Chronic and Complex Populations – Page 25 – The National Academy for State Health Policy

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

States Take Action to Improve and Expand Early Childhood Education

June 24, 2019/in Policy Blogs, Featured News Home Behavioral/Mental Health and SUD, Care Coordination, CHIP, CHIP, Chronic and Complex Populations, Eligibility and Enrollment, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Health Equity, Healthy Child Development, Infant Mortality, Integrated Care for Children, Maternal, Child, and Adolescent Health, Population Health, Social Determinants of Health /by Megan Lent

Participation in early childhood education programs has been linked to better health, higher educational achievement, and higher socioeconomic status in adulthood. Given that programs have been shown to yield a $2 to $4 return for every $1 invested, many states are looking upstream and investing in the education of their youngest residents.

What governors are pledging:
• Alabama Gov. Kay Ivey: “With Strong Start, Strong Finish, we are making our largest investment ever in education. We are setting high standards for student learning, and our efforts are paying off as we provide our students with the tools they need to grow and succeed.”
• New Mexico Gov. Michelle Lujan Grisham: “This is the session, this is the year, this is the moment we put New Mexico on the path to universal pre-k for every New Mexico child. … My budget calls for investing $60 million in new pre-k classroom slots … that includes money for early childhood educator scholarships, so that we are proactively building and supporting the next generation of top-flight educators in this state.”

As state leaders weigh the many important competing priorities for state spending, early childhood education has risen to the top in a number of states. A recent analysis by the National Academy for State Health Policy (NASHP) showed that 14 of the nation’s governors prioritized investments in early childhood education in their 2019 inaugural or state of the state addresses.
The following analysis shows how state policymakers are putting their priorities into action by improving how states plan and manage early childhood initiatives and invest in programming. Nationwide, state leaders have identified preschool/prekindergarten expansion, enhancing access to quality childcare, and providing economic supports for early childhood educators as priority areas. State leaders are advancing these initiatives through state budget appropriations, executive orders, and legislation. The following provides an overview of state actions.

Budgets

State leaders prioritized early childhood education through budget actions aimed at improving the program quality and expanding access for vulnerable populations. A sample of these budget actions include:
Alabama Gov. Kay Ivey signed the state’s education budget bill on June 6, 2019. The budget includes funds to support an expansion of Alabama’s prekindergarten program, allowing the addition of 164 new classrooms in 38 counties.
Colorado’s enacted budget, signed by Gov. Jared Polis on April 18, 2019, includes funding for universal, full-day kindergarten.
New Mexico’s budget, enacted on April 4, 2019, includes a $29.1 million increase (representing a 10.4 percent) for its Children, Youth and Families Department budget, a $24.5 million increase for prekindergarten, and new investments in at-risk childcare and childcare educator scholarships and wage supplements.
New Jersey Gov. Phil Murphy’s proposed budget includes a $68 million increase to maintain and expand access to preschool for more 3- and 4-year-olds from low-income families; a $15 million increase in childcare funding to improve childcare subsidy system program payment rates and create new incentives to expand infant care and prioritize quality care and services; and $30 million to increase the Earned Income Tax Credit as well as the continuation of the Child and Dependent Care Tax Credit, according to Advocates for Children of New Jersey.
New York’s enacted budget provides $6.8 million to reduce the risk of childhood exposure to lead paint and a 5 percent rate increase for Program For Infants And Toddlers With Disabilities, and $15 million to expand prekindergarten programs for three- and four-year-olds targeted to high-need school districts.
Wisconsin Gov. Tony Ever’s proposed budget includes increased support for YoungStar, Wisconsin’s childcare quality rating and improvement system, and Wisconsin Shares, a childcare subsidy program. It also includes a funding increase for the Pyramid Model, a tiered intervention that enhances social and emotional competence in infants, toddlers, and young children, and $5 million to support early childhood education programs.

Legislation

State legislators are also taking a leading role in enhancing early childhood education in their states by introducing and passing bills that expand access, improve quality, and provide support for families and teachers.
Arkansas Gov. Asa Hutchinson signed into law HB 1615/Act 506, which established a farm-to-school and early childhood education program to bring fresh, local food to children in school meals and created the position of a farm-to-school and early childhood education program coordinator.
Colorado Gov. Polis signed into law HB19-1005 entitled “Income Tax Credit for Early Childhood Educators,” which provides an income tax credit to early childhood educators who hold a professional credential.
State leaders in New Mexico also prioritized support for early childhood educators. Gov. Michelle Lujan Grisham signed HB 275 into law which, among other actions, amends the Teacher Loan Repayment Act to include early education teachers. She also approved SB 22, creating a cabinet-level Early Childhood Education and Care Department, and HB 589, which expands the state’s Community Schools Act to address the cultural and linguistic needs of students enrolled in early childhood programs and prekindergarten through high school by partnering federal, state, local, and tribal governments with community-based organizations.
In Maryland, The Blueprint for Maryland’s Future, SB1030, increases state spending on education by $1 billion over two years and expands access to full-day prekindergarten programs for 3- and 4-year olds.
In Virginia, SB1015 expands the eligibility for the Education Improvement Tax Credit Scholarship to prekindergarten, making scholarships available to middle-income families earning up to 300 percent of the federal poverty level (FPL), or 400 percent of FPL if a child has an Individualized Education Program (IEP).

Executive Orders

Governors acknowledge that supporting early childhood development is not only about investing funds, but making sure funds are spent effectively. Several governors used executive orders to establish or re-establish a children’s cabinet or advisory council/committee, or to task an existing council with new work related to early childhood.
Delaware Gov. John Carney issued Executive Order 24, “Making Delaware a Trauma-Informed State,” which orders the Family Services Cabinet Council to develop a Trauma-Informed Care toolkit and coordinate collection and reporting of adverse childhood experiences (ACEs) data and requires all state agencies that provide services for children and adults to integrate trauma-informed best practices.
Virginia Gov. Ralph Northam issued Executive Order 11, “The Way Ahead for Virginia’s Children: Establishing the Children’s Cabinet.” Priority areas include early childhood development, school readiness, nutrition, and food security. The commission, established by Executive Order 13, “Establishing the Governor’s Advisory Commission on Quality Child Care and Education,” explores the feasibility of providing an evidence-based early care and learning program for young children of state employees working in and around Capitol Square in Richmond.
Wisconsin Gov. Evers issued Executive Order 6, “Relating to Re-creating Non-Statutory Committees,” which re-created several councils and committees, including the Early Childhood Advisory Council, the Birth to Three Early Intervention Interagency Coordinating Council, and the Council on Autism.
These examples show how states can use executive and legislative policy levers to advance early childhood education and quality childcare in their states, thereby helping children get the best possible start and providing the foundation for a healthy future. Because early education is shown to produce positive returns, states investing in this area are also investing in their economic futures.
This report is part of a series exploring how state leaders can improve the upstream factors affecting health, such as healthy environments, safe housing, and equity.
Produced in partnership with the de Beaumont Foundation and the David and Lucile Packard Foundation.

How to Build the Wright Stuff: Behavioral Health Integration

June 21, 2019/in Policy Annual Conference Chronic and Complex Populations, Cost, Payment, and Delivery Reform /by NASHP Staff

Meeting the Behavioral Health Needs of Diverse Populations

June 21, 2019/in Policy Annual Conference Chronic and Complex Populations, Health Coverage and Access /by NASHP Staff

Ten States Selected to Attend Palliative Care Summit in Chicago

June 18, 2019/in Policy Arizona, Colorado, Hawaii, Kentucky, Massachusetts, Minnesota, Ohio, Oklahoma, Pennsylvania, Texas Blogs, Featured News Home Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Long-Term Care, Medicaid Managed Care, Medicaid Managed Care, Palliative Care, Physical and Behavioral Health Integration, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by NASHP Writers

NASHP is pleased to announce the 10 states selected to attend the State Policymakers Palliative Care Summit, supported by a grant from The John A. Hartford Foundation. Policymakers, including legislators as well as Medicaid and public health officials from Arizona, Colorado, Hawaii, Kentucky, Massachusetts, Minnesota, Ohio, Oklahoma, Pennsylvania, and Texas, will participate in the day-long summit where they will learn from national and state experts about strategies to improve access to and quality of palliative care. For more information about palliative care, explore NASHP’s Palliative Care Resource Hub and sign up for its palliative care listserv.

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.

Eliminating Hepatitis C: New State Payment Models for Treatment and Emerging Evidence

June 3, 2019/in Policy Louisiana, Washington Blogs Administrative Actions, Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Health System Costs, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Prescription Drug Pricing, Value-Based Purchasing /by Maureen Hensley-Quinn

With hepatitis C infections on the rise and curative, but expensive, prescription drugs now available, state leaders across the country are compelled to address this public health crisis, and Louisiana and Washington are developing innovative drug-purchasing strategies within their efforts. At the same time, the Patient-Centered Outcomes Research Institute (PCORI) is investing in patient-focused studies into hepatitis C treatment to help fill gaps in our knowledge with a patient focus to help guide future state efforts to combating this deadly liver disease.

During this National Academy for State Health Policy (NASHP) webinar, officials from Louisiana and Washington share their approaches to using negotiated fixed price payments to ensure unlimited access to hepatitis C drugs for individuals with public health coverage.

Since 2010, the number of new infections has tripled, which experts attribute to the opioid crisis and an increase of people who inject drugs. A growing number of states are committing to eliminating hepatitis C as the World Health Organization, the US Centers for Disease Control and Prevention, and others are advocating. Such a commitment is possible due to drugs introduced in 2011 that can achieve cure rates above 95 percent when the 12-week treatment regimen is followed. However, the costs of these drugs in the United States remains high even though prices have dropped since their introduction. Although prescription drugs are just one component of states’ comprehensive public health hepatitis C elimination campaigns, the high cost of these drugs is the one of the biggest challenges facing states as they address this growing public health crisis.
Although their payment strategies are slightly different, Louisiana and Washington are exploring agreements with drug manufacturers to pay a flat fee over a contracted time period to gain unlimited access to hepatitis C drugs, rather than pay on a per unit basis, which is how most drugs are purchased. In Louisiana, corrections system populations and individuals enrolled in Medicaid and will have access to the drugs. In Washington , incarcerated individuals, Medicaid enrollees, public and school employees, individuals covered by workers compensation, and those in state hospitals will have access to the drugs as needed.
During this National Academy for State Health Policy (NASHP) webinar, officials from Louisiana and Washington share their approaches to using negotiated fixed price payments to ensure unlimited access to hepatitis C drugs for individuals with public health coverage.
As states forge ahead to design and implement strategies to eliminate hepatitis C and find ways to ensure access to treatment while working to contain costs, PCORI research is seeking to learn more about:

Effective screening to identify more cases;
What harm results, compared to no treatment;
Direct comparison of treatments in the real world; and
Effectiveness of care delivery models.

As results from these ongoing patient-centered research studies become available, they will help inform evolving state efforts to address the hepatitis C crisis. The introduction of the effective drug treatment has changed states’ public health approaches and incentivized Louisiana and Washington’s innovative purchasing strategies.
According to an overview of PCORI’s hepatitis C research highlighted during the webinar, researchers are hoping to learn how to most effectively engage people living with hepatitis C who use injection drugs to provide treatment that works. Patient-centered research is also seeking to learn more about the prevalence of re-infection. The evidence from these studies will help with clinical interventions, but could also be taken into consideration as states design, implement, and review their public health campaigns and treatment payment strategies.
Emerging issues, such as public health crises, require immediate attention and innovative cost-effective solutions from state officials. States’ call to action to address the rise in hepatitis C infections is an example of how they must react quickly using the information, appropriate lessons learned, and resources they have to address current crises. State officials are designing their drug contracts and plans to be as flexible as possible so they are able to adjust their approaches as new information becomes available, such as new PCOR evidence. As Louisiana and Washington learn from their prescription payment model and evidence becomes available from PCORI about treatment outcomes and approaches, state efforts will continue to evolve.

NASHP Awarded New Grant on Family Caregiving from The John A Hartford Foundation

June 3, 2019/in The RAISE Act Family Caregiver Resource and Dissemination Center Blogs Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Community Health Workers, Cost, Payment, and Delivery Reform, Council Meeting Materials and Resources, Housing and Health, Long-Term Care, Medicaid Managed Care, Medicaid Managed Care, Palliative Care, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement, The RAISE Family Caregiver Resource and Dissemination Center /by NASHP Writers

NASHP has been awarded a three-year grant from The John A. Hartford Foundation to develop a comprehensive resource and dissemination center on family caregiving. The grant will fund NASHP’s RAISE Act Family Caregiver Resource and Dissemination Center, a national focal point for resources, technical assistance, and policy analysis for states and the broader community of stakeholders interested in this important and timely issue. The initiative builds on the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act, which was passed by Congress last year and establishes an advisory council charged with crafting the country’s first national family caregiver strategy. Under the auspices of the Administration for Community Living, the council will provide a framework for how the federal government, states, and communities can better address the needs of family caregivers.
Family caregiving is a timely and critical issue for state policymakers: state Medicaid programs cover six of every ten of the country’s nursing home residents, and spend $58.5 billion per year on home and community-based services (HCBS) for older adults and people with disabilities. As savings for US families decline and long-term care costs increase, state Medicaid programs will continue to serve as the de facto long-term care safety net for older Americans, including middle-class families who spend down assets. Research shows that engaged family caregivers can reduce the need for home health services, delay the need for nursing home care, and lower an individual’s overall risk for nursing home placement. However, to be successful, caregivers – who may be juggling a range of work, financial, and other family responsibilities – require appropriate policy and programmatic support. The current issue of Health Affairs, which focuses exclusively on long term and end of life care, notes that more innovation is needed at the state and federal levels to truly support older adults and their caregivers: “Ultimately, the focus of serious illness care must be expanded from the patient to the family unit.”
NASHP is excited to work with state leaders, federal partners, and other stakeholder organizations in their efforts to address the needs of family caregivers, and looks forward to supporting and disseminating the important work that results from the RAISE Act Advisory Council. Watch for more news of this innovative project in the coming weeks and months.

A New State Tool to Manage Drug Costs: Experts Share Insights into Outcome-Based Contracts for Medicaid Pharmacy Claims

May 27, 2019/in Policy Colorado, Michigan, Oklahoma Blogs Administrative Actions, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health IT/Data, Medicaid Managed Care, Population Health, Prescription Drug Pricing, Quality and Measurement, Value-Based Purchasing /by Jennifer Reck

Colorado and Michigan have joined Oklahoma to become the nation’s pioneering states with approved State Plan Amendments (SPAs) that enable Medicaid alternative payment models (APMs) for prescription drugs in the form of outcome-based contracts with pharmaceutical manufacturers.
In early May, state experts from Oklahoma, Colorado, and Michigan shared their experiences implementing their APMs during a NASHP webinar. A recording of the webinar is available here.

Experts from Oklahoma, Colorado, and Michigan shared their experiences implementing their outcome-based Medicaid alternative payment models during a recent NASHP webinar. Listen to the webinar here.

The SPAs enable states to negotiate contracts based on agreed-upon outcome measures tailored for specific drugs. Outcomes measures vary but may include measures such as patient adherence or reduced hospitalizations. If the drug’s performance fails to meet agreed-upon outcomes and triggers the need for additional manufacturer payments to the state, those payments are made in the form of supplemental rebates. The contract template was developed with the support of the State Medicaid Alternative Reimbursement and Purchasing Test for High-cost Drugs (SMART-D).
Though these outcomes-based APMs are valuable tools for states to manage escalating drug costs, APMs are best understood as “one more tool in our toolbox,” which are most effective when used in tandem with other strategies rather than in isolation, explained Cathy Traugott, pharmacy office director of the Colorado Department of Health Care Policy and Financing. Though these APMs may help states manage payment for high-cost drugs, the high-list prices themselves remain a problem that states are also attempting to address head on. During this year’s state legislative session alone, 47 states have filed 254 drug-cost-related bills (as of May 22, 2019).
Executing and implementing outcome-based contracting can be a time-consuming endeavor for states because of the necessity for state officials to engage with multiple manufacturers in exploratory discussions to identify drug candidates, followed by the data analysis necessary to design, and then track the outcome-based measures.
Oklahoma, whose work NASHP supported through a subgrant from the Laura and John Arnold Foundation, found that the process took longer than anticipated. Terry Cothran, director of the University of Oklahoma’s College of Pharmacy, advised states that pursue outcomes-based contracting to consider dedicating a project coordinator to execute the work most effectively.
To date, these contracts are with state Medicaid agencies only, and have not included inter-agency efforts. Rita Subhedar, state assistant administrator for Michigan’s Department of Health and Human Services, stressed the importance of broad engagement within a Medicaid department to effectively implement these APMs, including pharmacy, medical, and behavioral health staff. A separate, subscription-based payment approach, known as the “Netflix” model, utilizes a cross-agency approach engaging both Medicaid and a state corrections department. This approach was explored in another NASHP webinar, How States Pay for Hep C Drugs Using a “Netflix-style” Subscription Model.
The first results from outcome-based contracting will come from Oklahoma, whose first, one-year contract is scheduled to end July 2019, with three other contracts concluding soon after. Colorado and Michigan have not yet executed contracts.

Webinar: How States Pay for Hep C Drugs Using a “Netflix-style” Subscription Model

May 15, 2019/in Policy Louisiana, Oregon, Washington Webinars Administrative Actions, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Medicaid Managed Care, Medicaid Managed Care, Population Health, Prescription Drug Pricing /by NASHP Staff

Wednesday, May 15, 2019
3 p.m. (ET)

View Webinar Download Webinar

Faced with costly and effective treatment for hepatitis C, states are exploring innovative alternative payment methodologies (APMs) to expand access to treatment and generate savings. Using a “Netflix-style” subscription model, Louisiana and Washington are negotiating agreements with drug manufacturers to get unlimited access to hepatitis C drugs for a fixed, predetermined cost. Join this NASHP webinar to hear about Louisiana and Washington’s innovative APMs as well as related research into hepatitis C from the Patient-Centered Outcomes Research Institute (PCORI).
Moderator: Trish Riley, Executive Director, National Academy for State Health Policy
Speakers:

Pete Croughan, Health Policy Advisor, Louisiana Department of Public Health
Donna Sullivan, MS, PharmD, Chief Pharmacy Officer, Washington Health Care Authority
Robyn Liu, MD, MPH, Assistant Professor of Family Medicine, School of Medicine, Oregon Health and Science University