BOBCAT INTEGRATED DELIVERY SYSTEM

Bobcat Integrated Delivery System

Bobcat Integrated Delivery System

Balanced Budget Act of 1997

States can now implement mandatory Medicaid managed care for most groups of Medicaid recipients without applying for a waiver. A number of consumer protection/quality assurance measures have been added. States also have the option of establishing presumptive eligibility for all children less than 19 years of age and 12 months of continuous eligibility. The requirement that states provide sufficient reimbursement to ensure access to pediatric services has been eliminated. Medicaid coverage was continued to children who lost their SSI coverage because of the changes to the definition of disability in last year's federal welfare legislation. (Peterson & Fabozzi 2002)

States have the option of guaranteeing 12 months of continuous eligibility for all children under age 19. Once they are eligible and enrolled, their eligibility does not need to be determined for 12 months. This minimizes paperwork for the family, the pediatrician, and the state and supports the development of a medical home. States also have the option of adopting presumptive Medicaid eligibility for children under age 19. This allows providers to gather a few income details about a family, presume they are eligible, and commence treatment. Even if they are later found ineligible, Medicaid will still reimburse the physician or hospital. Under previous law, states could only do this for pregnant women and infants. States can use physicians, hospitals, Head Start programs, child care programs and WIC offices to assist in Medicaid enrollment.

• Urge your state officials to adopt 12 months of continuous eligibility for children under age 19.• Urge your state officials to adopt presumptive eligibility for children under age 19 (and for pregnant women if your state has not already done so). (Mercer 2006)

Section 1926 of Title XIX of the Social Security Act, regarding reimbursement for pediatric and obstetrical services, has been eliminated. This provision required states to reimburse pediatric and obstetric services at rates that are sufficient enough to enlist providers so that care and services under Medicaid are available at least to the extent they are to the general population in the same geographic area.

• States are still required to meet screening rate goals for the EPSDT program. Pediatricians can work with state Medicaid officials on strategies for meeting these goals and advocate for adequate reimbursement in the context of ensuring adequate physician participation to provide EPSDT services to all eligible children.• Build coalitions with parent and consumer groups to advocate for continued improvement in access to pediatric services. (Marshall 2003)

States no longer need 1915 (b) waivers (freedom of choice) to institute mandatory Medicaid managed care for most groups of Medicaid recipients. Waivers are still required for children under age 19 with special health care needs (those who are eligible for SSI or in foster care or adoption assistance).

The process for extending 1115 waivers (research and demonstration waivers) was simplified. At the written request of the state, the Secretary of Health and Human Services is authorized to extend 1115 waivers (current, ...