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Oklahoma Promotes Healthy Child Development through Increased Well-Child Visits and Screenings Using Innovative Funding

State-Only Preconference: From Plain to Supreme, a Children’s Coverage Menu

June 21, 2019/in Policy Annual Conference /by NASHP Staff

Changes to Poverty Measure Could Disqualify Thousands from State and Federal Programs

June 17, 2019/in Policy Blogs, Featured News Home CHIP, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Eligibility and Enrollment, Health Coverage and Access, Health Equity, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Social Determinants of Health /by Anita Cardwell and Christina Cousart

The Office of Management and Budget (OMB) is seeking public comment on possible changes to how the federal poverty measure is annually adjusted for inflation. The changes would impact individuals’ eligibility for multiple programs because the US Department of Health and Human Services uses the poverty measure to establish poverty level guidelines. A wide range of government assistance programs would be affected, including:

Alternative methods proposed by OMB … could reduce the poverty line by up to 3.4 percent over the next 10 years.

Medicaid
Children’s Health Insurance Program (CHIP)
Advanced Premium Tax credits (APTCs) and cost-sharing reduction payments (CSRs) allotted through state health insurance marketplaces
Supplemental Nutrition Assistance Program (SNAP)
Women, Infants, and Children (WIC) program
Health Professions Student Loans
AIDS Drug Assistance Program
Community Health Center funding
Low Income Home Energy Assistance Program (LIHEAP)

Currently, the poverty measure is adjusted by a factor known as the Consumer Price Index for all Urban Consumers (CPI-U), which has been in place since the measure was implemented. While changes could affect long-standing eligibility for state and federal programs, OMB states that an alternative inflation index would more accurately measure inflation. Alternative methods proposed by OMB include use of the “chained” CPI or the Personal Consumption Expenditures Price Index (PCEPI) — these two measures grow more slowly than the CPI-U and could reduce the poverty line by up to 3.4 percent over the next 10 years.
Over time, a slower rate of inflation would significantly impact individuals’ eligibility for the programs listed above. At particular risk would be individuals whose income hovers at the margin of eligibility, who would lose eligibility if the calculation was modified. For example, estimates indicate that more than 500,000 would lose eligibility for Medicaid or CHIP, including 300,000 children. In addition, the millions of Americans who qualify for subsidies to purchase coverage through the insurance marketplaces would see a reduction in the amount of subsidies they receive that make coverage more affordable, or they could become ineligible for those subsidies altogether. Similar reductions in eligibility would occur across programs critical to social determinants of health, including food assistance programs (SNAP and WIC) and early education programs such as Head Start.
An increase in the number of low-income individuals who are no longer eligible for health and other social supports could have significant repercussions on states’ safety net programs. There will be a rise in the number of uninsured as individuals lose eligibility for, or are priced out of coverage. Some may use their limited income for necessities like food, child care, and utilities instead of health care. These changes could result in increased uncompensated care costs. Additionally, states’ health care system costs could increase if individuals without coverage delay seeking care and wait to seek treatment for conditions only when they become urgent — and more costly to treat.
Additionally, using the chained CPI may not fully account for the rising price of necessities that low-income households spend a larger percentage of their income to purchase, such as housing, which in recent years has increased faster than overall CPI. Many analysts, as well as the National Academy of Sciences, have noted that the current poverty measure already does not accurately capture important costs such as child care that strain many low-income families’ budgets.
Comments on the OMB proposal are due Friday, June 21, 2019 and can be submitted here. Following this comment period, it is unclear whether the administration will conduct a more formal rule-making process related to these potential changes, or simply seek to implement them through OMB guidance.

Leveraging CHIP to Improve Children’s Health: An Overview of State Health Services Initiatives

May 20, 2019/in Policy Charts, Maps CHIP, CHIP, Chronic Disease Prevention and Management, Eligibility and Enrollment, Health Coverage and Access, Healthy Child Development, Maternal, Child, and Adolescent Health, Population Health /by Anita Cardwell

Considerations for States Crafting Budgets to Support Children’s Coverage

March 11, 2019/in Policy Blogs Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Healthy Child Development, Maternal, Child, and Adolescent Health, Medicaid Managed Care /by Anita Cardwell

After months of uncertainty and a three-month federal funding lapse, in early 2018 Congress passed the HEALTHY KIDS and ACCESS Acts, which appropriated federal funds for the Children’s Health Insurance Program (CHIP) through federal fiscal year (FFY) 2027. While the HEALTHY KIDS and ACCESS Acts’ long-term funding stabilizes CHIP programs and helps states develop forward-focused strategies to improve children’s coverage, a decrease in the federal CHIP match rate will require additional state funding beginning this October.

The Affordable Care Act (ACA) increased states’ federal CHIP match rates by 23 percentage points — referred to as the “23 percent bump” — beginning in FFY 2016, which resulted in match rates ranging from 88 to 100 percent. While the HEALTHY KIDS and ACCESS Acts continued to fund the 23 percent bump through FFY 2019, beginning this October it will be phased down to 11.5 percentage points. Subsequently, in FFY 2021 and beyond, the percentage returns to the regular enhanced CHIP match rate that states received prior to the 23 percent bump.

States are currently finalizing budgets for their CHIP programs and must factor in this reduction in the federal match rate to determine the state financing needed to sustain these critical programs. State officials in Alabama estimate that $30 to $35 million in additional state funding will be needed for the state’s CHIP program in FFY 2020, and Oklahoma predicts it will need $14.8 million more. Planning for the phased reduction in the CHIP match rate may pose a particular challenge for states with legislatures that only meet every other year, considering additional state dollars will be needed in FFY 2021 as well.

Some states may consider modifying income eligibility levels for CHIP as a way to address the decreasing federal CHIP match rate, but that is not an option because the 2018 CHIP funding extension includes a requirement that states maintain certain coverage levels for children enrolled in Medicaid and CHIP — called the maintenance of effort (MOE). The HEALTHY KIDS and ACCESS Acts build on the ACA’s MOE provision, which requires states to maintain their Medicaid and CHIP eligibility levels for children that were in place as of March 23, 2010.

Through the ACA, the MOE for children was set to expire at the end of FFY 2019, but the HEALTHY KIDS and ACCESS Acts extend the MOE requirements through FFY 2027. However, beginning Oct. 1, 2019, the MOE protection targets children in families with incomes up to 300 percent of the federal poverty level (FPL). This means that states with Medicaid or CHIP eligibility levels for children above this level have flexibility to lower them to 300 percent of FPL. However, because the majority of states do not provide coverage above 300 percent of FPL, most states will be required to keep their current eligibility levels in place. The intent of the MOE is to help ensure coverage stability for children enrolled in Medicaid and CHIP, and it may become increasingly important if recently reported declines in children’s coverage continue. For more information about the MOE, read 101: Maintenance of Effort (MOE) Requirements for Children in Medicaid and CHIP Fact Sheet.

As state officials weigh these budgetary issues, many states are also seeking to implement initiatives to enhance children’s coverage and care. Some states are developing innovative Health Services Initiatives, strengthening coordination with schools and other community partners to better meet children’s health and behavioral health needs, or improving integrated care for children. In the coming months, the National Academy for State Health Policy (NASHP) will be gathering and sharing information highlighting state efforts to improve children’s coverage and care.

State Health Officials Concerned about the Proposed Public Charge Rule

November 20, 2018/in Policy Blogs Behavioral/Mental Health and SUD, CHIP, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health Equity, Health System Costs, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health /by Anita Cardwell

State officials are concerned that the proposed federal public charge rule could increase the uninsured rate, which would have a negative financial impact and increase health programs’ administrative burden.

The Department of Homeland Security (DHS) has proposed significant changes to public charge determination policies that would affect the immigration status of certain individuals. The concept of determining if an immigrant is a public charge — someone who would be unable to care for himself or herself — has been a provision in US immigration policies since the late 1800s.

Currently, individuals can be prevented from entering the United States or denied lawful permanent residence if they are determined to be a “public charge” based on their enrollment in cash assistance programs, such as Temporary Assistance for Needy Families or Supplemental Security Income, or if they need long-term institutional care funded by the government. However, as outlined in NASHP’s earlier blog, DHS proposes to substantially expand the list of public assistance programs that would be considered in public charge determinations, including use of non-emergency Medicaid health coverage.

The proposal calls for the consideration of the duration of time, or number of months, that certain immigrants use Medicaid, Supplemental Nutrition Assistance Program, housing assistance, etc. within a 36-month period beginning on the date the rule is finalized. There are other criteria used, including an immigrant’s age, financial status, and skill set, etc. to determine if he or she meets the public charge definition.

Although immigration policy is within the federal domain and the public charge determination is made by DHS, immigrants live and work in states. States must balance multiple factors related to immigration, including their workforce needs and stabilization of health insurance markets – both private and publicly subsidized. State officials have serious concerns about the chilling effect on enrollment, or the likelihood that individuals – whether they are at risk of being determined a public charge or not – will either dis-enroll or not re-enroll in coverage due to the potential implication it may have on their citizenship status. State officials fear what the effect of reducing coverage could have on their budgets and overall economies.

Within the proposed rule, DHS estimates Medicaid disenrollment and non-enrollment rates among individuals who would be directly subjected to the proposed rule at approximately 142,000 annually. However, state health officials and policy experts have expressed concern that the broader chilling effect on health coverage enrollment would be considerably greater. The Kaiser Family Foundation has estimated that between 2.1 and 4.9 million individuals currently enrolled in Medicaid/CHIP would dis-enroll due to the proposed rule. For example, even though the proposed rule does not take into account a family member’s enrollment in Medicaid, immigrant parents may not enroll or may dis-enroll their children who are eligible (even though they are not subject to this rule change) from fear that their children’s participation could affect their ability to obtain a green card in the future. Though the proposed rule does not include enrollment in the Children’s Health Insurance Program (CHIP) as a factor in public charge determinations, immigrant families concerned about the proposed rule changes may be wary of enrolling their children in either Medicaid or CHIP —even if the proposed rule changes are never finalized.

Officials from several states noted that as the rate of insured residents has grown, their uncompensated care costs have been trending downward, particularly in states that expanded Medicaid through the Affordable Care Act. But, if uninsured rates begin to rise due to the chilling effect on enrollment from this proposed public charge rule, states’ health care safety net systems will be significantly strained. State officials expressed concern that this likely rise in uncompensated health care costs due to the changes associated with the proposed rule could be considerable. Additionally, individuals without coverage may delay seeking care, which in turn could result in individuals addressing health issues only when they become urgent, which would also lead to increased health care system costs.

State officials are also weighing the operational challenges that will fall to states to implement the proposal. Although public charge determinations will continue to be conducted by federal officials, details for how DHS will access the data needed to affirm immigrants’ use of Medicaid and other public programs are vague or non-existent in the rule. State health officials have identified the following potential administrative issues:

Challenges associated with identifying individuals’ participation in Medicaid: The proposed rule does not specify how information about individuals’ enrollment in public benefit programs will be collected or shared, and so the state role of providing data to DHS is unclear. Will DHS rely on immigrants’ self-attestation when completing their immigration applications? Or, will states be required to provide information about individuals’ enrollment in public benefit programs? If states are required to do so, would DHS routinely collect this information from state agencies, or contact state agencies on a case-by-case basis? Either of these data-sharing options requires significant state investments of staff time and other resources to develop and implement processes.
Increased risk of churn: Many anticipate that the chilling effect of this proposed rule will result in churn, with individuals dis-enrolling and re-enrolling in coverage. Not only will periods of uninsurance result in unmet health care needs at a greater cost, but processing enrollments requires more state resources than do renewals. Most states seek to actively minimize churn as an administrative cost-saving measure, so states do not have the resources to meet an increase in the prevalence of it in the future.
Handling increases in consumer inquiries: Due to the complexity of the proposed rule, if it is finalized, state health officials noted that both public health program enrollees and applicants will likely have a number of questions. This increase in the volume of consumer inquiries could place a substantial burden on call center staff and enrollment assisters. State health and human service agencies would also need to ensure that these frontline staff are appropriately informed about the rule changes.
Possible changes to program documents, such as applications and outreach materials: The proposed rule is not retroactive, meaning that an individual’s use of the public benefit programs that are identified by DHS prior to the rule being finalized would not be a factor in future public charge determinations. However, if the rule does become final, although it likely won’t be a requirement for states to provide information about the potential immigration status implications of enrolling in public benefit programs, some state agencies may decide to do so to ensure that individuals are adequately informed. This could require states to expend resources to modify or develop new application or eligibility notices and outreach materials.

As state officials process the potential changes resulting from DHS considering participation in health coverage and other public benefit programs in determining whether an immigrant may qualify as a public charge, there are concerns about the financial implications for states. Specific cost estimates aren’t possible because the extent of the chilling effect is unknown, as is the impact on uncompensated care, and it is unclear the process (and possible system) changes states will need to make to share information with DHS. However, it is highly likely that the inclusion of health coverage in the federal determination of an immigrant as a public charge will have a potentially substantial impact on states. Comments on the proposed rule are due Dec. 10, 2018 and can be submitted here.

Medicaid Managed Care Proposed Rule Would Give States More Flexibility

November 20, 2018/in Policy Blogs CHIP, CHIP, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care /by Kate Honsberger

The Centers for Medicare & Medicaid Services (CMS) has proposed a new regulation that gives states more flexibility to design and implement Medicaid managed care programs for Medicaid and Children’s Health Insurance Program (CHIP) enrollees. The proposal aligns with the Trump administration’s goal to reduce regulatory requirements imposed on states.
The majority of the proposed changes are policy and technical corrections to the 2016 Medicaid and CHIP Managed Care Final Rule. (The National Academy for State Health Policy has analyzed, and highlighted aspects of the rule relevant to children with special health care needs.) CMS notes the proposed rule addresses state officials’ concerns that existing federal regulations are overly prescriptive and administratively burdensome.
NASHP has performed an initial review of the proposed rule and found the following provisions may require fewer state administrative resources if the rule is finalized:

Rate setting:
- Rather than require states to develop and certify each individual rate paid per rate cell (or population group within certain regions, which can be numerous within Medicaid) to demonstrate actuarial soundness in managed care capitation rates as currently exists, states would have the option to develop and certify a rate range. Prior to the finalization of the 2016 regulation, most states used a rate range to justify managed care capitation rates.
Network adequacy:
- Instead of requiring time and distance standards for provider types within a managed care network, states would be able to implement a combination of “quantitative minimum access standards,” such as:
  - Minimum provider-to-enrollee ratios;
  - Maximum travel time or distance to providers;
  - A minimum percentage of contracted providers who are accepting new patients;
  - Maximum wait times for an appointment; and
  - Hours of operation requirements (for example, extended evening or weekend hours).
- The 2016 final rule required states to set time and distance standards for primary and specialist providers without providing a definition of specialist providers. The proposed rule clarifies that states may define “specialist” in whatever way they deem most appropriate for their programs.
Member information:
- To allow for the printing of shorter member marketing materials, states would only be required to include taglines in prevalent non-English languages and in large print on materials for potential enrollees who “are critical to obtaining services,” instead of all written materials.
- Managed care organizations (MCOs) would no longer have to provide monthly updates to paper provider network directories if they offer a mobile-enabled, electronic directory that is regularly updated.
- Provider directories would no longer have to indicate if an individual provider has completed cultural competency training – only the provider’s cultural and linguistic capabilities would be required, including the languages spoken by the physician or provider.
Quality rating system:
- The 2016 final rule required CMS, in consultation with states and other stakeholders, to develop a Quality Rating System (QRS) framework. States have the option to use the CMS-developed framework or establish their own QRS that contains “substantially comparable information about plan performance subject to CMS approval of the alternative system.” The proposed rule would:
  - Allow states to implement their own QRS as long as it was as “substantially comparable to the extent feasible to enable meaningful comparison across states,” and
  - Require CMS to identify a set of mandatory performance measures to be used in the QRS. A state alternative QRS would have to include the mandatory measures identified.

To submit a comment on the proposed rule, go to https://www.regulations.gov and follow the “Submit a comment” instructions. The public comment period is open through Jan. 14, 2019.

Health Coverage and Human Service Program Eligibility: Considerations for States Weighing Systems Integration

October 2, 2018/in Policy Blogs Cost, Payment, and Delivery Reform, Essential Health Benefits, Health Coverage and Access, Health IT/Data, Health System Costs, Medicaid Expansion, State Insurance Marketplaces /by NASHP Staff

Should states integrate their health insurance and human services eligibility and enrollment systems? Some state officials are weighing this question now that their revamped, Affordable Care Act (ACA) health coverage systems have been operational for several years and most of the early, initial glitches have been repaired. However, there are multiple factors to consider, some of which are new now that state health systems are expected to make eligibility determinations for Medicaid, the Children’s Health Insurance Program (CHIP), and marketplace subsidies.
Integration of health and human service systems is not a new concept. Most, if not all, states have used one integrated system to determine eligibility for Medicaid, Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), and other means-tested public service programs. Over time, as these programs evolved, some states opted to create separate systems for their health programs.
When faced with implementing the ACA’s requirements for new, streamlined, technology-driven enrollment systems that include health insurance marketplaces and use Modified Adjusted Gross Income (MAGI), a new methodology to determine income eligibility, many states delinked eligibility determination for health coverage from other public programs. For these states, an integrated enrollment system for health coverage programs became the goal to ensure applicants could be screened simultaneously for Medicaid, CHIP, and marketplace subsidies in a way that appeared seamless for consumers.
Today, some state officials who are eager to close the uninsured gap, particularly for children, are considering the value of integrating health with other human services systems as a way to share applicants’ eligibility data across programs. In addition, as states work to address social determinants of health, seamless eligibility screening could help. However, considering many states separated their health programs in order to implement new health eligibility and enrollment systems to meet ACA requirements, most states seeking to integrate must now bring together very separate systems and in some cases very separate infrastructures.
Georgia and Rhode Island officials will attest that integration is challenging, but not impossible. Both have recently launched new, integrated systems that enable individuals to apply for as many as six programs simultaneously. Here are some of the key issues states need to address when developing integrated, eligibility-determination systems.
Tailor applications to enrollees’ diverse needs: Integrating systems to offer families a single application and entry point for all public programs may ensure they enroll and have access to all of the supports for which they are eligible. However, families with slightly higher incomes who seek to enroll children in CHIP and adults in a qualified health plans (QHP) with marketplace subsidies may be deterred by a lengthier application that includes questions for programs for which they know they are not eligible.
States that are integrating health and human services eligibility systems are creating two types of applications to meet applicants’ different needs and allowing them to choose which version to complete:

One that includes questions to collect data necessary to determine eligibility for multiple programs, and
One more simplified health coverage application.

Although developing two applications requires extra work for states, officials recognize the importance of designing applications that meet the needs of all individuals applying for these programs.
Prepare to explain notices to enrollees: State officials acknowledge that the “combined notice” created and sent by integrated eligibility systems can be confusing. For example, individuals who apply for QHPs will likely receive notices that they have been denied Medicaid and SNAP though they didn’t apply for or realize they would be screened for those programs. Educating frontline eligibility staff and call center workers who may receive questions about these denial notices can help clear up confusion.
Align policies, processes, and staffing: State officials report the more challenging aspects of integrating eligibility systems for multiple programs, aside from the substantial cost and detailed system programming, is whether a state’s infrastructure supports true integration. Is there an integrated workforce or do health and human service programs have separate eligibility staff? Is there an integrated business management process in place to support the workforce and systems or are there separate processes for each distinct program? Officials caution that without integrating policies, processes, and eligibility staff across public programs, the resulting integrated eligibility system will have limited success providing individuals and families with truly seamless access.
Establish effective IT governance structures: A strong governance structure that oversees and guides the integrated technology for these programs, known as IT governance, is essential. When departments of human services, Medicaid agencies (which may or may not include CHIP), and the health insurance marketplace all use one system, which agency decides on and pays for the priorities for upgrades and repairs? Different programs must collect and report distinct data to different federal agencies – some of that data may align well while other information is program-specific, which inevitably means each program will need its own database. Which program will use which database and how will they share data? What happens when data do not align – which data are used? All of these questions fall within IT governance purview and coordination of these issues is critical if a state is to efficiently and effectively operate an integrated, eligibility-determination system.
Other options to link health and human services eligibility systems: For states committed to streamlining enrollment in both health and human service programs, there are alternatives to fully integrating systems. There are data-sharing and enrollment-simplifying strategies, such as Express Lane Eligibility (ELE) that states can pursue to identify families that are not enrolled in Medicaid but are enrolled in other means-tested programs. Louisiana uses ELE to link SNAP with Medicaid, even though the state’s health and human services systems are separate. Families can indicate interest in Medicaid on their SNAP application and eligible children can be enrolled in both programs. Although ELE is simple for families and, once fully operational, is efficient for a state, implementing this strategy was work-intensive for Louisiana’s state agencies, though not as complicated as integrating their eligibility systems.
There is no correct answer to whether a state should integrate its health and human service programs. However, there are recent state lessons about application and design, policies, and governance for state officials to consider as they seek to share data and simplify eligibility and enrollment across public programs.
The National Academy for State Health Policy will continue researching and reporting case studies to highlight states’ experiences and lessons as they work to improve data-sharing across programs, which may include integrating eligibility systems.

Health Services Initiative Gives States Unique Tools to Improve the Health of Low-Income Children

June 19, 2018/in Policy Arkansas, Delaware Blogs Behavioral/Mental Health and SUD, Care Coordination, Children/Youth with Special Health Care Needs, CHIP, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Health Equity, Healthy Child Development, Integrated Care for Children, Maternal, Child, and Adolescent Health, Medicaid Expansion, Medicaid Managed Care, Population Health, Social Determinants of Health /by Olivia Bacon

With federal funding for the Children’s Health Insurance Program (CHIP) assured through 2027, states can consider using a portion of their CHIP dollars to improve the health of low-income children through innovative Health Services Initiative (HSI). HSIs provide states with a mechanism to use CHIP administrative dollars to fund a range of activities beyond just health insurance.
To date, states have used HSIs to provide preventive services and interventions, such as school health or youth violence prevention programs, and more direct services like lead testing and poison control programs. States are also using HSIs to address emerging health issues. Recently, New York used an HSI to train school officials to administer naloxone to reverse opioid overdoses and Michigan expanded lead abatement activities through an HSI in response to the water crisis in Flint.
While HSIs offer states a unique way to fund new programs or support existing services for children, some states may debate whether to implement a long-term versus short-term HSI because of upcoming changes in the federal CHIP match rate. The most recent federal funding package that extended CHIP includes a phasing down of the 23 percent increase to the enhanced CHIP match rate – known as the 23 percent “bump”— that was initially included in the Affordable Care Act and available through FFY 2019. Despite this future phase-down, a number of states are still pursuing HSIs, and more than 15 have already implemented them.
For an example of a creative way to use an HSI for a short-term project, read NASHP’s report, Oklahoma Uses Focus Groups to Identify Strategies to Better Serve Foster Care Youth, to learn how one state used an HSI to study antipsychotic use among foster care youth.
Arkansas and Delaware provide two additional examples of states that are using HSI funding for unique projects to improve the health of low-income children.
Arkansas: Intensive Home and Community-Based Family and Child/Youth Support
Similar to Oklahoma, Arkansas implemented an HSI in 2017 to improve the quality of care provided to foster care youth. Under the HSI, the state uses a small portion of its CHIP funds to provide intensive home- and community-based family and support services for children with serious mental health issues who are involved in the Arkansas welfare system. The goal is to provide behavior management and wrap-around services to children and foster families to allow children to move out of a psychiatric or behavioral health treatment facility and into a home/community setting.
This transition is often a period of significant adjustment and can cause stress on both the child and family. To support children and families during this process, Arkansas’ HSI provides services to prepare and help families navigate the transition, and to help families safely manage the child’s behavioral health issues after discharge. These services are provided in conjunction with a state care coordination program and are outcome-oriented, trauma-informed, and individualized based on the child’s behaviors.
In addition to providing wrap-around services, this HSI also has the long-term goal of reducing the number of children in the state’s welfare system who are living in psychiatric residential treatment facilities by helping move them into family homes.
Delaware: Vision to Learn
Beginning in January 2017, Delaware used an HSI to launch a school-based initiative to increase access to vision services and eyeglasses for under- or uninsured children. The state CHIP program partners with Vision to Learn, a nonprofit Medicaid provider that administers eye exams and provides glasses on-site at schools through a mobile eye clinic. Although Vision to Learn has been operating in Delaware since 2014, this HSI provides additional public funds through CHIP to enable the program to reach more children in need.
In order to connect these services with low-income children, the HSI specifically targets Title I schools where at least 51 percent of the student body receives free or reduced price meals. In addition to providing vision services, Delaware uses this initiative to perform outreach to children not currently enrolled in Medicaid or CHIP by supplying the mobile clinics with brochures and information about enrollment in these programs.
HSIs offer states the flexibility to use a portion of their CHIP funding to implement a wide range of activities to improve children’s health. The projects in Arkansas and Delaware offer two recent examples, however, many states have used HSIs or are considering them as a unique option to fund vital new programs or support existing services for low-income children.

Report Highlights Effective State Strategies to Improve Lead Screening and Treatment in Children

April 10, 2018/in Policy Reports Behavioral/Mental Health and SUD, Care Coordination, CHIP, CHIP, Chronic and Complex Populations, Eligibility and Enrollment, Health Coverage and Access, Integrated for Pregnant/Parenting Women, Lead Screening and Treatment, Maternal, Child, and Adolescent Health /by NASHP Writers

Shutterstock.com

More than 535,000 children in the United States under age five have high blood lead levels, and low-income and minority children who live in older housing are particularly at risk. This issue brief details the health impacts of lead toxicity in children and Centers for Medicare & Medicaid Services requirements for screening and treatment under Medicaid and the Children’s Health Insurance Program. It highlights several effective state strategies to improve screening and treatment of lead toxicity in children.
Read the report: Lead Screening and Treatment Services under Medicaid and CHIP

This work is supported by the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) under grant number UC4MC28037 Alliance for Innovation on Maternal and Child Health: Expanding Access to Care for the Maternal and Child Health Population.