Healthy Child Development – Page 4 – The National Academy for State Health Policy

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

New Eight-State Policy Academy Advances Access to Care for Pregnant/Parenting Women with SUD

April 29, 2019/in Policy Alabama, Colorado, Kentucky, Mississippi, New Jersey, South Carolina, Texas, Virginia Blogs Behavioral/Mental Health and SUD, Care Coordination, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Healthy Child Development, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Primary Care/Patient-Centered/Health Home /by Erin Bonzon

Substance use disorders (SUD) and mental health conditions are prevalent among pregnant and parenting women in the United States, and they have far-reaching consequences for the health and well-being of women and their children. Integrated care models that support pregnant and parenting women’s physical and behavioral health and social service needs can improve outcomes for women and children and reduce health care costs.
Through the Maternal and Child Health Policy Innovation Program (MCH PIP), funded by the federal Maternal and Child Health Bureau of the Health Resources and Services Administration (MCHB, HRSA), the National Academy for State Health Policy (NASHP) is working with states to support and advance innovative policy initiatives that improve access to quality health care for pregnant and parenting women.
As part of the MCH PIP initiative, NASHP is convening a two-year policy academy including eight state teams made up of representatives from state Medicaid agencies, public health agencies, mental health/substance use agencies, and other state stakeholders. States selected to participate in the first cohort of the NASHP policy academy include:

Alabama
Colorado
Kentucky
Mississippi
New Jersey
South Carolina
Texas
Virginia

Over the next two years, these states will identify, promote, and advance innovative, state-level policy initiatives to improve access to care for Medicaid-eligible pregnant and parenting women with or at risk of SUD and/or mental health conditions. NASHP will work with the states to identify high-priority policy issues, challenges, and opportunities through targeted technical assistance, peer-to-peer learning, analyses of policy issues, and development of policy briefs and other resources that will be disseminated nationally.
While many states have identified pregnant and parenting women as a priority population for their SUD and behavioral health efforts, challenges and opportunities persist. NASHP recently published two Issue Hubs that provide valuable resources, including information on the Centers for Medicare & Medicaid Services’ Maternal Opioid Misuse (MOM) Model. They are available at:

Resources to Help States Improve Integrated Care for Pregnant and Parenting Women: This Issue Hub provides valuable resources for states interested in using the Maternal Opioid Misuse (MOM) model and others to improve access to comprehensive and coordinated care and implement innovative payment and care delivery models for pregnant and parenting women eligible for Medicaid.
Resources to Help States Improve Integrated Care for Children: This Issue Hub provides valuable resources for states interested in the Integrated Care for Kids (InCK) Model and others working to implement payment, coverage, and cross-agency strategies to improve for integrated care coordination of behavioral, physical and health-related social needs for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

New Governors Take the Long View in Addressing Early Childhood Development

April 8, 2019/in Policy California, Ohio Blogs Chronic and Complex Populations, Chronic Disease Prevention and Management, Eligibility and Enrollment, Health Equity, Healthy Child Development, Integrated Care for Children, Maternal, Child, and Adolescent Health, Physical and Behavioral Health Integration, Population Health, Social Determinants of Health /by Elinor Higgins

State policymakers have historically promoted early childhood development improvements, but this year a growing number are acknowledging children’s early years as critical in determining their future health and success during adulthood. As a result, governors are promoting investments in the future health of their states by focusing resources on their youngest citizens.
This investment can be a productive one – studies analyzing multiple programs have found that every $1 invested in early childhood programs can yield a $2 to $4 return.

“Making full-day kindergarten available and accessible for all children sets kids up to be more successful in school and throughout their lives — improving performance, narrowing achievement gaps, leading to earlier identification and intervention for those with special needs, even increasing high school graduation rates down the road. … It will save taxpayer money in the long run by increasing incomes and decreasing the achievement gap. It will strengthen families, our communities, and our economy.” – Colorado Gov. Jared Polis, 2019 State of the State Address.

California and Ohio are examples of states whose governors have taken this long view and focused on healthy child development.

Ohio

Gov. Mike DeWine, who discussed the importance of early childhood development on his campaign website as an “opportunity for every Ohio kid,” signed an executive order on Jan. 14, 2019, creating the Governor’s Children’s Initiative. The goals of the initiative include:

Improving communication and coordination across all state agencies that provide children’s services;

Encouraging local, state, federal, and private-sector partners to align efforts and investments to have the largest possible impact to improve outcomes for Ohio’s children;
Advancing policies to improve home visiting, early intervention services, early childhood education, foster care, and child physical and mental health; and

To coordinate and spearhead the initiative, Gov. DeWine created the director of the Governor’s Children’s Initiative position to be the point of contact for the many agencies that are involved. The position, recently filled by LeeAnne Cornyn, is situated within the governor’s office and has the authority to organize the initiative and issue directives across state cabinet agencies, boards, and commissions. To explore this and other organizational models that governors have created to carry out their health-related priorities, explore NASHP’s Organizational Models to Advance Health chart and read NASHP’s Toolkit on Upstream Health Priorities for New Governors.
Gov. Dewine’s current 2019 budget proposal includes significant investment in young children. Notably, the budget:

Recognizes the return on investment for home visiting programs, and proposes an additional $30 million to support evidence-based approaches to home visiting; and
Proposes a $46.5 million investment in early intervention programs through Ohio’s Department of Developmental Disabilities. The additional funding would expand eligibility for early intervention services and care coordination.

California

In January, 2019, California Gov. Gavin Newsom proposed a budget with a special focus on early childhood intervention whose three-pronged strategy includes:

Improved early education and health care service access, which includes making preschool accessible to all four-year olds regardless of income, investing in child care, and improving access to developmental screening and referrals;
A two-generation approach that supports parents through an expansion of paid family leave, home-visiting assistance, and medical screening so that they can support their children; and
Easing financial burden on low-income parents, including increased California Work Opportunity and Responsibility to Kids (CalWORKS) grants that recognize the importance of stable food and housing as prerequisites for healthy development.

Ohio and California’s approaches recognize that supporting children’s well-being and development in their first years of life requires collaboration across multiple agencies to effectively focus resources and initiatives.
NASHP’s Healthy Child Development State Resource Center highlights successful state Medicaid and other early childhood policies nationwide, and illustrates how states can effectively promote early identification and intervention. The resource center will continue to be an information hub as the National Academy for State Health Policy (NASHP) tracks state policies that promote children’s health and well-being. NASHP will also continue to monitor how governors use policy levers to improve early childhood development so young children can become healthy, educated, productive citizens.

New Report Highlights Successful, Cross-Agency Strategies to Address Substance Use Disorder

March 25, 2019/in Policy Reports Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Health Equity, Healthy Child Development, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health /by NASHP Writers

States are realigning policies, funding, staffing, and data across agencies to better meet the needs of people living with or at risk of developing substance use disorder (SUD). In 2018, NASHP and the Association of State and Territorial Health Officials (ASTHO) convened a group of Medicaid and public health leaders to discuss state strategies for working across agencies to address SUD. Their new report highlights recommendations for structuring and advancing cross-agency approaches to SUD prevention and treatment.
Read or download: Cross-Agency Approaches to Substance Use Disorder Prevention and Treatment – National Recommendations
Watch the NASHP-ASTHO webinar Cross-Agency Approaches to Substance Use Disorder Prevention and Treatment, recorded March 20, 2019, which explores this topic.

How States Promote Lead Screening and Treatment

March 25, 2019/in Policy Maps CHIP, Chronic Disease Prevention and Management, Health Equity, Healthy Child Development, Housing and Health, Lead Screening and Treatment, Maternal, Child, and Adolescent Health, Population Health /by NASHP Staff

How the President’s Proposed Budget Impacts Critical State Health Programs

March 18, 2019/in Policy Blogs Administrative Actions, Behavioral/Mental Health and SUD, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Healthy Child Development, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Medicaid Managed Care, Population Health, Prescription Drug Pricing, State Insurance Marketplaces /by NASHP Writers

The President’s 2020 budget request proposes a 12 percent reduction in the US Department of Health and Human Services (HHS) budget, compared to 2019 federal fiscal year (FFY) funding levels. The following highlights some of the key components of the President’s proposed $87.1 billion HHS budget proposal that could impact state health programs.

Affordable Care Act (ACA) and Insurance Markets

The proposed budget recommends the following changes to the ACA and insurance markets:

Converts Medicaid and private market subsidies into state block grants: The changes are modeled after a 2017 bill originally proposed by Sens. Lindsay Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI), which would convert Medicaid as well as private market subsidies (e.g., advance premium tax credits and cost-sharing reductions) into block grants for states. The program would require that states dedicate 10 percent of their grants toward funding that protects high-cost individuals, including those with pre-existing condition. The change is estimated to result in $777 billion in cuts to these programs over a 10-year period.
Establishes a minimum contribution standard for health insurance premiums. Amends premium tax credit calculations to require that individuals contribute a minimum percentage of their income toward insurance premiums. Currently, there is no such requirement, enabling some consumers to pay as little as zero for insurance once tax credits are calculated.
Funds the cost-sharing reduction (CSR) program: Proposed appropriation for CSR payments through calendar year 2020, with a request that CSR funding remain in place as long as the CSR requirement remains in place for health insurers. However, the budget only allocates $479 million in funding for calendar year 2020, which falls significantly short of the Congressional Budget Office’s CSR cost estimate of $10 billion in FFY 2020. The President’s proposed FFY 2019 budget included a similar proposal that was not funded.
Reduces the grace period for payment of health insurance marketplace premiums: This suggests that the 90-day grace period consumers are given to enact marketplace coverage be reduced to 30 days.
Expands availability of health savings accounts (HSAs): Allows HSAs to be combined with any plans that are below a certain value threshold based on their benefits and cost-sharing structure (actuarial value of up to 70 percent). Current law only allows for use of HSAs with high-deductible health plans.

Medicaid

The President’s FFY 2020 budget contains some significant changes to Medicaid financing that were in the FFY 2019 budget, as well as other proposals impacting its policies and program operations:

Cuts overall program funding: Proposes to cut $777 billion over 10 years from Medicaid and marketplace subsidies.
Repeals ACA’s Medicaid expansion and targets Medicaid funding: Advocates repealing the ACA’s Medicaid expansion and supports a refocusing of Medicaid on individuals the program was “originally intended to serve.”
Requires work and community engagement initiatives: Notes that work and community engagement demonstrations for able-bodied adults enrolled in Medicaid have been approved in eight states. Proposes that all able-bodied, working-age individuals meet work requirements to receive Medicaid benefits (and other federally funded public assistance programs), predicting this will save $130.4 billion over 10 years.
Gives states the ability to change certain program elements and eligibility determination processes: Proposes to give states additional flexibility over Medicaid benefits and cost sharing, including making non-emergency medical transportation optional and allowing states to use state plan authority to increase copayments for nonemergency use of emergency departments rather than requiring a waiver to do so. Proposes to allow states to apply asset tests for individuals who are financially eligible for the program through the Modified Adjusted Gross Income (MAGI) standard. States would also be permitted to conduct eligibility redeterminations for MAGI-eligible individuals more frequently.
Reduces the federal match rate for Medicaid eligibility staff: Reduces the federal match rate for Medicaid-eligibile workers from 75 percent to 50 percent by FFY 2024, predicting this will save $7.4 billion over 10 years.
Prohibits Medicaid payments to public providers in excess of costs: Proposes to limit Medicaid reimbursement for health care providers operated by a unit of government to no more than the cost of providing services to Medicaid beneficiaries.
Allocates resources for program integrity and data collection: Includes measures designed to address waste, fraud, and abuse, as well as forthcoming guidance from the Centers for Medicare & Medicaid Services (CMS) about improving data collection of Medicaid supplemental payments.
Continues Medicaid Disproportionate Share Hospital (DSH) reductions: Current law reduces Medicaid DSH allotments between FFY 2020 and FFY 2025. This budget proposes to continue DSH allotment reductions from FFY 2026 through FFY2029 and estimates this will save $25.9 billion over 10 years.
Allows states to provide postpartum coverage for pregnant women with substance use disorders (SUDs): Proposes to make it easier for states to offer pregnant women diagnosed with SUD full Medicaid benefits for one year postpartum, which would cost $245 million over 10 years.
Improves maternal mortality and morbidity interventions: Through the Center for Medicare and Medicaid Innovation, it proposes to explore a potential service delivery model to test ways to address maternal mortality and morbidity rates.
Extends postpartum Medicaid coverage: Proposes making it easier for states to extend full Medicaid coverage for up to one year after birth for postpartum women with SUD. Currently, postpartum Medicaid coverage ends 60 days after birth, which can be a barrier to SUD treatment for postpartum women.
Expands flexibility for enrolling out-of-state providers in Medicaid: Currently, when Medicaid beneficiaries receive care outside of their home state, their provider must enroll in the beneficiary’s home state Medicaid program to receive payment. To reduce paperwork and promote access to specialized out-of-state care, the budget proposes allowing out-of-state providers to be paid as long as they are enrolled in Medicare or any state Medicaid program. This proposal would cost $9 million over 10 years.
Extends Medicaid managed care waivers: Currently, to implement mandatory, risk based Medicaid managed care, states must request waivers from HHS every two to five years. This budget proposes permitting the HHS secretary to approve waivers for longer time periods, and even make the state’s managed care authority permanent if a waiver has been renewed once before.

Proposals Affecting Individuals Dually Eligible for Medicare and Medicaid

Coordinates review of Dual Eligible Special Needs Plans marketing materials: Allows for joint state and CMS review of marketing materials for Dual Eligible Special Needs Plans.
Revisits Part D special enrollment period for dually eligible individuals: Clarifies the special enrollment period (SEP) for Medicare Part D to allow CMS to apply the same annual election process for all eligible individuals, but maintains the ability for dually eligible beneficiaries to use an SEP to opt into integrated care programs or to change plans following auto-assignment.

Prescription Drugs

Expands Medicaid drug coverage demonstration: Would allow up to five state Medicaid programs to test a closed formulary under which they negotiate prices directly with drug manufacturers. However, states in this demonstration cannot participate in best-price reporting or the Medicaid Drug Rebate Program. Closed formularies would permit states to pursue a selective and more cost-effective specialty pharmacy network, but leaving the rebate program is a risk states need to weigh. Predicted savings is $410 million over 10 years.
Eliminates the Medicaid rebate cap: There is currently a statutory cap on manufacturer drug rebates at 100 percent of a drug’s average manufacturer price. Once the cap is reached, manufacturers can increase a drug’s price without increasing associated Medicaid rebate. Lifting the cap will ensure manufacturers pay rebates covering all prices of a drug. It will also protect state Medicaid programs from the cost of excessive price spikes and incentivize lower list prices.
Authorizes the Health Resources and Services Administration (HRSA) to collect a user fee from participating 340B hospitals. Covered entities would pay 0.1 percent of total 340B drug purchases to create a sustainable source of funding to manage the 340B Drug Pricing Program.
Requires 340B transparency. All 340B-covered entities would need to report savings achieved from the 340B program and their uses to HRSA.
Improves integrity of rebate program: Enables HHS to impose fines on manufacturers when they misclassify drugs for Medicaid drug rebate purposes. Predicted savings are $347 million over 10 years.

Children’s Health Insurance Program (CHIP)

The President’s proposed budget only includes one suggested policy change that does not offer much detail.

Eliminates an existing fund and establishes a new one to provide states with additional federal CHIP funds in case of a shortfall. The proposed budget eliminates the Child Enrollment Contingency Fund, which provides additional funding to states that anticipate a shortfall of federal funds due to higher-than-expected CHIP enrollment. However, it also creates the Shortfall Fund and tasks CMS to transfer unused annual appropriations to this fund for states that need additional federal CHIP dollars.

Prevention and Public Health

The HHS budget request prioritizes public health through its investments in the opioid crisis and by targeting funds to support the launch of an initiative designed to end HIV/AIDS across the country. The high-level budget breakdown:

Continues support to prevent, treat, and support recovery from opioids, including:
- $1.5 billion for State Opioid Response grants in support of all states and territories;
- $221 million to expand the behavioral health workforce, including an additional $4 million for a new effort authorized in the SUPPORT for Patients and Communities Act to increase the number of providers that are able to prescribe medication-assisted treatment;
- $120 million to support SUD treatment and prevention, including opioid abuse, in rural communities at the highest risk;
- $476 million for the US Centers for Disease Control and Prevention to continue current activities in support of all 50 states and territories, as well as local jurisdictions, to track and prevent overdose deaths;
- Align SUD treatment privacy protections with other confidentiality protections;
- Prevent abusive prescribing by establishing HHS reciprocity with the Drug Enforcement Administration (DEA) to terminate provider prescribing authority;
- $330 million in Department of Justice funding for opioid-related state and local assistance, including: $145 million for the Comprehensive Opioid Abuse Program to support, treatment and recovery, diversion, and alternatives to incarceration programs; $125 million for drug courts, mental health courts, and veterans treatment courts; $30 million for residential substance abuse treatment; and $30 million for prescription drug monitoring programs, as well as funding for the DEA to combat illicit drug use and trafficking; and
- Funding for US Department of Agrilculture: $44 million in distance learning and telemedicine grants, of which $20 million would be dedicated to projects that combat the opioid crisis. In addition, the budget proposes $60 million in community facilities grants, which can be used to support treatment centers and other community needs.
Aims to end the HIV epidemic: The HHS budget invests $291 million in FFY 2020 for the first phase of the administration’s proposed initiative, which will target areas with the highest infection rates with the goal of reducing new diagnoses by 75 percent in five years and 90 percent in ten years. The initiative includes:
- $140 million investment in CDC to test and diagnose new cases, link newly infected individuals to treatment, connect at-risk individuals to pre-exposure prophylaxis (PrEP), expand HIV surveillance, and directly support states and localities;
- $70 million in new funds for the Ryan White HIV/AIDS Program within HRSA to increase direct health care and support services, in an effort to increase viral suppression among patients in targeted, high-incidence areas. Also includes $50 million to HRSA for expanded PrEP services, outreach, and care coordination in community health centers;
- Prioritizes the reauthorization of the Ryan White program; and
- $25 million in new funds for the Indian Health Service to screen for HIV and prevent and treat hepatitis C in those living with HIV/AIDS.

Expands activities to address HIV/AIDS: Allocates $54 million for the Minority AIDS Initiative within the Office of the Secretary and $116 million for the Minority AIDS program in the Substance Abuse and Mental Health Services Administration in an effort to increase services to disproportionately affected communities of color.
Prioritizes funding for programs that address the needs of older Americans, many of whom require some level of assistance to continue living independently within their communities. This funding provides critical help and support to seniors, providing direct services such as respite care, transportation assistance, and personal care services. These services also include $907 million for senior nutrition programs. This funding is estimated to provide 221 million meals to more than 2.3 million older Americans nationwide.
Cuts CDC’s total discretionary budget authority by $1.276 billion, compared to 2019 funding levels. Program-level cuts would be $153 million. Other changes include:
- A cut of $237 million for chronic disease prevention and health;
- The creation of the America’s Health Block Grant as a means of reforming state-based chronic disease programs; and
- An increase of $10 million for influenza monitoring and prevention.

Health and Housing Issues and Other Programs Addressing Social Determinants of Health

Some components of the HHS budget, and several aspects of the US Department of Housing and Urban Development (HUD) budget, could affect states’ abilities to address health through housing and other social determinants of health. The proposed budget cuts HUD funding by $8.7 billion — a 16.4 percent decrease from 2019 estimate.

Proposes changes to federal investment in rental assistance. The budget request would increase rental assistance to $37.9 billion, which would maintain services for all currently enrolled HUD-assisted households. However, “work-able” residents would be required to pay a greater share of their rent.
Adds funds to the Rental Assistance Demonstration (RAD) program, which supports transitioning public housing to housing voucher and project-based rental assistance units. RAD would prioritize the redevelopment of public housing units in designated Opportunity Zones.
Increases funding for lead-safe healthy homes by $60 million to $290 million.
Supports changes to existing programs:
- Cuts $45 million from Housing Opportunities for People with AIDS, and
- Eliminates the Community Development Block Grant (CDBG), “recognizing that state and local governments are better equipped to address local community and economic development needs.”
Proposes policy and financial changes for safety net programs. The budget cuts $17.4 billion from the Supplemental Nutrition Assistance Program and cuts approximately $1.1 billion from the Temporary Assistance for Needy Families (TANF) block grant. Adds additional work requirements in federally funded public assistance programs, including Medicaid and TANF.

Other Programs

Eliminates several programs serving children and youth with special health care needs (CYSHCN): Proposes eliminating several programs funded by HRSA that help states better serve CYSHCN. These include initiatives to improve systems of care for those with autism and other developmental disorders, pediatric mental health conditions, genetic disorders, and sickle cell disease.
Ends programs promoting screenings for infants and mothers: The budget proposes ending an initiative that supports universal newborn hearing screening and a program that promotes screening and treatment for maternal depression.
Promotes innovations to address maternal mortality: The budget proposes that the Centers for Medicare and Medicaid Innovation (CMMI) create a service delivery model for states to test interventions to improve maternal morbidity and mortality. This proposal would not require Congressional approval, and is in addition to CMMI’s recently released Maternal Opioid Misuse and Integrated Care for Kids models.
Funds Family-to-Family (F2F) Information Centers: Funds F2F Health Information Centers at their current level through 2021.
Maintains Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program: Maintains MIECHV program at current levels.
Promotes foster care: To promote family-based foster care for children with significant disabilities, proposes spending of $357 million over 10 years on salaries for foster parents. The recent Family First Preventive Services Act (FFPSA) placed restrictions on funding for congregate care placements (such as group homes), so this proposal would support states in developing alternatives to congregate care. Additionally, the FFPSA allows states to provide preventive services, such as mental health or substance abuse services, to keep children with their families. The budget proposes creating a flexible funding option that would further broaden eligibility for preventive services and increase the types of services that states can provide.
Caps benefits for families with more than one child enrolled in the Supplemental Security Income (SSI) Disability Program: Creates a cap on the total SSI benefits that families with more than one child receiving SSI disability payments can receive.
Increases Individuals with Disabilities Education Act (IDEA) funds: Proposes a slightly increased level of funding ($13.2 billion) for IDEA formula grants to states to support special education and early intervention services.
Maintains funding for Women, Infants, and Children (WIC): Proposes maintaining current level of funding ($5.8 billion) for the Special Supplemental Nutrition Program for WIC.

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.

CMS Releases State Funding to Improve Integrated Care for Children and Pregnant and Postpartum Women Enrolled in Medicaid and CHIP

February 11, 2019/in Policy 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, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Healthy Child Development, Infant Mortality, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Population Health, Primary Care/Patient-Centered/Health Home, Quality and Measurement /by NASHP Writers

Last week, the Centers for Medicare & Medicaid Services (CMS) released two highly anticipated initiatives — the Maternal Opioid Misuse (MOM) Model and the Integrated Care for Kids (InCK) Model — which will provide multi-year funding to states to improve integrated care for maternal and child health populations enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).
NASHP has been tracking these important initiatives since they were first announced by the CMS Center for Medicare and Medicaid Innovation (Innovation Center) last year and has compiled and promoted exemplary integrated care delivery models, strategies, and innovations for pregnant and postpartum women and children that states can consider as they develop their applications for these initiatives.
The MOM Model is designed to:

Improve quality of care and reduce costs for pregnant and postpartum women with opioid use disorder (OUD) and their infants;
Expand access, service-delivery capacity, and infrastructure based on state-specific needs; and
Create sustainable coverage and payment strategies that support ongoing coordination and integration of care.

The CMS Innovation Center will award a maximum of $64.5 million through up to 12 cooperative agreements with state Medicaid agencies and their care delivery model partners for a five-year period. Applications for the MOM Model are due to CMS by 3 p.m. (EST), May 6, 2019. A CMS webinar about the MOM Model Notice of Funding Opportunity was held Feb. 21, 2019. The recording, slides, and transcript from the webinar are available here.
The InCK Model is designed to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and CHIP through prevention, early identification, and treatment of behavioral and physical health needs. States and local organizations will work to conduct early identification and treatment of children with health-related needs across settings to:

Increase behavioral health access;
Respond to the opioid epidemic; and
Improve child health outcomes.

The CMS Innovation Center will award a maximum of $128 million through eight cooperative agreements with state and local participants for a seven-year period (awarding up to $16 million per recipient). Applications to implement the InCK Model are due to CMS by 3 p.m. (EST), June 10, 2019. A CMS webinar about the InCK Model NOFO is scheduled for 2:30 to 4 p.m. (EST) Tuesday, Feb. 19, 2019.

Fact Sheet Highlights Medicaid’s Critical Role in Screening for Maternal Depression

January 29, 2019/in Policy Reports Behavioral/Mental Health and SUD, Chronic and Complex Populations, Chronic Disease Prevention and Management, Health Coverage and Access, Healthy Child Development, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Population Health /by NASHP Writers

Despite evidence that maternal depression is common and can impede the development of young children, it is often undiagnosed and untreated. Medicaid can play a leading role in identifying at-risk mothers and connecting them to treatment. NASHP’s new fact sheet provides background on maternal depression while also presenting a summary of state Medicaid policies for screening for maternal depression in the context of well-child visits.
Read or Download the Fact Sheet

New Federal Initiatives Help States Expand Support for Children and Families Affected by Substance Use

December 4, 2018/in Policy Blogs Behavioral/Mental Health and SUD, Care Coordination, CHIP, Chronic and Complex Populations, Chronic Disease Prevention and Management, Eligibility and Enrollment, Healthy Child Development, Integrated Care for Children, Integrated for Pregnant/Parenting Women, Maternal Health and Mortality, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Population Health /by Hannah Eichner

Shutterstock.com

In the recent election, Republican and Democratic gubernatorial candidates offered strategies to address the opioid epidemic and meet the needs of children and families affected by substance use disorder (SUD). Incoming and incumbent executives will have new federal resources – including the new Maternal Opioid Misuse (MOM) and Integrated Care for Kids (InCK) models and the SUPPORT for Patients and Communities Act – to bolster their state efforts.
The MOM and InCK models, recently announced by the Center for Medicare & Medicaid Innovation (CMMI), are designed to help selected states better coordinate and integrate treatment and support to improve outcomes and reduce costs.

Under the MOM model, state Medicaid agencies and care-delivery partners will work to improve care for pregnant and postpartum women with opioid use disorder (OUD). CMMI will award up to $64.5 million over five years, with the funds divided in varying amounts among up to 12 MOM cooperative agreements.
Under the InCK model, state Medicaid agencies and community partners will collaborate to bolster prevention, early identification, and treatment for children covered by Medicaid. CMMI will award up to eight InCK cooperative agreements, with up to $16 million available to each awardee over a seven-year period.

More information about applying for these initiatives is expected in early 2019.
The recent SUPPORT for Patients and Communities Act includes a number of provisions that also support children and families affected by SUD, including several provisions that could provide new funding to states and new ways for states to use existing federal funds. A previously-published NASHP blog described some of the law’s provisions affecting state Medicaid agencies, while this blog focuses on other key provisions targeting children and families.
Several of the act’s provisions address the impact of childhood trauma. There are multiple connections between SUD and trauma — childhood trauma is a risk factor for SUD and growing up with a parent who has an SUD is itself considered a traumatic experience. Recognizing the significant and long-lasting impacts of childhood trauma, the SUPPORT Act:

Creates an interagency task force to develop best practices for identifying and supporting children and families who have experienced or are at risk of experiencing trauma. The task force is also responsible for crafting a coordinated federal response to families impacted by SUD and other forms of trauma. These best practices and coordinated federal approach will help states as they promote evidence-based approaches to care. (Section 7132)
Permits the US Centers for Disease Control and Prevention to collect data about adverse childhood experiences through existing public health surveys, in cooperation with states, with $2 million in annual funding. States can use the findings to track trends, allocate resources, and refine programs that address adverse childhood experiences. (Section 7131)
Authorizes $50 million per year for grants to state, local, and tribal educational agencies to increase student access to trauma support services by linking educational agencies with mental health systems. The US Secretary of Education would administer the grants in coordination with the Assistant Secretary for Mental Health and Substance Use. (Section 7134)

Other parts of the law are designed to strengthen care delivery systems for children and families affected by SUD. These provisions:

Authorize $20 million in grants to state governments and other entities to develop and evaluate family-focused SUD residential treatment programs, which permit children to reside with parents in the treatment facility. Due to the recently-enacted Family First Prevention Services Act, evidence-based SUD treatment services for certain parents will soon be eligible for funding from current state allocations of Title IV-E child welfare dollars (learn more in this NASHP blog.) The grants will help additional programs qualify Title IV-E funding. An additional provision requires the US Department of Health and Human Services (HHS) to issue guidance on how states can promote family-focused residential treatment programs and leverage both Medicaid and Title IV-E funds to support them. (Sections 8083 and 8081)
Appropriate $15 million for HHS to conduct a randomized evaluation of a “recovery coach” program that provides integrated treatment and supportive services to parents who have temporarily lost custody of their children due to SUD. If the evaluation shows positive results, the program could potentially be funded using a state’s existing Title IV-E dollars under the Family First Prevention Services Act. (Section 8082)
Authorize HHS to provide grants to any state agency to improve implementation of plans of safe care for substance-exposed infants. Existing law requires states to create plans of safe care for all substance-exposed infants. If HHS chooses to award these grants, funds could be used for a number of purposes, including to improve access to treatment, train health professionals and child welfare staff, and strengthen cross-agency collaboration. This provision also requires HHS to provide written guidance and technical assistance outlining how to implement plans of safe care. (Section 7065)

To learn more about how states are supporting children and families with SUD:

View NASHP’s issue hubs that highlight important information and resources about the InCK and MOM models.
Read the NASHP issue brief and view the webinar addressing State Options for Promoting Recovery among Pregnant and Parenting Women with Opioid or Substance Use Disorder.

Read NASHP’s issue brief State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis, and listen to NASHP’s webinar on the topic.
View presentations from NASHP’s preconference Turning the Tide: State Strategies to Meet the Needs of Families Affected by Substance Use Disorder.

NASHP is also in the process of creating a new policy academy that will support states working to improve access to care for Medicaid-eligible pregnant and parenting women with SUD and/or mental health conditions. The call for applications will be released in December 2018.