"What pierced our heart cannot crush our hope." 1. QUEST to Start Dental Fee-for-Service ProgramHonolulu Star-Bulletin 09/15/01 The state's QUEST participants starting October 1 will receive dental services under a fee-for-service program. QUEST now provides dental services to 50,000 adults and 80,000 children under managed-care dental plans. The change to a fee-for-service program will not affect dental services, says the state Department of Human Services. Participants will be enrolled automatically in the program and will receive new identification cards during the last week of this month. Recipients who need help with the new dental plan should call 524-3370 on Oahu or 1-800-316-8005 toll-free from the Neighbor Islands. Participants can continue to see their present dentists if they are providers in the fee-for-service program. If a dentist chooses not to be in the new program, the participant will have to select a new dentist from the fee-for-services dentists. The list will be mailed to QUEST recipients this month. Dentists who would like to join the fee-for-service program should call the Med-QUEST Division at 692-8099 for an application. The Department of Human Services is selecting a Care Coordination Organization to assist QUEST members in finding a dentist, making dental appointments, and arranging for translation and transportation services. For more information, call 692-8098. 2. Cultural Competency in Medicaid Asian Pacific Islander Health Information Action Alert On 20 August 2001, the Centers for Medicare and Medicaid Services (CMS) published a revised Proposed Rule for Medicaid Managed Care. There are several important changes from the January 2001 version of these regulations, which were never allowed to go into effect by the Bush Administration. The regulations still contain critical requirements for States and managed care organizations to identify and serve enrollees and potential enrollees, including persons with limited English proficiency (LEP). The Proposed Rule also includes requirements for the provision of written materials in prevalent non-English languages, oral interpretation services free of charge, and notification that these services are available and how to access them. While advocates for improving linguistic access in government programs applaud the inclusion of these provisions, the revised Proposed Rule greatly weakens the requirements for the provision of culturally competent services by managed care organizations compared to previous versions of the rule. CMS has asked for public comment on the Proposed Rule. While this provides additional opportunity for input, it also allows those opposed to the linguistic access requirements to organize and urge the weakening or elimination of those requirements. 3. Child Health Conference Call Replay The Children's Defense Fund and Families USA conducted a child health conference call on Friday, 21 September. The topic was changes to the Section 1115 Medicaid waiver, called the "Health Insurance Flexibility and Accountability" initiative, announced by the Center for Medicaid and Medicare Services (CMS) last month. The new Section 1115 waiver will allow states greater authority in the operations of their Medicaid programs, including the ability to change Medicaid benefits, implement and/or increase cost-sharing to families, and cap enrollment in the program. All persons enrolled in "Optional" categories of Medicaid may be affected. All those enrolled in the State Children's Health Insurance Program (State CHIP) may also be affected. Those persons enrolled in "Mandatory" categories of Medicaid [pregnant women and infants below 133% of the Federal Poverty Level (FPL), children below 100% of the FPL, very low-income adults above 65, and persons with disabilities] will not be affected. States may use the savings from Medicaid to extend the program to more individuals. The waiver guidance and the application template are both available at: http://www.hcfa.gov/medicaid/hifademo.htm Speakers included Tim Westmoreland, Counsel for Representative Henry Waxman (CA) and former Director of Medicaid and State Operations at HCFA and a state health advocate; Dennis Smith, Director of Medicaid and State Operations at CMS; and Janet Varon of Northwest Health Law Advocates. 4. Medicaid: Stronger Efforts Needed to Ensure Children's Access to Health Screening Services The U.S. General Accounting Office has released a new report assessing states' effectiveness in providing children enrolled in Medicaid with requisite health screenings and finds that many of these children are not receiving these services. Services mandated by federal law for children in Medicaid include appropriate immunizations, a comprehensive physical exam, lead screening, and vision, dental and hearing services. http://www.gao.gov/new.items/d01749.pdf 5. Families USA Charges Medicaid Delays Hurt Families States will have difficulty obtaining waivers to expand coverage of Medicaid and Children's Health Insurance Programs, according to an analysis by Families USA. The report says there is no funding to expand coverage so any waivers to change state levels will likely result in reduced benefits, caps on enrollment and increased cost sharing.