DHS Commissioner Details Medicaid Expansion’s Second Phase

With the second phase of the Medicaid expansion, the V.I. Department of Human Services aims to maximize federal dollars by making as many Virgin Islanders as possible Medicaid-eligible, according to Human Services Commissioner Christopher Finch.

In an interview Monday, Finch said the department’s goal is to, as quickly and sensibly as it can, “cover the people who right now have no health security at all.”

In Aug. 2013, Human Services announced the first phase of the Medicaid expansion that the territory selected over health insurance exchanges. This included a raise in Medicaid’s allowable income limit for all family sizes by $1,000, which extended Medicaid eligibility to some 3,000 children – up to age 18 – and some 200 pregnant women.

The second phase, scheduled to begin in January 2014, would enroll more children and pregnant women, as well as parents of the children added, senior citizens, disabled citizens and former foster children ages 18 to 26.

According to Finch, Human Services is considering taking a “far more aggressive” approach than originally planned for the second phase of the expansion.

“We had first thought that we were going to be raising our income limits by either $1,000 or $2,000, depending on the family size,” said Finch about the second phase roll-out. “When we did a modeling of the numbers, we realized that we could go further than that.”

Human Services started weighing two options: either consider much higher income eligibility limits or use a percentage of the Federal Poverty Level.

Human Services would normally set dollar amount as the income limit for a family of one, and then raise it by $1,000 for each additional family member. If it decides to go with drastically increasing income eligibility limits, Human Services could go as high as $4,000 more per additional family member.

As for the option of using a percentage of the Federal Poverty Level, which has never been done in the territory, Human Services would have to deviate significantly from common practice in the mainland, Finch said.

“We would not at this point be able to go up to 100 percent of the Federal Poverty Level, which is what the Medicaid program in the states would look like,” he said. “But we would look at either 75 percent or 80 percent.”

Implementation of the elements of the first phase has had its ups and downs, Finch said. The Aug. 1 roll-out of the Medicaid Management Information System, a digital platform for managing patient information, has been “very successful,” but the same could not be said about Express Lane Eligibility. Finch said the latter has progressed “slower than anticipated,” in spite of saving parents time by using SNAP benefits data to produce a Medicaid cards for eligible children.

“To this date, only about half the parents have come in to pick up their cards,” he explained. “We’ve called and we’re about to do another round of calling again to make sure that they really understand what a great opportunity this is for them.”

The Medical Home model, which allows more efficient patient-centered collaboration between Department of Health primary providers and federally qualified health centers, is also progressing, according to Finch, making do with interim steps until the computer systems that would facilitate such collaboration are fully reconfigured.

Finch said community participation is essential in spurring forward phase one implementation and in preparing for the January 2014 roll-out of phase two. Parents of children made eligible by phase one are urged to pick up their children’s cards and complete their own applications for eligibility.

“And when we announce the new [second phase] limits formally, those who realize that they would qualify need to come in and get the paperwork done,” he said, adding that Human Services wanted to sign up people as quick as possible to “start reaping the benefits as a territory.”

Human Services on St. Thomas can be contacted at 774-0930; St. Croix offices at 773-2323; and St. John offices at 776-6334. Residents can also visit the department’s website at www.dhs.gov.vi.

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