Planning Now: State Policy and Operational Considerations if Federal CHIP Funding Ends
Federal funding for the Children’s Health Insurance Program (CHIP) is currently set to end in September 2017, and states need to be prepared for the possibility that Congress will not act to extend the funding. Medicaid expansion CHIP programs are required through the Affordable Care Act’s (ACA) maintenance of effort (MOE) provision to maintain eligibility levels for children through 2019, even if federal CHIP funding ends. In this scenario, they would receive the regular Medicaid match rate for enrollees in these programs rather than CHIP’s enhanced match. However, the 42 states with separate CHIP programs can limit enrollment in these programs if federal funds are not available.
If it becomes necessary for states to close their separate CHIP programs and begin to transition enrollees to other sources of coverage, this process will take time and states will need to begin planning many months ahead. Based on guidance and input from state CHIP officials, NASHP developed a timeline that outlines key budgetary, statutory, and operational issues and changes states would need to consider and/or implement.
The timeline assumes the current September 2017 federal funding termination date and is intended to highlight for federal policymakers and other stakeholders the main policy and programmatic issues and critical decision points that states would confront. While states would exhaust their federal CHIP allotments at different points in time due to factors such as program structure and state expenditures, the timeline assumes that states will have funds available to spend from their federal CHIP allotments through at least the first quarter of federal fiscal year 2018.
Some factors that add complexity to the issue of how states can begin planning for the possibility of federal CHIP funding ending are that states have different budget cycles and legislative calendars. As a result, the timing of state decisions and changes that will need to be made, especially for those with biennial budgets or legislatures that meet every other year, may differ. States will also have to consider making modifications to existing or future contracts with managed care organizations, third party administrators, and/or call centers and planning for potential eligibility, claims, and other systems changes. State officials emphasized that implementing many of the changes reflected in the timeline could involve significant administrative expenses and staff resources.
A primary concern raised by state officials if future federal funding for CHIP remains uncertain months into 2017 is providing clear communication to families about the potential changes to children’s coverage. Officials expressed serious concerns about having time to identify children receiving ongoing health care and facilitating a seamless coverage transition to minimize any care disruption. And CHIP does not only cover children—some states also use CHIP funding to provide coverage to pregnant women, and so issues related to transitioning these enrollees to other sources of coverage will also be a consideration for states.
Additionally, should CHIP end, there are concerns about the availability of affordable, appropriate pediatric benefits in private coverage, outlined in this NASHP brief. Ideally state officials from CHIP, Medicaid, insurance commissions, and health insurance exchanges along with health providers and other stakeholders would coordinate efforts to develop transition plans to minimize coverage gaps and promote care continuity.
Further, the impact of the uncertainty of future federal CHIP funding affects more than just the program itself. CHIP funding is also used by states to provide support for some sister agency programs including Title V programs, and in a limited way some states use the funding for other children’s services such as Health Services Initiatives to improve low-income children’s health.
States will need guidance from federal officials to implement many of the issues identified in the timeline, and consequently the timing of this guidance will affect the ability of states to address the policy and program changes needed. State officials managing separate CHIP programs will be in a challenging position if the future of federal CHIP funding continues to remain uncertain in the coming year. Maintaining the gains in children’s coverage is an important issue for states within the changing health care environment, and NASHP will be continuing to convene state officials and offer further resources to help states ensure strong children’s coverage into the future.
Infographic: A Timeline for States
Pooling and Braiding Funds for Health-Related Social Needs: Lessons from Virginia’s Children’s Services Act
Low-income and at-risk populations often need services and supports outside the scope of a single state agency in order to live productive, healthy lives. State health policymakers seeking to combine funding streams to meet health-related social needs could benefit from learning about Virginia’s long-term experience pooling funds to meet the needs of at-risk youth and families through its Children’s Services Act. Building on NASHP’s previous work exploring the braiding and blending of funding streams as a means of meeting health-related social needs, this brief examines lessons from Virginia about the promise and pitfalls of braiding and blending funding across agencies, and explores whether the state’s model could serve as a roadmap for other states seeking to coordinate funding and services for other populations.
State Health Insurance Exchange Websites
This chart provides useful links to state-based exchange and federal marketplace web portals, where consumers can purchase coverage, as well as links to relevant agency websites containing exchange policy and consumer assistance-related information.
Know of something we should add to this compilation? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process. Please email calberts@oldsite.nashp.org.
Know of something we should add to this compilation? Eager to update a fact we’ve included? Your feedback is central to our ongoing, real-time analytical process. Please email calberts@oldsite.nashp.org.
|
State |
Model |
Consumer Portal [1] |
Exchange or Relevant Agency Website [2] |
Exchange Call Center Phone Number [3] |
|
Where consumers will shop for health insurance |
Reference site for policy documents or additional health reform information |
Phone number for consumer call center. |
||
|
AL |
FFM |
800-318-2596 |
||
|
AK |
FFM |
800-318-2596 |
||
|
AZ |
FFM |
800-318-2596 |
||
|
AR |
SPM |
800-318-2596 |
||
|
CA |
SBE |
800-300-1506 800-300-0213 (Spanish) |
||
|
CO |
SBE |
855-PLANS-4-YOU/855-752-6749 |
||
|
CT |
SBE |
855-805-HEALTH/855-805-4325 |
||
|
DC |
SBE |
855-532-LINK/855-532-5465 |
||
|
DE |
SPM |
800-318-2596 |
||
|
FL |
FFM |
800-318-2596 |
||
|
GA |
FFM |
800-318-2596 |
||
|
HI |
SBE |
877-628-5076 |
||
|
ID |
SBE |
855-YHIdaho/855-944-3246 |
||
|
IL |
SPM |
800-318-2596 |
||
|
IN |
FFM |
800-318-2596 |
||
|
IA |
SPM |
800-318-2596 |
||
|
KS |
FFM |
800-318-2596 |
||
|
KY |
SBE |
855-4kynect/855-459-6328 |
||
|
LA |
FFM |
800-318-2596 |
||
|
ME |
FFM |
800-318-2596 |
||
|
MD |
SBE |
855-642-8572 |
||
|
MA |
SBE |
877-MA-ENROLL/877-623-6765 |
||
|
MI |
FFM |
800-318-2596 |
||
|
MN |
SBE |
855-3MNSURE/855-366-7873 |
||
|
MS |
FFM |
800-318-2596 |
||
|
MO |
FFM |
800-318-2596 |
||
|
MT |
FFM |
800-318-2596 |
||
|
NE |
FFM |
800-318-2596 |
||
|
NV |
SBE |
855-7-NVLINK/855 768-5465 |
||
|
NH |
SPM |
800-318-2596 |
||
|
NJ |
FFM |
800-318-2596 |
||
|
NM |
SBE |
855-99-NMHIX/855-996-6449 |
||
|
NY |
SBE |
855-355-5777 |
||
|
NC |
FFM |
800-318-2596 |
||
|
ND |
FFM |
800-318-2596 |
||
|
OH |
FFM |
800-318-2596 |
||
|
OK |
FFM |
800-318-2596 |
||
|
OR |
SBE |
855-CoverOR/855-268- 3767 |
||
|
PA |
FFM |
800-318-2596 |
||
|
RI |
SBE |
855-840-HSRI/855-840-4774 |
||
|
SC |
FFM |
800-318-2596 |
||
|
SD |
FFM |
800-318-2596 |
||
|
TN |
FFM |
800-318-2596 |
||
|
TX |
FFM |
800-318-2596 |
||
|
UT |
FFM |
800-318-2596 |
||
|
VT |
SBE |
855-899-9600 |
||
|
VA |
FFM |
800-318-2596 |
||
|
WA |
SBE |
855-WAFINDER/855-923-4633 |
||
|
WV |
SPM |
800-318-2596 |
||
|
WI |
FFM |
800-318-2596 |
||
|
WY |
FFM |
800-318-2596 |
Notes:
[1] For state benefit exchanges, the ‘Consumer Portal’ link goes direct to the consumer portal for the state exchange; for SPM and FFM exchanges, the link goes to the federal portal.
[2] Links to a state exchange policy/board site, where applicable, or to a state health reform or consumer assistance webpage.
[3] Phone number for the main call center to assist consumers.
Chart produced by Rachel Dolan and Leo Quigley
[2] Links to a state exchange policy/board site, where applicable, or to a state health reform or consumer assistance webpage.
[3] Phone number for the main call center to assist consumers.
Chart produced by Rachel Dolan and Leo Quigley
Enhancing Care Quality for Medicaid Beneficiaries Living with HIV/AIDS: New NASHP Case Studies
NASHP has written two case studies for HealthHIV’s Three D HIV Prevention Program, which is supported by the Centers for Disease Control and Prevention (CDC), and provides technical assistance to better inform programmatic decisions impacting the delivery of quality HIV prevention and treatment services:
- New York’s experience implementing performance metrics for the HIV/AIDS population in its Medicaid managed care program may offer lessons for other states considering how to implement metrics to help ensure quality care for people living with HIV/AIDS or other populations with complex needs. Read the case study here.
- Wisconsin operates the country’s first and only health home program for Medicaid beneficiaries living with HIV/AIDS. Wisconsin’s experience operating the HIV/AIDS health home program may provide insight to other states considering the health home state plan option as a strategy to support integrated care for Medicaid beneficiaries living with HIV/AIDS, or for states considering a health home program for patients with other complex, chronic conditions. Read the case study here.
Comprehensive Early Childhood Mental Health Systems to Improve Outcomes and Reduce Costs
Nearly one in five Americans has some type of diagnosable mental health disorder. With these disorders costing $201 billion in 2013, behavioral health is a critical issue for state health policymakers. Children, including very young children, can experience mental health problems, and addressing these issues early can improve outcomes and lessen costs. Approximately 15 percent of young children ages birth to five experience some type of emotional, relational, or behavioral disturbance. More than 40 percent of adolescents have experienced a behavioral health problem before they reach seventh grade. Half of adult mental illnesses including schizophrenia, bipolar disorder, and major depressive disorder begin before age 14.
Early environments and experiences in young children’s lives matter, and evidence-based interventions designed to promote children’s healthy social-emotional development can make a difference. Many states and communities are developing comprehensive strategies that recognize the importance of early childhood mental health as part of overall health and well-being, and school readiness and success. Several of these efforts were featured at a recent meeting, Cross-Systems Collaboration for Children’s Social-Emotional Development, hosted by the National Academy for State Health Policy (NASHP) in partnership with the Alliance for Early Success. Below are five key themes with selected state examples identified as being essential to addressing the healthy social-emotional development of children.
- Address family risk factors. Through federal Project LAUNCH grants, states like Massachusetts are identifying family stressors and risk factors affecting early childhood mental health. Research indicates that maternal mental illness is a powerful predictor of a child being diagnosed with a mental health condition. The Minnesota Department of Human Services conducted an analysis of children enrolled in its public health insurance programs to assess the prevalence of family risk factors, such as parental mental illness or chemical dependency, affecting children. As a result of the findings, the state implemented strategies such as systematically training mental health providers in interventions targeting the parent-child relationship, particularly for children whose primary caregiver has a mental health diagnosis such as depression. The Medicaid agency also reimburses maternal depression screening conducted at a well-child visit.
- Seek to integrate behavioral health services in pediatric primary care settings. Pediatric primary care practices are important settings for addressing early childhood mental health given the frequency of well-child visits. Healthy Steps at the Children’s Hospital at Montefiore in New York has fully integrated mental health specialists in pediatric primary care at 21 sites. Specialists provide a range of services including universal mental health screening, assessment, treatment and referral of infants and their caregivers, optional home visits, parent discussion groups, and provider education about infant mental health. Payment for early childhood mental health services that address family needs is an ongoing challenge since our health care delivery system is based on payment for individual, rather than family, services. Strategies for braiding or blending different funding sources are an area of continued interest.
- Explore innovative financing and strategic planning efforts to leverage and integrate cross-sector investments and planning in early childhood health. For example, Louisiana developed an early childhood systems integration budget to reflect state early childhood investments in health care, early care and education, family supports, and mental health services. The integrated budget was an important tool for leveraging limited resources, comparing early childhood investments including early childhood mental health to the total state budget, and in strategic planning.
- Leverage health care delivery transformation opportunities to align health care and early learning policies. In recognition that good health is critical for school success, Oregon is leveraging federal health care and education grants to align early learning system transformation and health care delivery reform. The state has developed shared responsibilities and measures across health care and early learning systems. Improvement in developmental screening is already a key focus area among both systems, and state leaders are exploring options to promote early childhood mental health as part of this alignment.
- Engage in public-private partnership. The Illinois Action Plan to Integrate Early Childhood Mental Health in Child- and Family-Serving Systems, Prenatal through Age Five was developed with the engagement of broad cross-section of public and private stakeholders in the state to outline plans for integrating early childhood mental health promotion, early intervention and treatment services and supports into the state’s child and family-serving systems. This plan builds upon decades of targeted investments and an intentional focus on early childhood development, and in a statewide gubernatorial initiative, The Illinois Children’s Mental Health Partnership, to transform the state’s mental health system for children and adolescents.
Learn more by accessing meeting materials online, and stay tuned for a session at NASHP’s 2016 Annual State Health Policy Conference about integrating children’s mental and physical health services!
Looking Ahead: A Timeline of State Policy & Operational Considerations if Federal CHIP Funding Ends for States
Without Congressional action, federal funding for the Children’s Health Insurance Program (CHIP) is due to end in September 2017. The National Academy for State Health Policy (NASHP) created this infographic to highlight the main policy and operational issues that would need to be considered and addressed in states with separate CHIP programs if future federal funding for CHIP remains uncertain in the coming months.
States with separate CHIP programs can limit enrollment if federal funds are not available, and this timeline reflects the key issues for 42 states with these types of CHIP programs. However, Medicaid expansion CHIP programs are required through the Affordable Care Act’s (ACA) maintenance of effort (MOE) provision to maintain eligibility levels for children through 2019, even if federal CHIP funding ends; they would receive the regular Medicaid match rate for children enrolled in these programs.*
Infographic: A Timeline for States
Printable version of Timeline.
Blog: Planning Now: State Policy and Operational Considerations if Federal CHIP Funding Ends
Supported by the David and Lucile Packard Foundation.
A Timeline for state health policy and operational considerations if CHIP funding ends.
Color key below chart.
|
Month |
January |
February |
March |
April |
May |
June |
July |
August |
September |
October |
November |
December |
|
Budgetary Cycle |
Budgeting for FY2017 and FY2018, depending on state budget cycles (Making assumptions re: federal funding for programs) |
|
|
|
|
|
States with Biennial budgets may need to begin an amendment process to address major budgetary changes |
Implementing State Budget Contingency Plans |
Begin internal planning for systems changes and care transitions |
|
|
|
|
Begin finalizing FY2017 budgets |
|
|
|
|
|
|
|
|
|
|||
|
|
|
|
|
|||||||||
|
Statutory Change Cycle |
|
|
|
|
|
|
|
Develop transition plans to ensure continuity of care
|
Begin internal planning for systems changes and care transitions |
Develop transition plans to ensure continuity of care
|
|
Draft & Pass State Legislation |
|
Enrollment Policy and Practices |
|
|
|
Consider other coverage options available |
|
|
|
|
Begin internal planning for systems changes and care transitions |
|
|
|
|
Minimize Disruption of Care |
|
|
|
State by State review of EHB vs. CHIP (identify services children may lose in transition) |
|
|
|
Develop transition plans to ensure continuity of care
|
Develop transition plans to ensure continuity of care Begin internal planning for systems changes and care transitions |
|
|
|
|
Contractual Obligations |
|
|
|
|
|
|
|
|
Begin internal planning for systems changes and care transitions |
|
|
|
|
Systems Changes |
|
|
|
|
|
|
|
|
Begin internal planning for systems changes and care transitions |
|
|
|
|
Exchange Plan Cycle |
|
|
|
QHPs set rates for 2017 |
|
|
|
|
Begin internal planning for systems changes and care transitions |
Consider a pediatric benefit in exchanges |
|
|
|
Month |
January |
February |
March |
April |
May |
June |
July |
August |
September |
October |
November |
December |
|
Budgetary Cycle |
Begin finalizing FY2018 budgets |
|
|
|
|
|
|
|
|
|
|
|
|
Review agency staffing needs |
Start of Many State Fiscal Years |
|||||||||||
|
Budgeting for FY2018 and FY2019, depending on state budget cycles (Making assumptions re: federal funding for programs) |
|
|
|
|
|
|
|
|
|
|||
|
Current Authorization for Federal CHIP Funding Ends |
||||||||||||
|
Statutory Change Cycle |
Ideal time for Federal Government decision on CHIP funding (Latest possible date for any state law changes) State law should include a transition plan |
|
Assess current state policies, regulations and laws and make changes to regulations (4-5 mo.) |
|
|
|
State Laws take effect unless stated otherwise State Transition plan can begin |
|
|
Current Authorization for Federal CHIP Funding Ends |
|
|
|
|
||||||||||||
|
Enrollment Policy and Practices |
|
Develop comprehensive communications plan |
Work with CMS on the clarification of maintenance of effort (MOE) and address continuous eligibility
|
Develop and submit appropriate information to CMS: SPA, waiver, financial plan (dependent upon CMS timeline – could take 9 months or longer) |
Draft Notices to Families |
|
Freeze CHIP Enrollment (6 months from end of allocation) |
Send notices to families (3 mo. from end of program/ allotment) |
|
Current Authorization for Federal CHIP Funding Ends |
Transition Enrollees (will depend on when allotment ends) |
|
|
|
|
|||||||||||
|
Minimize Disruption of Care |
|
Develop comprehensive communications plan |
|
Identify children receiving long-term treatments |
Identify children receiving long-term treatments |
Engage provider and health plans on payment issues in advance of losing funds |
Implement communications plans with health providers, plans, and stakeholders |
|
|
Current Authorization for Federal CHIP Funding Ends |
|
|
|
Contractual Obligations |
|
Develop comprehensive communications plan Evaluate all system contracts (e.g. MMIS, etc.) to identify possible changes needed |
|
Address Call Center Contracts (likely increased demand as notices sent and to set end date for service) |
Modify existing or future managed care or third party administrator contracts |
Modify existing or future managed care or third party administrator contracts |
Modify existing or future managed care or third party administrator contracts |
|
|
Current Authorization for Federal CHIP Funding Ends |
Final IBNR** and Payment Appeals |
Final IBNR and Payment Appeals |
|
Systems Changes |
|
Develop comprehensive communications plan Review and identify needed changes for systems |
Review and alter RFPs, contracts for system upgrades
|
Implement MMIS, eligibility system changes |
|
|
|
|
|
Current Authorization for Federal CHIP Funding Ends |
Develop manual workaround during the transition period |
|
|
Consider interagency agreements and data sharing obligations necessary to transition children to other coverage sources
|
|
|
||||||||||
|
Exchange Plan Cycle |
Engage QHPs with Medicaid/CHIP early to inform rate setting and to plan a pediatric benefit |
Review existing and establish new transitions rules/policies for Medicaid and exchanges |
|
|
|
|
|
|
|
|
|
|
|
QHPs set rates for 2018 |
Coordinate with marketplace leadership to transition enrollees |
Take initial steps to implement a pediatric benefit to be offered by QHPs for 2018 |
Current Authorization for Federal CHIP Funding Ends |
Open Enrollment for Exchanges |
|
|
Month |
January |
February |
March |
April |
May |
June |
July |
August |
September |
October |
November |
December |
|
Budgetary Cycle |
|
|
|
|
|
|
|
|
|
|
|
|
|
Statutory Change Cycle |
|
|
|
|
|
|
|
|
|
|
|
|
|
Enrollment Policy and Practices |
Transition Enrollees (will depend on when allotment ends) |
Transition Enrollees (will depend on when allotment ends) |
|
|
|
|
|
|
|
|
|
|
|
Minimize Disruption of Care |
|
|
|
|
|
|
|
|
|
|
|
|
|
Contractual Obligations |
Final IBNR** and Payment Appeals |
Final IBNR and Payment Appeals |
Final IBNR and Payment Appeals |
Final IBNR and Payment Appeals |
Final IBNR and Payment Appeals |
|
|
|
|
|
|
|
|
Systems Changes |
|
|
|
|
|
|
|
|
|
|
|
|
|
Exchange Plan Cycle |
Open Enrollment for Exchanges |
|
|
|
|
|
|
|
|
|
|
|
|
Month |
January |
February |
March |
April |
May |
June |
July |
August |
September |
October |
November |
December |
|
Budgetary Cycle |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
|
Statutory Change Cycle |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
|
Enrollment Policy and Practices |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
|
Minimize Disruption of Care |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
|
Contractual Obligations |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
|
Systems Changes |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
|
Exchange Plan Cycle |
|
|
|
|
|
|
|
|
|
End of Federal Maintenance of Effort (MOE) Requirement for children |
|
|
* This timeline was developed based on guidance and input from state CHIP officials, and outlines key budgetary, statutory, and programmatic issues and changes that states would need to consider and/or implement. This timeline assumes that states will have funds available to spend from their federal CHIP allotment through at least the first quarter of federal fiscal year 2018. States have different budget cycles and while this timeline notes critical decision points for states, the time in which changes will need to be made, especially those with biennial budgets, may differ. Also, states will need to work closely with CMS to make many of the policy changes needed if the future of federal funding remains uncertain, so the timing of federal guidance will affect states’ ability to make some critical changes.
**Incurred but not reported
State Levers to Advance Accountable Communities for Health
States are testing a myriad of models that strive to achieve the Triple Aim objectives of improved care, reduced health care costs, and better health. Though several statewide health care delivery and payment system reforms have been shown to help slow the growth of health care expenditures and improve methods for delivering health care, taken alone they are not enough to fully attain the Triple Aim goals. In an effort to improve the overall health of populations while further reducing healthcare costs, many state and federal health policymakers are partnering with communities to implement population health initiatives that engage new community partners to address the social factors influencing health such as housing, food, work, and community life. Among the models for implementing community-based interventions, Accountable Communities for Health (ACHs) are surfacing as a promising state strategy to integrate and align state health care delivery system transformation with community-based social services to create communities that promote health and well-being.
This brief and the accompanying state profiles identify state levers that advance ACHs by examining the ACH programs in California, Minnesota, Vermont, and Washington State. Specifically, this brief weighs the roles states and communities have played in establishing core ACH components including governance structures, geographic boundaries, financing mechanisms, priority conditions and target populations. It also considers state-level resources that can be leveraged to support and sustain ACH models going forward.
Full Brief
California State Profile
Minnesota State Profile
Vermont State Profile
Washington State Profile
NASHP Announces Pharmacy Costs Work Group
The newly launched National Academy for State Health Policy (NASHP) Pharmacy Cost Work Group will look beyond the strategies currently used in states to identify and develop new ideas which address the growing problem of Rx costs. The group will look broadly at states as purchasers, regulators, policymakers, and investors to develop the next generation of state–based reforms to address the rapid growth of prescription prices.
The rising cost of drugs goes beyond just Medicaid, challenging also vaccine programs, state psychiatric providers, corrections, state employee and retiree health programs, and public university employee and teachers’ health plans. These costs all directly or potentially impact state budgets. The effect of prescription drug costs on commercial insurers carries implications for rate reviews carried out by insurance regulators, and for the integrity of the insurance markets in our states.
The group will take into account the next steps– individually and collectively – that states might take to re-double efforts to reduce prescription drug spending and assure access to important life saving and life sustaining pharmaceuticals while also balancing cost concerns.
Members include:
- Susan Barrett, J.D., Executive Director, Green Mountain Care Board
- Burl Beasley, D.Ph., MPH, MS Pharm Clinical Pharmacist, Oklahoma Health Care Authority
- Robert Crittenden, M.D., Senior Policy Advisor to Governor, Washington
- James DeBenedetti Director, Plan Management Division, Covered California
- Rebekah Gee, Secretary, Dept. of Health and Hospitals, State of Louisiana
- Richard Gottfried, Chair, Committee on Health, New York Assembly
- Emily Hancock, RPH, Phar. D., MPA Clinical Pharmacist, Indiana Dept. of Social and Family Services
- Nathan Johnson, Chief Policy Officer, Washington State Health Care Authority
- Wendy Kelley, Director, Arkansas Dept. of Corrections
- Heather Korbulic, Executive Director, Silver State Health Insurance Exchange
- Kevin Lembo, Comptroller, State of Connecticut
- Janet Mills, J.D., Attorney General, State of Maine
- John McCarthy, Medicaid Director, State of Ohio
- Rebecca Pasternik-Ikard, Chief Executive Officer, Oklahoma Health Care Authority
- David Seltz, Executive Director, Massachusetts Health Care Commission
- Norman Thurston, Ph.D., Utah State Legislature
- Eileen Mallow, Deputy Director, WI Dept. of Employee Trust Funds
State Medicaid and Early Intervention Agency Partnerships to Promote Healthy Child Development
Facilitating a robust system of communication and coordination between medical and community service providers, an important goal of many health care delivery system reforms, is challenging for many states. With a variety of federal and state agencies sharing responsibility for child health and development, creating effective linkages among services is critical to optimizing outcomes. This issue resonates strongly with state Medicaid and Part C Early Intervention (EI) agencies, which are responsible for creating comprehensive systems of care that coordinate a wide range of services to support healthy child development. To ensure children receive timely access to necessary care within the scope of limited state budgets, Medicaid and EI agencies must establish carefully articulated processes for medical and community-based service providers to deliver developmental screening, referral, and follow-up services. Building stronger partnerships between Medicaid and EI agencies can facilitate better coordination of these services to expedite the referral and follow-up process, helping agencies adhere to federally mandated timelines and enabling children and families to receive more timely services. Strong partnerships between these agencies are also key to avoid excess costs that result from duplicative services. This issue brief provides concrete examples of how Medicaid and EI agencies in Connecticut, Illinois, and Oregon have partnered to improve care for young children in their states who are identified with, or at risk for, developmental delays. A forthcoming companion brief will closely examine Medicaid screening reimbursement policies in several leading states.
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. 
