New Eight-State Policy Academy Advances Access to Care for Pregnant/Parenting Women with SUD
Substance use disorders (SUD) and mental health conditions are prevalent among pregnant and parenting women in the United States, and they have far-reaching consequences for the health and well-being of women and their children. Integrated care models that support pregnant and parenting women’s physical and behavioral health and social service needs can improve outcomes for women and children and reduce health care costs.
Through the Maternal and Child Health Policy Innovation Program (MCH PIP), funded by the federal Maternal and Child Health Bureau of the Health Resources and Services Administration (MCHB, HRSA), the National Academy for State Health Policy (NASHP) is working with states to support and advance innovative policy initiatives that improve access to quality health care for pregnant and parenting women.
As part of the MCH PIP initiative, NASHP is convening a two-year policy academy including eight state teams made up of representatives from state Medicaid agencies, public health agencies, mental health/substance use agencies, and other state stakeholders. States selected to participate in the first cohort of the NASHP policy academy include:
- Alabama
- Colorado
- Kentucky
- Mississippi
- New Jersey
- South Carolina
- Texas
- Virginia
Over the next two years, these states will identify, promote, and advance innovative, state-level policy initiatives to improve access to care for Medicaid-eligible pregnant and parenting women with or at risk of SUD and/or mental health conditions. NASHP will work with the states to identify high-priority policy issues, challenges, and opportunities through targeted technical assistance, peer-to-peer learning, analyses of policy issues, and development of policy briefs and other resources that will be disseminated nationally.
While many states have identified pregnant and parenting women as a priority population for their SUD and behavioral health efforts, challenges and opportunities persist. NASHP recently published two Issue Hubs that provide valuable resources, including information on the Centers for Medicare & Medicaid Services’ Maternal Opioid Misuse (MOM) Model. They are available at:
- Resources to Help States Improve Integrated Care for Pregnant and Parenting Women: This Issue Hub provides valuable resources for states interested in using the Maternal Opioid Misuse (MOM) model and others to improve access to comprehensive and coordinated care and implement innovative payment and care delivery models for pregnant and parenting women eligible for Medicaid.
- Resources to Help States Improve Integrated Care for Children: This Issue Hub provides valuable resources for states interested in the Integrated Care for Kids (InCK) Model and others working to implement payment, coverage, and cross-agency strategies to improve for integrated care coordination of behavioral, physical and health-related social needs for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP).
Toolkit: State Strategies to Improve Health Outcomes for People Living with HIV
Collaboration between state health department HIV programs and Medicaid is integral to providing quality, comprehensive care to people living with HIV (PLWH). With consistent, well-coordinated care and access to antiretroviral therapy (ART) many PLWH can achieve virologic suppression. Those who achieve sustained virologic suppression tend to have better health outcomes and a reduced risk of transmitting HIV to others. Collaboration and partnership can be challenging in many states, particularly when the Medicaid and state health departments are housed in separate agencies. There are, however, numerous strategies states can implement to improve collaboration and partnership between Medicaid and state health departments to implement policy and program changes to achieve this goal.
In 2017, NASHP completed work with 19 states to support them in identifying and implementing policy and program changes to improve rates of sustained virologic suppression among Medicaid and CHIP beneficiaries living with HIV. While working with these states, NASHP identified that state officials needed additional resources on a variety of topics, such as data sharing and use and quality improvement.
This toolkit, supported through a cooperative agreement with the Health Resources and Services Administration, is intended provide state officials with tools and resources, including issue briefs, webinars, and presentations, they need to improve rates of sustained virologic suppression. New items will be added to the toolkit on a regular basis, providing state officials with up-to-date information and timely policy resources.
Tools and Resources
Publications
One-Page Summary: HIV Health Improvement Affinity Group Evaluation Report
March 2019
This two-page summary 2019 highlights state action plans designed to increase viral suppressions and improve health outcomes for people living with HIV enrolled in Medicaid.
HIV Health Improvement Affinity Group Evaluation Report
March 2019
This full report explores the state action plans that 19 states and Medicaid agency staff developed to increase viral suppression and improve the health of people living with HIV. Federal agency partners and NASHP supported this one-year, peer-to-peer learning initiative.
States play critical roles in ensuring that people living with HIV (PLWH) have access to quality care through their Medicaid and Ryan White HIV/AIDS programs. PLWH can be among the most medically complex individuals covered by state health programs, and their care can cost five-times the average Medicaid beneficiary. Given limited resources, state policymakers are working to develop policies and strategies that are accessible, well-coordinated, and effective. This three-part series explores policy levers and strategies that states are using to focus limited resources and provide comprehensive and accessible care to PLWH.
This mini-brief highlights promising strategies for HIV Health Improvement Affinity Group states to successfully engage managed care organizations, health systems, and providers in quality improvement efforts aimed at increasing rates of virologic suppression. Louisiana, Michigan, New York, and Wisconsin are featured. This mini-brief was written as part of the HIV Health Improvement Affinity Group project.
How States Use Medicaid and State Health Department Data to Improve Health Outcomes of People Living with HIV
December 2017
This issue brief discusses key considerations and promising state strategies to share and then analyze Medicaid claims and HIV surveillance and Ryan White HIV/AIDS Program data. Analyses of these interagency data sets can help inform state and local policy and program changes aimed at increasing rates of virologic suppression for Medicaid and CHIP beneficiaries living with HIV. The brief also provides an overview of select data sets that states may be interested in sharing. This issue brief was written as part of the HIV Health Improvement Affinity Group project.
This mini-brief highlights promising strategies for HIV Health Improvement Affinity Group states to successfully engage managed care organizations, health systems, and providers in quality improvement efforts aimed at increasing rates of virologic suppression. Louisiana, Michigan, New York, and Wisconsin are featured. This mini-brief was written as part of the HIV Health Improvement Affinity Group project.
States Share Data to Improve the Health of People Living with HIV
December 2017
This blog presents lessons learned from three HIV Health Improvement Affinity Group states—Alaska, Louisiana, and Maryland—that are working toward sharing and analyzing Medicaid and state health department data to ultimately increase rates of virologic suppression among people living with HIV. This blog was written as part of the HIV Health Improvement Affinity Group project.
Better Together: How Cross-Agency Data Sharing Can Improve the Care Continuum for People Living with HIV/AIDS
October 2017
The state of Georgia leveraged a data sharing agreement between its public health and Medicaid departments in order to assess care quality for Medicaid beneficiaries living with HIV. Data use agreements are critical for agencies interested in sharing data. This blog was written as part of the HIV Health Improvement Affinity Group project.
As states continue to focus on integrated care and delivery system reform, meaningful opportunities exist to improve care for people living with HIV. The Ruth M. Rothstein CORE Center in Chicago, Illinois – part of the Cook County Health & Hospitals System – operates an integrated care model they call “one-stop shopping.” This issue brief showcases the CORE Center’s model and how it is partnering with the Illinois Department of Health to improve care for people living with HIV. The accompanying webinar can be accessed here. The webinar and issue brief were developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.
Advancing HIV Prevention Through Health Departments: Health Homes for People Living with HIV/AIDS
June 2016
This case study highlights Wisconsin’s health home program for Medicaid beneficiaries living with HIV, which is the first and only health home program exclusively for this population. Wisconsin’s experience may assist other states considering the health home state plan option as a strategy to support integrated care for Medicaid beneficiaries living with HIV. This case study was developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.
Advancing HIV Prevention Through Health Departments: HIV-Specific Quality Metrics for Managed Care
June 2016
This case study highlights New York’s use of HIV-related performance metrics to incentivize its Medicaid managed care plans to improve care for their members living with HIV. Their experience may assist other states considering how to incentivize quality improvement in their managed care program. This issue brief was developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.
Strategies for Coordination Between Medicaid and Ryan White HIV/AIDS Programs
November 2013
This policy brief discusses the importance of coordination between a state’s Medicaid agency and the Ryan White HIV/AIDS Program (RWHAP) to ensure that people living with HIV have access to comprehensive, high-quality care. NASHP interviewed Medicaid and RWHAP officials in 14 states about successful coordination efforts. This brief highlights those examples, along with additional promising practices for coordination that facilitate delivery improvements for people living with HIV. An accompanying webinar can be accessed here. The Health Resources and Services Administration (HRSA) provided support for this issue brief and webinar.
Webinars and Presentations
Overview of state and federal HIV programs
State Health Department HIV Programs: An In-Depth Look
February 23, 2017
View the webinar | Download the slides
The purpose of this webinar was to provide Medicaid and other state officials with information about the structure and components of state health department HIV programs and resources, as well as opportunities for collaboration between these programs and Medicaid. The Centers for Disease Control and Prevention discussed state HIV surveillance and prevention programs and the Health Resources and Services Administration discussed the Ryan White HIV/AIDS Program. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
Housing Opportunities for Persons with AIDS: Presentation for HIV Health Improvement Affinity Group
December 7, 2016
Download the slides
This presentation described the Housing Opportunities for Persons with AIDS (HOPWA), a federal program dedicated to assisting with the housing needs of people living with HIV, and work in Alabama focused on improving health outcomes for people living with HIV/AIDS through greater access to housing. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
Health Resources and Services Administration and HIV/AIDS Bureau Update
December 6, 2016
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Laura Cheever, Associate Administrator for the HIV/AIDS Bureau within the Health Resources and Services Administration presented an overview of the Bureau’s priority areas and a preview of 2015 Ryan White HIV/AIDS Program Services Report data. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides
This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.
Overview of state Medicaid programs
The Medicaid Program: An In-Depth Look
February 16, 2017
View the webinar | Download the slides
While Medicaid programs vary greatly across states, the purpose of this webinar was to provide state health department and other officials with information about the structure and components of this program, as well as opportunities for collaboration between Medicaid and state health departments. The Centers for Medicare & Medicaid Services and NASHP presented about Medicaid structure, eligibility, benefits, financing, payment and delivery, as well as waivers and state plan amendments. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
Interagency collaboration
Rhode Island Lessons Learned: Relocating Ryan White
December 7, 2016
Download the slides
Rhode Island presented on how Medicaid and its Ryan White HIV/AIDS Program are partnering on quality improvement projects and the implementation of Medicaid benefits, such as a targeted case management program. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination
August 29, 2013
Download the slides
This webinar highlighted strategies that California, Massachusetts, Tennessee, and Washington have used to improve interagency coordination, as well as implement policy changes to improve health outcomes for people living with HIV. An accompanying issue brief is available here. The Health Resources and Services Administration (HRSA) provided support for this webinar and issue brief.
Opportunities for state policy improvement
Webinar: Increasing Rates of Virologic Suppression: Promising Practices from HIV Health Improvement Affinity Group States
Wednesday, Dec. 6, 2017
View the webinar | Download the slides
Increasing rates of virologic suppression among people living with HIV is critically important to improving their quality of life and decreasing the risk of further HIV transmission. For the last 12 months, the HIV Health Improvement Affinity Group has worked with state health departments and Medicaid agencies from 19 states to develop and implement performance improvement projects aimed at improving rates of sustained virologic suppression among Medicaid beneficiaries living with HIV. This webinar featured leaders from the Office of HIV/AIDS and Infectious Disease Policy in the US Department of Health & Human Services, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention. It also featured Affinity Group states, Alaska and North Carolina, that shared lessons learned and best practices from their performance improvement projects.
Improving Quality of Care for Medicaid Beneficiaries Living with HIV: Strategies to Engage Managed Care Plans and Providers
August 17, 2017
View the webinar | Download the slides
It is important for states to engage key partners, such as managed care plans and providers, in order to improve the quality of care provided to Medicaid beneficiaries living with HIV. This webinar showcased New York state’s work to incentivize managed care plans to improve rates of virologic suppression for their members living with HIV. The New England AIDS Education and Training Center also shared resources and promising strategies to engage HIV providers in quality improvement. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
HIV Health Improvement Affinity Group: Policy and System Change
December 7, 2016
Download the slides
This presentation highlighted the role that Medicaid plays in ensuring many people living with HIV have access to comprehensive, high quality care. It also showcased policy changes that states could implement to improve access to and quality of care for beneficiaries living with HIV, including increased access to HIV testing, benefit design changes, and network adequacy standards. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
Rhode Island Lessons Learned: Relocating Ryan White
December 7, 2016
Download the slides
Rhode Island presented on how Medicaid and its Ryan White HIV/AIDS Program are partnering on quality improvement projects and the implementation of Medicaid benefits, such as a targeted case management program. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
Recent HIV Data to Care (D2C) Experiences in Maryland
December 6, 2016
Download the slides
Maryland presented on how it is using analyses of HIV surveillance and Medicaid claims data to identify people living with HIV who are not engaged in regular HIV care, and then developing policy and program changes to address these gaps in care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides
This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.
Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination
August 29, 2013
Download the slides
This webinar highlighted strategies that California, Massachusetts, Tennessee, and Washington have used to improve interagency coordination, as well as implement policy changes to improve health outcomes for people living with HIV. An accompanying issue brief is available here. The Health Resources and Services Administration (HRSA) provided support for this webinar and issue brief.
Data sharing and use
Data Sharing and Use: Creating Platforms for Exchange, Insight, and Action
May 24, 2017
View the webinar | Download the slides
This webinar highlighted the importance of building technological infrastructure to link and use data sets across state agencies, programs, and provider groups, as well as provided details about available 90/10 match funding to support infrastructure development. Louisiana and the District of Columbia both shared their experiences with developing information technology infrastructure to share data among agencies and programs. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
Data Transfer and Use: Navigating Federal and State Laws and Regulations
March 28, 2017
View the webinar | Download the slides
This webinar discussed various data sharing regulations at the state and federal level, such as HIPAA and 42 CFR Part 2, and how these regulations may impact the sharing and use of HIV-related data across state agencies. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
North Carolina’s Engagement in Care Database for HIV Outreach (NC Echo): A Collaborative Effort
December 7, 2016
Download the slides
North Carolina presented on its Engagement in Care Database, which analyzes data from Medicaid claims and health department surveillance and Ryan White HIV/AIDS Program to identify people living with HIV that are not engaged in HIV care. State program staff then use this information to target outreach to these individuals to get them re-engaged in HIV care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
Public Health Innovation: Emerging Opportunities for Leveraging Health Systems Data
December 6, 2016
Download the slides
This presentation explained why data sharing between Medicaid and state health departments is critical to better understanding utilization patterns and health outcomes for people living with HIV. It also identified key considerations for states interested in advancing this work. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
Data analysis and presentation
How Data Visualization Efforts Impact Care and Decision Making
July 20, 2017
View the webinar | Download the slides | Presentation handout
The way in which data is presented is important when trying to increase stakeholder understanding and engagement on a particular issue. This webinar discussed strategies states can use to tailor their communication of data to specific audiences. The Massachusetts Department of Public Health shared how it designed a new website about the impact of the state’s opioid epidemic to be a rich, user-friendly resource for policymakers and community members. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
Recent HIV Data to Care (D2C) Experiences in Maryland
December 6, 2016
Download the slides
Maryland presented on how it is using analyses of HIV surveillance and Medicaid claims data to identify people living with HIV who are not engaged in regular HIV care, and then developing policy and program changes to address these gaps in care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides
This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.
Provider- and system-level quality improvement
Improving Quality of Care for Medicaid Beneficiaries Living with HIV: Strategies to Engage Managed Care Plans and Providers
August 17, 2017
View the webinar | Download the slides
It is important for states to engage key partners, such as managed care plans and providers, in order to improve the quality of care provided to Medicaid beneficiaries living with HIV. This webinar showcased New York state’s work to incentivize managed care plans to improve rates of virologic suppression for their members living with HIV. The New England AIDS Education and Training Center also shared resources and promising strategies to engage HIV providers in quality improvement. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
Data, Delivery, and Decisions as Levers for Enhancing Whole-Person Care for People Living with HIV: Lessons from the Ruth M. Rothstein CORE Center
January 26, 2017
View the webinar
As states continue to focus on integrated care and delivery system reform, meaningful opportunities exist to improve care for people living with HIV. The Ruth M. Rothstein CORE Center in Chicago, Illinois – part of the Cook County Health & Hospitals System – operates an integrated care model it calls “one-stop shopping.” This webinar featured speakers from the CORE Center and the Illinois Department of Health who shared lessons learned from their partnership to improve care for PLWH. The accompanying issue brief can be accessed here. The webinar and issue brief were developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.
Process Improvement Methods and Tools
November 18, 2016
View the webinar | Download the slides
Dr. Kevin Larsen from the Centers for Medicare & Medicaid Services shared methods and tools that states can use to design quality improvement initiatives. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.
Addressing social determinants of health
Housing Opportunities for Persons with AIDS: Presentation for HIV Health Improvement Affinity Group
December 7, 2016
Download the slides
This presentation described the Housing Opportunities for Persons with AIDS (HOPWA), a federal program dedicated to assisting with the housing needs of people living with HIV, and work in Alabama focused on improving health outcomes for people living with HIV/AIDS through greater access to housing. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.
The State of State Health Policy: Governors’ 2016 State of the State Addresses
State of State speeches provide governors with an opportunity to highlight recent policy successes as well as outline key plans and issue areas of focus for the coming year. These speeches are generally strong indicators of governors’ main priorities and sometimes also include specific proposal suggestions and funding recommendations for deliberation by legislatures.
Currently, 31 governors are Republican, 18 are Democrats and one is an Independent. Two states—Kentucky and Louisiana—elected new governors in 2015. So far this year, 40 governors have outlined policy priorities through state of state speeches and/or budget addresses.[1] The chart and descriptions below summarize some of the main health-related themes from these speeches.
See a state-by-state comparison
Six governors mentioned the issue of more broadly addressing population health and building healthy communities.
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Launching Great State 2019 Plan in honor of state’s upcoming 200th birthday; initiative will focus on addressing longstanding problems from healthcare to prison reform and will involve building opportunities for citizens, and promoting education, healthcare, access to technology, job growth and economic opportunity |
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Highlighted poverty’s negative effects and mentioned state’s Two Generation initiative to address poverty that links with the state’s efforts to be the healthiest in the nation; initiative recognizes that residents’ health has economic and overall quality of life impacts; also importance of reducing children’s screen time and the need to promote healthier behaviors such as involvement in outdoor activities |
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Will be investing in issue of homelessness, which will include addressing the needs of the most vulnerable homeless, such as those with chronic health conditions |
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Need to make more coordinated investments and transform towards focusing more intensely on prevention and public health and paying for outcomes rather than volume and services |
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Noted that safe and healthy communities are the foundation of the state; to maintain the state’s high quality of life investments should continue in priorities that support economic growth |
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Mentioned consumer health concerns regarding access to safe and healthy food and the need for meaningful food labeling |
In addition to mentioning health care costs within the context of Medicaid, eight governors also spoke about state health care costs more broadly; often mentioning costs associated with state employee health benefits.
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Noted that state has not allocated enough funding to cover future retiree health benefits for state workers |
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Identified sharply rising health care costs as the state’s biggest challenge, particularly costs of state employee health plans; also importance of shifting from fee-for service health care to a system focused on high quality and affordable outcomes, and ensuring that individuals appropriately use care to help reduce overall costs |
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Commented on the rising costs of mandated health care expenditures for state employees |
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Mentioned state employee health care obligations as one of the state’s biggest fixed expenses, but recent changes to how these obligations are funded will save costs in the future |
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Noted state budget crisis and need for new revenue to avoid severe cuts in assistance programs for disabled individuals and other health programs and potentially having to close safety net hospitals |
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Noted that if state does not address $2 billion budget deficit will have to make significant cuts to basic state services, including health programs such as prescription drug assistance for seniors, services for individuals with mental illness and disabilities, and home and community-based services |
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Mentioned the rising cost of health care as the most significant challenge to the state’s budget and the overall economy as well as creates challenges for families and businesses; noted state’s current work to shift from fee-for-service to an all-payer model focused on better health outcomes and targeted provider spending |
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Commented on the need to reform the administration of state employee health insurance to achieve savings |
In total, 17 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches. Specifically, 11 governors provided general comments about their states’ Medicaid programs in their remarks, such as commenting on recent program improvements or the growth of overall program costs.
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Mentioned commitment to implement Medicaid reforms to improve the state’s Medicaid program |
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Noted positive benefits of state’s Medicaid program but that there has been a significant rise in state Medicaid costs; requests legislature consider proposal to restructure taxes on Medicaid managed care organizations |
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Commented that state Medicaid costs have increased from $2.6 billion in FY2013 to $3.1 billion in FY2017 |
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Mentioned plans to move to a Medicaid managed care system to improve care coordination and address significantly rising state Medicaid costs |
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Recent reforms and modernizations to Medicaid program have demonstrated cost savings and also resulted in more client services and increased provider reimbursement rates |
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Access to in-home Medicaid services for individuals with developmental disabilities has significantly improved |
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Noted significant rise in state Medicaid costs |
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Highlighted the success of TennCare as a well-run system with high customer satisfaction ratings |
In total, 17 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches. Specifically, 11 governors provided general comments about their states’ Medicaid programs in their remarks, such as commenting on recent program improvements or the growth of overall program costs. Thirteen governors mentioned Medicaid expansion in their speeches. Eight were governors that have not implemented expansion, and five of these governors spoke about the need to expand Medicaid or find another state-specific solution to cover the uninsured (Missouri, South Dakota, Utah, Virginia, and Wyoming). Two governors (Kansas and Nebraska) expressed continued opposition to expansion. Kentucky’s newly elected governor mentioned plans to transform the delivery of publicly assisted health care and to make changes to the state’s traditional Medicaid expansion, although the proposed budget contains funding for expansion in its current form.
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Noted expansion has resulted in greater health coverage for residents and state has benefited from increased federal revenue from expansion |
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Mentioned expansion has resulted in greater health coverage for residents |
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Highlighted the work of cabinet in exploring Medicaid expansion alternatives; also mentioned recently released plan to provide state-funded primary care |
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Mentioned state’s unique expansion program has resulted in increased access to health care and is based on personal responsibility |
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Noted continued opposition to implementing expansion |
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Mentioned plans to transform delivery of publicly assisted health care and to make changes to the state’s current Medicaid expansion; proposed budget contains funding for current expansion |
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Suggested state should act to cover the uninsured through expansion; can develop a state-tailored solution that rewards work and incorporates personal responsibility |
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Noted continued opposition to implementing expansion |
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Urged legislators to support continuation of the Health Protection Program, the state’s Medicaid expansion program, which has increased access to behavioral health services but will end in December 2016 without legislative action |
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Noted opposition to ACA but importance of considering expansion to make the best decisions for the state; current negotiations with federal officials to change reimbursement process for services provided to Indian Health Services enrollees could cover the state’s expansion costs; will not move forward on expansion without legislative budget authority or if any new general funds are needed; also detailed how cost projections for the expansion population were developed; encouraged any expansion legislation to include language to end expansion if the federal match is reduced |
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Noted flaws of ACA but urged legislators to find a state-tailored solution to covering the uninsured |
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Urged legislators to consider Medicaid expansion through a bipartisan, state-tailored solution |
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Noted opposition to ACA overall but that state should craft tailored expansion plan; commented on loss of federal revenue from not expanding affecting hospitals and businesses, and uninsured individuals lacking coverage; cited many organizations that support expansion (e.g. state business alliance and chambers of commerce) |
Two governors spoke about the topic of the ACA’s exchanges in their speeches.
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Mentioned plans to cease operations of the state’s exchange, Kynect, and that individuals will enroll through the federal exchange |
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Noted improvements in eligibility determinations and access to the state’s Health Connector in the past year |
Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 26 governors mentioning these issues in some way. Governors’ frequently highlighted strategies that have been implemented or that they plan to implement to increase access to behavioral health services.
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Highlighted the issue of drug addiction; plans to convene a group of experts on substance abuse issues, recovering addicts and providers to identify appropriate treatments and reduce barriers to care |
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State is working to improve access to mental health care through State Innovation Model project; also plans to address links between suicide, mental illness and guns |
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State has significantly increased access to substance use treatment and is working with law enforcement to address overdoses; budget includes funding to provide team-based care for individuals in need of intensive treatment services; also plans for the Department of Health and Social Services to work with primary care providers to identify substance abuse issues earlier |
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Mentioned behavioral health issues as the underlying cause of many social, health and economic challenges and that mental health is the most pressing unmet health issue facing the state |
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Local behavioral health crisis centers have been effective; proposed budget includes funding for an additional center |
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Need to increase treatment options for drug addiction; will create task force on enforcement, treatment and prevention; also plans to build the first new mental health hospital in a generation |
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Highlighted the importance of addressing the needs of individuals with severe mental illnesses; will be launching a crisis prevention program for individuals ages 21 to 35 with severe mental illnesses and substance use disorders |
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Recent passage of state laws that increase access to substance abuse treatment; state still needs to “double down” on drug addiction and to treat it as an illness; committed to providing $100 million to improve access to mental health and substance use treatment by providing higher reimbursement rates for services and providers; plans to increase funding for three Accountable Care Organizations focused on providing coordinated physical and behavioral health treatment for Medicaid patients |
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In the past five years the highest amount of funding in the state’s history has been provided for mental health; legislation was passed to reduce prescription drug and substance abuse fatalities |
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Recent investments of over $700 million in the state’s mental health system to restore prior service cuts, but additional focus on the issue is still needed; proposed budget includes funding directed towards building a stronger mental health system |
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Substance abuse has become one of the most significant challenges in the state; have invested in treatment services and resources to publicize services, updated prescription drug monitoring efforts, and implemented other measures to reduce the oversupply of pain medication |
Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 26 governors mentioning these issues in some way. The issue of heroin and other types of opioid abuse and overdoses were specifically mentioned by a number of governors in their remarks.
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Recently passed state law allowing healthcare providers to make an antidote available to address opioid overdoses and to allow Medicaid to cover inpatient detoxification |
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Plans to address heroin and opioid addiction; proposed budget includes funding for treatment programs and continuation of efforts to monitor prescription drugs |
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State is working to address heroin and opioid addiction through a state-level task force |
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Legislation being developed to address the heroin and opioid abuse epidemic by building capacity in prevention, education, and treatment efforts |
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Need for a prescription drug monitoring program to address the opioid abuse epidemic |
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State has worked to address the heroin and opioid abuse crisis but the issue remains the most urgent public health and public safety concern; efforts are underway to strengthen the state’s prescription drug monitoring program and improve access to treatment, but need further funding for law enforcement and efforts to strengthen prevention, treatment and recovery initiatives |
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Plans to launch a treatment intervention pilot program for individuals recovering from drug overdoses; individuals in recovery will help lead the intervention programs |
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State views opioid overdoses as a public health crisis; aiming to reduce overdoses by one-third in the next three years by investing in treatment, overdose reversals, prevention and recovery |
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State has coordinated trainings for first responders on administering Narcan, an antidote for opioid overdoses; plans to introduce legislation to expand access to Narcan without a prescription |
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Proposing funding to make a pilot program for overdose drug naloxone permanent; also funding for needle exchange programs, additional state staff resources and to develop a new treatment hub |
Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 26 governors mentioning these issues in some way. Governors spoke about the issue of behavioral health within the context of better addressing the needs of justice-involved individuals, and providing mental health and substance use treatment services rather than incarceration when appropriate.
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Will be focusing on providing drug treatment and counseling to justice-involved individuals to help reduce recidivism |
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Mentioned justice reforms have diverted justice-involved individuals with substance use disorders to treatment rather than incarceration when appropriate |
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Bipartisan commission to reform the criminal justice system recommended enhancing cognitive behavioral therapy and substance abuse treatment programs in the corrections system |
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As part of the state’s justice policy reforms, will be focusing on rehabilitation instead of incarceration and on looking at funding models for drug and mental health courts |
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Proposing $1.6 million to reduce the number of severely mentally ill individuals cycling through jails and emergency rooms and to direct them to treatment instead |
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With reductions in the state’s prison population, one of the correctional facilities has been closed and will be converted into a certified drug abuse treatment facility for justice-involved individuals |
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Importance of addressing the behavioral health issues of justice-involved individuals; proposed budget includes funding for new crisis triage centers, mobile crisis response teams, and community behavioral health clinics |
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State has significantly increased the number of drug and DUI courts; more non-violent justice-involved individuals are receiving community treatment rather than being incarcerated |
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State has increased the number of drug recovery courts, resulting in reduced incarceration costs; proposing to invest more in these courts in order to offer services in all counties |
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Need to address issue of individuals with severe mental illnesses who cycle between jails and emergency rooms; proposed budget includes funding for four new 16-bed crisis triage facilities and three new mobile crisis teams |
Five governors noted issues related to the health care workforce, primarily commenting on strategies to address shortages.
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Mentioned physician and dentist shortage in nearly all of the state’s counties, and outlined plans to increase funding for medical scholarships and loan forgiveness for students committing to serve in underserved areas; also aims to create tax credits for rural providers and increase funding for 12 new residency programs |
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Noted that programs to train individuals in the health care field are expanding |
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Commented on need to address state’s lack of primary care physicians by maintaining funding for physician residency slots and providing medical loan reimbursement; also requests that the Board of Education work with the medical community and higher education institutions to develop plans to address the growing need for healthcare providers |
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Mentioned current state legislation that would permit the state to enter into a compact with other states to allow medical licenses to be interchangeable across states |
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Commented on how plans to expand employment training programs will help address healthcare workforce shortages; a task force will focus on developing innovative solutions to further address these shortages |
Some governors mentioned other specific health topics in their speeches, either as recent accomplishments or as future plans. These included topics such as enhancements to autism coverage, improvements in health coverage eligibility determinations, or lowered prison pharmacy costs.
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Mentioned that state will be providing health care coverage to children of undocumented workers; also state leads the nation in providing Medicaid home-based care, which also gives jobs to health care providers |
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Noted plans to partner with a national nonprofit organization to improve access to contraceptive options by offering better training for health care providers |
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Mentioned that in recognition of the need for private sector resources for Maui’s public hospitals, recently transferred hospital management to Kaiser Permanente |
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Will be forming a working group to address rural health care delivery issues |
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Addressed the water crisis in Flint and proposes support for increasing children’s access to health care and treatment for health issues associated with elevated blood lead levels |
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Highlighted passage of autism legislation to ensure that appropriate services are available through health plans; will expand services at existing autism centers and build a new center |
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Mentioned improvements at state’s Department of Health and Human Services have streamlined low-income residents’ access to nutrition assistance and other assistance programs |
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Mentioned that Department of Correction worked with TennCare to lower prison pharmacy costs annually by $5 million; proposed budget includes funding for a mobile seating and positioning unit in the Department of Intellectual and Developmental Disabilities |
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Noting the importance of helping individuals cope with health and mental health care needs to retain workplace talent, mentioned a recently completed informational kit for employers to provide to employees caring for family members with dementia or Alzheimer’s disease |
Improving Access and Building Behavioral Health Capacity Through Telehealth and Teleconsultation: Lessons from Mississippi and New Mexico
Date: November 18, 2015
Time: 3:00-4:00pm
View Webinar Here
Download Webinar Slides
Workforce shortages and other resource constraints directly impact access to behavioral health care. In recent years, states have increasingly turned to telehealth and teleconsultation programs to build provider capacity and increase access for bothbehavioral and physical health services. Although more research is required, early evidence indicates that these programs result in equal or better care when compared to traditional in-person services and may result in cost savings. During this webinar, attendees hear from leaders from two nationally-acclaimed programs, including the Center for Telehealth at the University of Mississippi Medical Center and Project ECHO. Discussion includes overviews of each program, including identification of best practices, lessons learned, and key takeaways for state policymakers. Audience Q&A follows.
Moderator:
- Pamela Riley, MD, Assistant Vice President, Delivery System Reform, The Commonwealth Fund
Speakers:
- Kristi Henderson, DNP, Chief Telehealth & Innovation Officer, University of Mississippi Medical Center
- Miriam Komaromy, MD, Associate Director, Project ECHO
This webinar is supported by The Commonwealth Fund.
For more information on this topic, please see the following issue brief.
A Closer Look at the Oversight of State-based Marketplaces
The 17 states, and the District of Columbia, electing to operate a State-based Marketplace (SBM) are subject to comprehensive oversight from a varied set of federal and state agencies, committees, and regulators. Ongoing reporting, site visits, and auditing spans the full range of SBM functions, including eligibility and enrollment, data security, consumer privacy, financial transactions, business operations, grant monitoring, budget, consumer assistance, and marketplace personnel policies.
For SBM states to cooperate and assist with the numerous inquiries and audits related to their operations, they must utilize staff resources from all marketplace departments. SBMs also frequently need to rely on other agencies such as IT, data, policy, legal, and Medicaid in order to meet all components of an oversight request. In addition to this staff time, SBMs also typically have one staff member who is responsible for coordinating with the auditors and obtaining all the necessary information and data for compliance.
| Download the Brief |
Mississippi – Medical Homes
New Jersey has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions.
HB 1192, signed into law in 2010, defined patient-centered medical homes and made a number of legislative findings about the medical home model of care. It also orders the State Board of Health to adopt guidelines for practices run by physicians, nurse practitioners, and physician assistants that incorporate PCMH principles.
Federal Support: Mississippi has received a planning grant from the Centers for Medicare & Medicaid Services (CMS) to develop a state plan amendment to implement Section 2703 of the Affordable Care Act (ACA), establishing health homes for Medicaid enrollees with chronic conditions. To learn more about Section 2703 Health Homes, visit the CMS Health Homes webpage.
Last Updated: April 2014
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Definition: HB 1192 states that patient-centered medical homes “provide a whole-person orientation that includes care for all stages of life, including acute care, chronic care, preventive services and end-of-life care.” It goes on to state that “care in a patient-centered medical home is coordinated across all elements of the health care system and the patient’s community to assure that the patient receives the indicated care when and where the patient needs the care in a culturally appropriate manner.”
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Mississippi
In Mississippi:
- As of 2011, the state had 621,607 individuals enrolled in Medicaid.
- 541,854 of these individuals received non-emergency transportation services through a Prepaid Ambulatory Health Plan (PAHP).
- 51,626 of these individuals received services through Mississippi’s coordinated care program, Mississippi Coordinated Access Network (MississippiCAN) in 2011. Enrollment in MississippiCAN is limited to 45% of Medicaid beneficiaries and is available in all 82 counties. The state’s Division of Medicaid has contracted with two coordinated care organizations (CCOs), capitated health plans that provide the full range of Medicaid benefits to MississippiCan enrollees, excluding inpatient hospital services or transportation services to and from doctor visits. The program is mandatory for certain Medicaid groups, including individuals receiving SSI (ages 19-65), adults with disabilities, women with breast or cervical cancer, pregnant women and infants, families receiving Temporary Assistance for Needy Families, and children age 0-1. The program is voluntary for the following populations: children (ages 0-19) receiving SSI, children (ages 0-19) with disabilities, and foster children (ages 0-19). Voluntary enrollees have the option to opt-out and receive their Medicaid benefits on a fee-for-service basis.
- The state provides 1915(c) waiver services to children with serious behavioral health needs through Mississippi Youth Programs Around the Clock (MYPAC). MYPAC provides services and supports including intensive case management, wraparound services, and respite services.
As of 2012, 429,897 individuals (aged 0 – 20) were eligible for Mississippi Cool Kids, Mississippi’s Medicaid benefit for children and adolescents (also known as the Early Periodic Screening, Diagnostic and Treatment benefit, or EPSDT). According to CMS data from 2012, Mississippi Cool Kids achieved a screening ratio of 65%. Additionally, 193,415 eligibles received dental services, with 176,016 receiving preventive dental services.
Last updated December 2013.
| Medical Necessity |
Mississippi’s Medicaid provider policy manual defines “medically necessary services” as those that are
In the state’s Medicaid manual for EPSDT services, a “medically necessary service” is defined as “any service that is reasonably necessary to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap or cause physical deformity or malfunction. There must also be no other equally effective, more conservative, or substantially less costly course of treatment available or suitable for the client requesting the service.”
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| Initiatives to Improve Access |
The Department of Health (DOH) is a major provider of Mississippi Cool Kids (EPSDT) well-child services in the state. In partnership with Mississippi Medicaid, DOH has developed nurse-run clinics that provide well-child screens, and refer out to physicians for other services, referrals, and follow up. These nurses work with Head Start programs and visit daycare centers to expand access to Mississippi Cool Kids well-child services.
Mississippi works with schools to support a range of school-based health services designed to identify and assist children who have medical issues that interfere with learning. Nurses employed by the Department of Education may also perform Mississippi Cool Kids screens.
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| Reporting & Data Collection |
Billing
Only enrolled Mississippi Cool Kids providers are permitted to bill for EPSDT screens, and these providers must use an EPSDT modifier when billing.
Reporting Requirements
Mississippi’s coordinated care program, MississippiCAN, includes EPSDT-specific contract language for participating coordinated care organizations (CCOs)—capitated health plans with specified care management responsibilities—on data and reporting. The state Medicaid agency evaluates EPSDT claims data and sample medical records to determine CCO compliance with EPSDT service provision requirements. CCOs are required to achieve a screening rate of 85% and an immunization rate of 90%; those who do not meet these rates are required to refund Mississippi Medicaid $10 per enrollee for all enrollees under age 12 months. Medicaid publishes the screening rates of CCOs that achieve rates of 85% or greater for the Medicaid population and the medical community in applicable service areas. CCOs are also required to make these screening rates known to potential enrollees in educational and marketing presentations.
MississippiCan CCOs also supply the Department of Medicaid with encounter data that includes claims payment for EPSDT services. In addition to the encounter data, the CCOs must submit quarterly 416 reports that indicate whether the CCOs have met the screening and immunization standards described above.
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| Behavioral Health |
Mississippi Medicaid delivers behavioral health services on a fee-for-service basis through Mississippi’s private mental health providers and community mental health centers.
The state provides 1915(c) waiver services to children with Serious Emotional Disturbance (SED) through Mississippi Youth Programs Around the Clock (MYPAC). MYPAC provides services and supports including intensive case management, wraparound services, and respite services. On the MYPAC website, Mississippi provides the MYPAC Initial Screening Form to determine if a child meets criteria for the waiver services, and a Freedom of Choice Form for the families to ensure they have made an informed choice between treatment in a Psychiatric Residential Treatment Facility and participation the MYPAC community-based demonstration.
Mississippi Medicaid has developed an Adolescent Counseling Form for use by physicians during the EPSDT screen for children aged nine and above. The form facilitates a structured interview with adolescents on issues such as substance use, coping skills, and relationships. Providers can bill Medicaid for an EPSDT adolescent screen separately from other EPSDT services using screening code 99401-EP.
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| Support to Providers and Families |
The Mississippi Department of Health (DOH) operates an EPSDT website that provides information on the benefit and how to determine eligibility for these services.
Managed care organizations participating in the Mississippi Coordinated Access Network (MississippiCAN) are required to provide “instructions advising enrollees about EPSDT and how to access such services.” Families of children with special health care needs enrolled in managed care may also request that their specialist be the primary care provider for their child, and “the Contractor shall have in place procedures for ensuring access to needed services for these enrollees or shall grant these PCP requests, as is reasonably feasible and in accordance with Contractor’s credentialing policies and procedures.”
Mississippi Youth Programs Around the Clock (MYPAC)
Youth enrolled in MYPAC, the state’s 1915(c) waiver for children with serious behavioral health needs, are assigned a Family Support Specialist (FSS), who acts as their personal advisor to answer questions about the program. An FSS is someone who has experience as a parent/guardian of a child with Serious Emotional Disturbance (SED). Support to Providers
Mississippi Medicaid produced a provider manual for EPSDT services, which outlines topics such as provider requirements, covered services, and reimbursement.
Medicaid providers in Mississippi also receive pamphlets and books describing the Medicaid benefit for children and adolescents. The state has developed Screening Documentation Forms for all ages, from 1 month to 15 – 20 years. These forms include a checklist for the providers when performing a screen under the benefit. The forms, and the periodicity, schedule follow Bright Futures guidelines.
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| Care Coordination |
The Mississippi administrative code requires the Medicaid agency to pay for an EPSDT case manager for families of children with developmental disabilities. Case managers must have experience in service coordination for children with disabilities up to age 18 or two years of experience in service provision to children under 6 years of age. Case managers carry out Early Intervention/Targeted Case Management (EI/TCM) activities to assist and enable a child with developmental disabilities receiving the Mississippi Cool Kids benefit to gain access to needed medical and other services, provide service coordination for the child and his or her family, and assist in the development of the Individualized Family Services Plan (IFSP). Case Managers are required to make a minimum of one (1) face-to-face contact quarterly and documented successful contacts monthly.
Coordinated Care Organizations under the state’s MississippiCAN program are required to “be responsible for the management and continuity of medical care for all Enrollees.” In particular, contract language establishes their responsibility for child-specific care coordination such as:
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| Oral Health |
Mississippi Cool Kids (EPSDT) providers are encouraged to perform an oral health assessment and apply fluoride varnish at the same time as the child’s regularly scheduled Mississippi Cool Kids Screening.
Medicaid also reimburses dental providers for an oral evaluation and counseling with each child’s primary caregiver for children under the age of three.
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Mississippi
NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@oldsite.nashp.org.
Last updated: October 2012
Mississippi
No HIE Strategic Plan available yet.
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
