DHFAC Meeting Minutes
March 28, 2001
Present:
- Joseph DiPinto
- Thomas Grabowski
- Deborah Hudson
- Bethany Hall-Long
- Joseph Lieberman
- David McBride
- Vincent Meconi (Chair)
- Dennis Rochford
- Calvin Wilson
Absent:
- Patricia Blevins
- Charles F. Reinhardt
Welcome & Introductions
Secretary Meconi welcomed the committee and the public.
Approval of minutes
Minutes from the February 21 meeting were approved without amendment.
Update on the Uninsured Action Plan
Paula Roy provided an update on the Uninsured Action Plan. The update shared progress on two components:
- Community Access Program-improving access to services for uninsured
- State Planning Program-reducing the uninsured
Community Access Program (CAP)
Goals
- Enroll those who are eligible into existing programs
- Find a health home for the remaining uninsured
- Emphasize primary/preventive care services
- Decrease expensive visits to hospital emergency departments
Progress
- Care coordinator sites established
- Health home referral points established:
- 100+ private physician volunteers (VIP II)
- Community Health Centers/FQHCs
- Acute care hospitals
- Evaluation tools developed
- Health assessment tool developed
- Patient's Rights and Responsibilities document developed
- Fifty-five member coalition in place
- Projected launch date is May 2001
State Planning Program
- Goal: develop a comprehensive plan to significantly reduce the percentage of uninsured
- Process: research, information sharing, option refinement, report preparation
- Possible policy options (examples): small employer purchasing pools, employer buyin, CHIP /Medicaid expansions/waivers, subsidies to small businesses or low-income workers.
Key Milestones
- Feb: Statewide Summit
- May: Honing in on feasibility and cost of options
- June: Second Summit: Public discourse on key findings
- July-August: Refining options
- Sept: Third Summit: Present recommendations
- Sept 30: Submit report to HHS, Governor, and General Assembly.
What is Ahead
Additional funding for the Uninsured Action Plan will:
- Supplement what the two grants cannot do
- Assure continued support of the safety net
- Coordinate the two grants
- Implement strategies as appropriate after 9/30/01
Preliminary Estimates for Expanding Public Programs
Debra Lightsey reported that preliminary estimates on expanding Medicaid and/or the Delaware Healthy Children's Program to cover adults with incomes up to 200% of the Federal Poverty Level are in the range of $15 million to $20 million per year.
Long Term Care Capital Needs
Secretary Meconi reviewed a handout on capital needs in the state's long term care institutions. The funds are needed to:
- Meet state and local codes
- Meet hospital codes and licensing requirements
- Comply with ADA requirements
- Comply with EPA requirements
- Provide a safe environment for patients
- Prevent further deterioration of facilities
- Provide Delaware residents with high quality service
Further detail will be shared with the committee as requested.
Review of Available Funds
Debra Lightsey reviewed the following table, noting that the "projected unexpended" funds are one-time in nature, so may be best used for one-time costs or for the strategic reserve.
| Initiative | FY01 Approp. | Project. Unexpend. | GRB |
|---|---|---|---|
| Strategic Reserve | $14,934.8 | ||
| DE Prescription Assistance | $7,472.8 | $1,574.0 | $5,150.4 |
| Tobacco Control & Prevention | $2,833.0 | $85.4 | $2,836.0 |
| DPS | 315.5 | 0 | 316.5 |
| DOE | 217.0 | 0 | 217.0 |
| DOJ | 110.0 | 0 | 111.3 |
| DSCYF | 110.0 | 0 | 110.0 |
| DHSS/DPH | 2,080.5 | 85.4 | 2,080.5 |
| Minor Capital Improvements to State-Run Long Term Care Facilities | $1,900.0 | 0 | $4,000.0 |
| Medical Coverage: Persons who Lose SSI due to Unearned Income (SSDI) | $1,485.0 | $495.0 | $2,970.0 |
| Uninsured Action Plan | $1,000.0 | 0 | $1,000.0 |
| Public Access Defibrillation | $752.9 | 0 | $375.0 |
| Chronic Diseases: Diabetes Pilot Project | $500.0 | 0 | $500.0 |
| Heroin Residential Program | N/A | $500.0 | |
| Increased Medicaid Eligibility for Pregnant Women & Infants | $408.7 | $308.7 | $408.7 |
| Survey of Disabled in Delaware | $250.0 | $42.6 | $0 |
| Substance Abuse: Transitional Housing | $200.0 | $17.2 | $200.0 |
| Lesser-Known Illnesses: Testing Regimens | $150.0 | 0 | $150.0 |
| Staff Assistance on Health Issues: Delaware Health Care Commission | $56.5 | 0 | $57.1 |
| TOTAL | $17,008.9 | $2,522.9 | $18,147.2 |
| Total + Strategic Reserve | $31,943.7 |
- Expected payments in FY01 are estimated at $24.3 million ($6,152.8 more than GRB)
- One time funds available from unexpended FY01 balances projected at $2,522.9
The committee raised issues related to the timing of HFAC recommendations and the development of the Governor's Recommended Budget. The committee agreed to discuss next year's process and schedule at the May meeting.
The committee reached consensus on several items:
| Iniative | Amount |
|---|---|
| DE Prescription Assistance | $ 5,150.4 |
| Tobacco Prevention/Control | More than $2,836 |
| Medical Coverage for SSI Trans.* | $ 2,970.0 |
| Uninsured Action Plan | $1,000.0 |
| Chronic Disease Pilot | $ 500.0 |
| Medicaid increase for pregnant | $ 408.7 |
| Substance Abuse Trans. Hsg | $ 200.0 |
| Lesser-Known Illnesses | $ 150.0 |
| DHCC staff assistance | $ 57.1 |
* If Federal match is approved, this amount could be reduced to $1.485 million
Several items needed further discussion:
- Minor Capital Improvements for state long-term care facilities. The committee debated whether this was a priority for HFAC or not.
- Public Access Defibrillation. There was a consensus on some level of funding, but not on the amount. More information on current placements will be provided.
- Heroin residential program. The committee noted that this recommendation did not originate in HFAC. Renata Henry, Director of Alcoholism, Drug Abuse, and Mental Health, provided background on the proposal:
- National studies have indicated that Delaware has a high rate of heroin addiction among young adults.
- Residence would serve up to twenty 19-25 year olds for up to six months, with outpatient follow up.
- Treatment would include new medications for treating heroin addiction.
- Outcome measures are built in.
The committee asked for a written summary of the program.
During the discussion, committee members emphasized the importance of evaluation to be sure that these investments provide a return. However, some noted that outcomes can not be measured this early in the program.
Priorities for HFAC Members
Members were asked to share their priorities.
Patricia Blevins (via Debra Lightsey)
- $5 million for tobacco prevention and control
- $100,000 for Gift of Life as a one-time grant to promote organ donation
- $200,000 to support people with cancer through organizations like the Wellness Community and the Cancer Care Connection
Dennis Rochford
- Funding to support people with tobacco-related cancers with services from the Wellness Community
Joseph Lieberman
- Should avoid new programs and secure the strategic reserve
Calvin Wilson
- No new priorities
David McBride
- Should secure the strategic reserve
Vincent P. Meconi
- Attendant care presentations were very powerful, but may not be able to move forward
Joseph DiPinto
- Attendant care
- Organ donation promotion
- Support services for people with cancer, like the Cancer Care Connection
Deborah Hudson
- One-time funds for existing groups who can get results quickly
Bethany Hall-Long
- Attendant care
- Cancer Care Connection
- Perinatal Resource Mothers
- Gift of Life organ donation
Tom Grabowski
- Tobacco prevention and control
Members were asked to send detailed priorities to Debra Lightsey by April 9.
Public Comment
Alice Goodfellow Davis, Perinatal Association of Delaware
- Suggests supporting prevention of smoking during pregnancy and other preventive services of the Resource Mothers program with $200,000. This would replace federal funding ending on June 30, 2001.
Ann Rogan
- Suggests putting AEDs in schools statewide to prevent deaths of students and community members who use the buildings.
Ty Johnson, Churches Take A Corner
- Requests $75,000 - $90,000 to support healthy lifestyle activities, building on CTAC's model of interfaith, community based action. The program would include providing information throughout Delaware relying on mentoring and experiential learning models.
Rob Simmons, Christiana Care
- Referenced Dr. Charles Smith's earlier letter stating that the highest priority should be tobacco control. Dr. Simmons noted that the tobacco industry has increased advertising by 22.3%, with point-of-sale advertising increased by 60%.
Chris Manning, American Heart Association
- Pleased that there is consensus to increase tobacco control funding. Much has been accomplished already, even though it is too early for outcome evaluation.
Tom McGonigle, Gift of Life Foundation
- Suggests one-time funding of $105,000 to increase awareness and participation in Delaware's organ donor program.
