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Growing Pains, Seeing Gains: Improving Youth Transitions
Thursday, August 16th
10:00am – 11:30am
Transitioning from youth to adulthood requires increased responsibility for many areas of life, including managing one’s health. This can be particularly challenging for children with a range of social and health care needs, particularly children with special health care needs. Policymakers from several states, including Georgia and Wisconsin, discuss innovative approaches to support young adults’ transitions to adult health care services and programs through managed care, quality improvement, family engagement, care coordination, and interagency collaboration and cooperation.
This session is supported by the Lucile Packard Foundation for Children’s Health
Moderators
Lori Abramson, Director-Georgia Families 360, Georgia Department of Community Health
Lori Abramson, LCSW is Director of the Georgia Families 360° program at the Georgia Department of Community Health. She ensures that children in foster care, adoption assistance, and youth in the juvenile justice system receive medical, dental, and behadvioral health care without barriers. Lori has 38 years’ experience in clinical practice, advocacy, collaboration building, and the managed care environment. Lori’s professional focus is about leveraging that experience on behalf of Georgia’s children and families.
Donna Bradbury, Associate Commissioner, NYS Office of Mental Health
Donna Bradbury directs the Division of Integrated Community Services for Children and Families at the Office of Mental Health. She oversees all community-based children’s mental health programs in New York State. She is currently leading the effort to transition children’s behavioral health services into Medicaid managed care as part of the larger Medicaid Redesign project.
Prior to state service, Donna worked for twelve years for the Rensselaer County Department of Mental Health. She delivered clinical services to children and their families, served as a consultant to Family Court as well as county-operated human service departments and schools, ran a specialized treatment program which successfully prevented institutional placement for many youth, and assisted in the creation and implementation of several interagency initiatives that resulted in children and their families having easier access to better quality services.
Speakers
Becky Burns, Statewide Coordinator, Wisconsin Children and Youth with Special Health Care Needs Program
Becky’s career centers on supporting children and families whose lives have been affected by unanticipated journeys through the world of disability services. She treasures the opportunities to work with these families whose resilience and growth continues to astound her. With a Master’s of Science in Social Work, she has used her education along with her personal experience of being raised in a family with a child who has a disability to influence her work with families. She has worked in one capacity or another for the state of WI for over 18 years.
Gordon Lee, Health Program Administrator, KY Office for Children with Special Health Care Needs
Lee holds a Master of Public Administration (MPA) and a Bachelor of Health Science in Health Administration. He is employed by the Office for Children with Special Health Care Needs (OCSHCN) where he carries out the duties of the agency’s Transition Administrator. Lee works with children, adolescents, families, support groups, service providers and OCSHCN staff to help ensure that Kentucky’s children with disabilities are prepared to successfully transition from pediatric to adult health care, from school to work, and from home to independent living. Lee coordinates the activities of the OCSHCN’s Youth and Parent Advisory Councils.
Peggy McManus, President, The National Alliance to Advance Adolescent Health
Peggy McManus is President of The National Alliance to Advance Adolescent Health and Co-Director of Got Transition. With Dr. White, she led the revision of the Six Core Elements of Health Care Transition, developed new transition quality improvement and consumer feedback measurement tools, published systematic reviews on transition outcomes and measures, and published extensively on transition quality improvement, payment options, state Title V transition efforts, and the status of transition preparation in the US.
Success Spurs Growth of Medicaid Managed Care for Children with Special Health Care Needs
Two decades ago, the majority of state Medicaid programs that served children and youth with special health care needs (CYSHCN) relied on a traditional, fee-for-service model to pay for the complex mix of health care services that this group of children often need. But as states became more adept at designing new health care delivery programs, they have begun enrolling Medicaid beneficiaries with chronic and complex medical needs into Medicaid managed care (MMC) programs.
Some states are discovering that MMC can provide greater opportunities for coordinating care, controlling costs, and improving health care quality and outcomes for CYSHCN.
To implement these programs, state Medicaid agencies are contracting with managed care organizations (MCOs) to provide care and support services for a set price (per member, per month) with the goal of providing high-quality care at lower costs. These state programs are unique, with each state creatively designing plans to serve specific CYSHCN populations. Knowing what plans and policies states have adopted, outlined in a 50-state scan, provides important insights into national trends and new approaches that states can use to transform their MMC models to serve CYSHCN.
A recent NASHP nationwide analysis found 47 states and Washington, DC, now use some form of managed care to serve all or some children and adults enrolled in Medicaid today. Of the states with managed care delivery systems, all enroll at least some or all of their CYSHCN into some type of Medicaid managed care. Most enrollment is in risk-based managed care, where the MCO assumes financial risk.
NASHP’s issue brief, and 50-state map and chart provide an easy-to-use reference guide to learn what individual states are doing as they redesign health care for their CYSHCN. NASHP’s analysis found that enrollment in MMC varies by state and subpopulation of CYSHCN:
- 42 states enroll children in the Medicaid Aid to the Aged, Blind and Disabled (ABD) category of assistance in MMC;
- 42 states enroll foster care youth in MMC;
- 22 states enroll children who receive Supplemental Security Income (SSI) in MMC; and
- 14 states enroll children in 1915(c) Medicaid waiver programs in MMC.
Most states with MMC enroll CYSHCN on a mandatory basis and serve CYSHCN in standard health plans that serve all Medicaid beneficiaries. A small number of states have developed specialized managed care plans for CYSHCN.
In addition to rapidly expanding MMC, states are also evaluating if this health care delivery model is truly improving the quality of care for Medicaid beneficiaries. Two-thirds of states (33) have incorporated quality measurement requirements specifically for CYSHCN into their managed care contracts to assess how well these systems are serving children’s needs. These and other findings about enrollment of CYSHCN in MMC are summarized in a new issue brief and a 50-State Chart and Map. NASHP has also taken an in-depth look at Medicaid managed care delivery systems for CYSHCN in six states, and state use of Medicaid quality metrics for CYSHCN. These and other resources will be released in the next two
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. 
