Human Services Announces Raised Medicaid Income Cap, Other Health Care Initiatives

The V.I. Department of Human Services announced a series of Medicaid expansions and initiatives that would affect thousands of previously uncovered individuals and change the landscape of medical assistance in the territory.

Human Services Commissioner Christopher E. Finch detailed in a press conference Wednesday the forthcoming changes in the territory’s Medical Assistance Program, beginning with a raise in Medicaid’s allowable income limit for all family sizes by $1,000.

Currently a family of three must have a combined annual income of $7,500 to qualify for Medicaid benefits; when the raised income cap takes effect on August 1, a family of three can earn up to $8,500 and still qualify.

The raise in income limit extends Medicaid eligibility to some 3,000 children – up to age 18 – and some 200 pregnant women.

To fast-track the identification of newly eligible families, Human Services is using Express Lane Eligibility. The special process, approved by the Center for Medicare and Medicaid Services, involves using statistics from the Supplemental Nutrition Assistance Program (SNAP), more commonly known as the Food Stamp Program, to single out families that meet the new criteria.

Human Services is also setting up special Saturday hours to accommodate families with children falling within the new income limit. Through the month of August, offices will be open from 9 a.m. to 3 p.m. at the following locations: New Hampton Complex on St. Thomas; and on St. Croix at Golden Rock Human Services Building in Christiansted and the Food Stamp Building in Frederiksted.

The Medicaid Management Information System

Starting Aug. 1, Medicaid is also implementing the Medicaid Management Information System, a digital platform for managing patient information.

The MMIS software was originally used by the state of West Virginia, provided by Molina Medicaid Solutions. Plans to use MMIS in the territory began in 2011 when Gov. John deJongh Jr. sat down with then-governor of West Virginia, Joseph Manchin III, who discussed how West Virginia handled its Medicaid information.

Eventually deJongh signed a memorandum of agreement with the state of West Virginia to share use of the software. Human Services is calling it the first state-to-territory, or even state-to-state, partnership of its kind.

According to Finch, MMIS should make Medicaid more attractive to doctors by streamlining the payment process.

“Doctors will be able to bill electronically receive their payments much quicker,” explained Finch. “It will encourage more local participation.”

Finch said he is also excited about MMIS because it would give Human Services instantaneous access to patient data.

“That actually opens up the world to us as to how we can improve and expand the program,” said Finch. “We wouldn’t have to worry about financially getting out of control because we will be able to see data on a very real-time basis.”

Medical Home Care Model

Human Services is also pushing the Sept. 1 adoption of a more comprehensive model of care that takes responsibility for complete patient care called Medical Home.

Currently Medicaid patients have to get their primary care from federally qualified health centers or from Department of Health clinics, and then go through a lengthy process at the Medicaid office if they need specialized care. Health care providers adopting the Medical Home model should be able to make referrals directly to specialists and authorize payments, instead of going through Medicaid offices for review and approval.

“Allowing Medical Home to make those referrals and stay in contact with the specialists will lead to overall patient care,” said Finch. “It will speed up the process considerably and make sure that the primary doctor and the specialist are in communication instantly.”

Human Services is also moving to assist paying Medicare rates for both in-patient and out-patient services performed by local doctors, instead of just out-patient care.

“Many Medicaid recipients have to go to Puerto Rico or Florida to have surgeries,” said Finch. “We’re trying to turn that process around and make it more attractive for local providers to make it easier for people.”

Future Expansions

Depending on the outcome of current Medicaid initiatives, particularly the expansion of the Medicaid income criteria, the territory could be looking at additional expansions, according to Finch.

A second expansion is already scheduled for Nov. 1, which would again raise the allowable income limit for all family sizes by $1,000. It would also include extend eligibility to senior citizens, persons with disabilities and former foster children who have aged out of foster care.

In June 2014, a third expansion could even include parents of low-income children falling within the new income criteria, and single adults, including homeless persons.

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