly or yearly) 2. Household (Gross) Earned Monthly or Yearly Income (see Appendix C, page 7-8) (Circle monthly or yearly) 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) 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) 7. Total Monthly or Yearly Income Add lines 2 through 6 (Circle monthly or yearly) 7. Total Monthly or Yearly Income Add lines 2 through 6 (Circle monthly or yearly)
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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 childs disability. Extraordinary expenses cannot include anticipated or future costs or familys anticipated out-of-pocket cost participation expenses.) (See Appendix C, page 9) 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 childs disability. Extraordinary expenses cannot include anticipated or future costs or familys anticipated out-of-pocket cost participation expenses.) (See Appendix C, page 9) 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 childs disability. Extraordinary expenses cannot include anticipated or future costs or familys 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
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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 Cant 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 Participation Note CMS Baseline is 150 of Federal Poverty Level. (See Appendix C, page 6) Family Cost Participation
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Family Size
07/01/06
Income Income Income 1 2 3 4 5 6 7 8 9
  Annual Monthly Weekly 67,200 5,600 1,292 35 30 25 20 15 10 5 0 0
  Annual Monthly Weekly 74,000 6,167 1,423 40 35 30 25 20 15 10 5 0
  Annual Monthly Weekly 80,800 6,733 1,554 45 40 35 30 25 20 15 10 5
  Annual Monthly Weekly 87,600 7,300 1,685 50 45 40 35 30 25 20 15 10
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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
familys 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
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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

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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

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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

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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

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

17

• 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 familys contribution or cost share
  is fulfilled by the payment received from their
  private insurance.

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Why does FCP Work for Georgia?

• Consistent policies procedures
• Same criteria is applied to all families
• Scheduled updates revisions

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Ongoing Review of Policy

• FCP scale is updated annually to include most
  current Federal Poverty Guidelines and other
  necessary changes

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Modifications are Based on Ongoing Monitoring

• Local monitoring site reviews
• Complaints
• Identification of new fund sources

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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
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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

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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

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Revisions that Occurred in Response to Ongoing
Monitoring

• New Funding Sources Coordination
• Private Insurance provisions
• Expansion of FCP to Title V

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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

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Why does FCP Work for GA?

• Consistent Policies
• Determination of inability to pay
• Ongoing Monitoring
• Widespread acceptance expectations

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Family Cost Participation -Whats Next in GA?

• Changes in Political and Economic Context
• Look at FCP fee scale, levels
• Infrastructure Changes
• Data system enhancements

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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)

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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

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Consider this as you study FCP in your state

• Stakeholders
• Data
• Other options
• Authority needed

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Any Questions???

• Georgias FCP forms are included in your
  Symposium materials.
• Contact Stephanie Moss at skmoss_at_dhr.state.ga.us
  
• or
• 404-657-2721