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Challenges and Opportunities for Pediatric Medical Home Implementation and CYSHCN

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NASHP in collaboration with the National Center for Medical Home Implementation developed a new fact sheet addressing challenges and opportunities to provision of care for children and youth with special health care needs (CYSHCN) enrolled in Medicaid managed care. The fact sheet identifies states that leverage Medicaid managed care to advance the pediatric medical home model through payment incentives, technical assistance, and care coordination services.

View and download the full fact sheet.

What a Difference a Day Makes…

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Tomorrow it will all be over, this long, costly, bitter, and divisive election will be behind us and we will know who America has chosen as our President, who has been elected to Congress, and a host of other important electoral outcomes. While this election has too often highlighted the differences within our country, a recent news story caught my attention – a bakery in North Carolina is reviving the tradition of baking election cakes. It seems our forebears celebrated each election with community events and rum soaked cakes – where all sides came together to celebrate democracy.
In the spirit of that history, let’s look for the icing on the cake. Perhaps this election will be the tipping point, bringing us all out of our corners and together to solve problems. Maybe this bitterness will give way to resolution that will usher in an era when Congress and the new Administration can work together to solve the challenges we face as a nation. But no matter what happens in Washington, states remain pragmatists, working to balance budgets and address priorities.
In health care, states have made extraordinary progress with support from the federal government. CMS has operationalized the Office on Medicare and Medicaid Coordination and the Center for Medicare and Medicaid Innovation is investing in multiple demonstrations designed to improve how care is delivered and financed.
While the rhetoric around Obamacare has been heated and the policy debates real and intense, progress is inescapable, as is the fact that it is largely fueled by the Affordable Care Act (ACA). More people have health coverage than ever before. There is general support for the elimination of preexisting conditions, for allowing kids to stay on parents’ health plans until age 26; for the need to address costs and particularly pharmaceutical costs. And thanks to ACA investments, states are actively engaged in creative efforts to restructure how care is delivered and paid for to improve health and lower the cost trajectory.
Seventeen states administer state-based insurance exchanges or do so in partnership with the federal government. All 50 states have streamlined and simplified Medicaid eligibility and enrollment, and are working with the exchanges. For the first time, state demonstrations are coordinating Medicare and Medicaid to better serve elders and persons with disabilities.
The debates around Medicaid expansion and the opposition to the ACA mask bipartisan progress. Some “red states” have established State-based Marketplaces and expanded Medicaid using models that address state differences. Ten states – both “red and blue”- have implemented ACA-funded demonstrations testing whether financial incentives will motivate Medicaid beneficiaries to seek and initiate activities that improve health. States have created new community-based approaches to support health care delivery and payment models that address social determinants of health and one state will soon test an all payer statewide ACO. Thirty-six states are implementing Systems Innovation Model (SIM) federal demonstrations and 10 states, again both “red and blue”, have launched Delivery System Reform Initiative Programs (DSRIP)-among many other Medicaid waivers and similar initiatives. The states are alive with demonstrations and eager to focus these efforts into a strategic, on-going approaches to reform. Increasingly states realize that moving our health care system from paying for volume to value requires alignment among payers and this will require new partnerships with the federal government as well as new federal approaches to cross-agency collaboration. Now that Medicaid covers more people than Medicare, new approaches to policymaking and collaboration can enhance the purchasing power of those two important programs.
Regardless of the outcome of this election, there is considerable work underway in the states to inform national policy. NASHP convened a Summit of state leaders who have thought hard about state roles and a new Administration. We will release a paper soon informed by those discussions that lays out ideas to continue and expand state initiatives. States have long served as laboratories of innovation – major federal legislation like the Children’s Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the ACA were enacted only after states had experimented with children’s health care; insurance regulation, and insurance exchanges. Of course there are staggering challenges before us; the results of these state demonstrations won’t all be positive and there are many, many barriers to overcome to assure all have access to quality, affordable health care and better health. But on this Election Day, let’s reflect and think back to the early colonies and their experiment in federalism and democracy. An election cake and a celebration of this day may no longer have a place in our hurried, modern world but the idea of coming together – building on the federal-state collaboration underway to improve health and lower costs- still has great promise.

Pooling and Braiding Funds for Health-Related Social Needs: Lessons from Virginia’s Children’s Services Act

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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. 

Read the full brief.
Pooling and Braiding infographic.

In the Zone: State Strategies to Advance Health Equity by Investing in Community Health

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In the wake of national health care reform, many states are transforming their health care delivery systems to improve the health of populations while controlling costs. Reducing health disparities—and addressing the social and economic conditions driving them—is at the heart of many of these efforts. Embedded within larger statewide system transformations such as enhanced primary care and prevention, innovative multi-payer state payment and delivery models, and value-driven health care are a number of local and regional strategies to improve health equity.
Building on larger health reforms, some states are leveraging cross-agency, multidisciplinary partnerships to address the social determinants of health. A number of these efforts seek to promote healthy lifestyles and prevent or treat chronic disease by targeting resources to the areas with greatest need, or strengthening the linkages between clinical care and community resources. State and local agencies, health systems, community organizations, schools, and local businesses are important partners in a number of these state initiatives, underscoring the role of cross-sector partners in meeting health-related social needs.
The table below compares the goals, methods, funding sources, and governance structures of initiatives in four states, and examines their alignment with other state reform efforts. It is important to note that the initiatives are in various stages of development. Connecticut is still early in the planning process, Delaware is concluding its planning phase and preparing to bring to scale three of ten planned statewide Healthy Neighborhoods in 2016, and the Rhode Island and Maryland initiatives have been operational for at least a year. As the initiatives develop and mature, questions to consider include how savings from the initiatives can be reinvested in population health, and how the initiatives measure success.
Read the full In the Zone brief.

Connecticut

 

Lead Agency

Geographic reach and criteria for selection

Goal

What is paid for

Funding Source(s)

Governance

Alignment with Other Reform Initiatives

Status

Health Enhancement Communities (HECs)

CT Dept. of Public Health, in collaboration with the SIM Program Management Office and the state Medicaid agency

 

HECs aim to address “social-demographic factors that affect health.” 

 

To create synergies and coordinate community resources in the areas with the highest disease burden, low socioeconomic status, and disparities.  (SIM Program Management Office)

Plan to support multi-sector coordination between providers, community organizations, schools, and other entities (CT SIM at a Glance)

-SIM

-The state is exploring financing options

To be determined

HECs are intended to build on and align with SIM and accountable care initiatives

In the early planning phases

Delaware

 

Lead Agency

Geographic reach and criteria for selection

Goal

What is paid for

Funding Source(s)

Governance

Alignment with Other Reform Initiatives

Status

Healthy Neighborhoods

Delaware Center for Health Innovation (DCHI),* in collaboration with the DE Health Care Commission

 

*Note:

DCHI is a public/private partnership

 

 

-Goal is for all residents to live in a “Healthy Neighborhoods Community.”

-DCHI proposes 10 non-overlapping communities of 50k-100k. (map on Healthy Neighborhoods Operating Model p. 6

-Each Healthy Neighborhood would exist within a Community.

-Align community organizations and delivery systems “to address the social determinants of health in a sustainable way to improve health outcomes.”

-Develop a three-year strategy to improve health in one or more priority areas:

-healthy lifestyles

-maternal and child health

-mental health and addiction

-chronic disease prevention and management

 

(Healthy Neighborhoods p. 3)

 

 

-Integrating providers and community organizations through Community Council and Neighborhood Task Force initiatives.

– Staff: One program director to provide strategic guidance and support for the 10 councils; 5 community coordinators to provide hands-on support and help councils implement the program.

-Shared resources and partnership opportunities for community organizations

-A resource library to share data collected in partnership with state agencies and the state university

-TA and a learning collaborative for Healthy Neighborhoods

(Healthy Neighborhoods p. 2-3)

Potential sources include:

-Fund development through grants, stakeholder support, and other sources

-In-kind contributions from local organizations

-Indirect support from the Department of Public Health for developing CHW roles in Healthy Neighborhoods.

-Hospital community benefit funds-Staff support through DPH

-Possible SIM funding

 

-DCHI will work with Healthy Neighborhoods to identity local leaders or organizations to form the Local Councils for each Neighborhood

-Local Councils will lead the needs assessment, priority selection, and program plan process.

-Each Council will develop a governance structure with support from DCHI

-Councils are meant to be inclusive and representative of the community

– (Healthy Neighborhoods p. 5-9; SHIP, SIM p. 3-4)

Healthy Neighborhoods is one of several Delaware Center for Health Innovation (DCHI) initiatives. Each initiative is a strategic stream of work intended to bring to scale delivery system changes to achieve the state’s SIM goals. (Healthy Neighborhoods p. 12)

-Adopted the Healthy Neighborhoods Operating Model paper in Sept. 2015

-Selected the first of three Healthy Neighborhoods to be launched in 2016

-Will finalize hiring of lead staff to support Healthy Neighborhoods by June 2016

Maryland

 

Lead Agency

Geographic reach and criteria for selection

Goal

What is paid for

Funding Source(s)

Governance

Alignment with Other Reform Initiatives

Status

Health Enterprise Zones

MD Dept. of Health and Mental Hygiene and the Maryland Community Health Resources Commission (CHRC)

-Currently there are 5 Zones, which do not cover the entire state.

–Zones are “contiguous geographic areas with measurable and documented economic disadvantage and poor health outcomes”

Reduce health disparities; improve health outcomes, and reduce costs and hospital admissions and readmissions.

Develop provider and community service capacity to meet unmet needs.

Each zone also has its own specific goals.

-Provider incentives to work in underserved areas covered by an HEZ

-State TA to the Zones

-Grant funding awarded by the CHRC

–Exploring funding sources for sustainability

–Legislatively created funding source ends June 2016

 

 Each HEZ has a coordinating organization, which is either a hospital, health system, or county health department. The Community Health Resources Commission administers the reserve fund. (HEZ p.3)   Aligned with PCMHs, Medicare ACOs, LHICs (see below) and other CHRC initiatives, and the state’s all-payer hospital model -HEZ hiring tax credits are available as of January 2015–Loan repayment programs are available for providers-The five HEZs meet together periodically

Local Health Improvement Coalitions (LHIC)

MD Dept. of Health and Mental Hygiene. The CHRC also supports the LHICs.

All Maryland counties; targeting “areas of greatest population health need” within the geographic areas (LHIC).

-Improve population health outcomes as measured by 40 metrics

-Facilitate innovative partnerships and build a collaborative health system at a local or regional level.

-Reduce health disparities and promote health equity (LHIC)

-Grants primarily fund personnel hiring and training, including program administrators and community health workers.

-Equipment purchasing

–One LHIC developed a guide to community resources and enlisted CHWs in linking patients to community resources.

The state Community Health Resources Commission (CHRC) awards grants to the LHICs. The CHRC funding includes state general revenue and private funding (CHRC 2015-16 annual report, p. 10).

LHICs are co-chaired by a local health department officer and a hospital system senior leader. 

Aligned with the Maryland State Health Improvement Process (SHIP) as well as other CHRC initiatives, such as HEZs

The CHRC awarded grants to LHICs in spring 2012 and summer 2013

Rhode Island

 

Lead Agency

Geographic reach and criteria for selection

Goal

What is paid for

Funding Source(s)

Governance

Alignment with Other Reform Initiatives

Status

Health Equity Zones

RI Dept. of Health (DOH) 

-11 zones throughout the state

-Minimum population of 5,000

-Community collaboratives defined their Zones’ geographic areas

To “support innovative approaches to preventing chronic diseases, improve birth outcomes, and improve the social and environmental conditions of our neighborhoods” (RI press release)

-Community collaboratives to look at the factors driving poor health outcomes and create evidence-based interventions 

-Community needs assessments in year 1, followed by the implementation of community- and evidence-based work plans to address health inequities

– A learning collaborative and state-level team of subject matter experts to build capacity across HEZs

–CDC and HRSA funding awarded to RI Department of Health

-State funding

-Considering private funding sources

Each HEZ has a local backbone organization (a community organization, health center, or local government office), an organization coordinator and evaluator, and a RI DOH project officer and evaluator (HEZ Leads)

-Aligning with SIM -Potentially aligning with existing PCMHs, Health Homes, and ACOs.  

-Grantees conducted community needs assessments and identified a plan of action in year 1

-Implementation of action plans will start in year 2, which began April 2016.

Medicaid Strategies to Promote Increased Access to Long-Acting Reversible Contraception (LARC)

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Unplanned pregnancies can present a tremendous challenge for many women, healthcare payers and the community, and are associated with a number of negative health outcomes, such as delayed prenatal care and premature births. Efforts like the Centers for Medicare and Medicaid Services’ (CMS) recent guidance and the Collaborative Improvement & Innovation Network to Reduce Infant Mortality (IM CoIIN) have improved maternal and infant health outcomes, while also highlighting the $10 billion cost burden Medicaid expends on unplanned births.
To reduce and avoid unplanned pregnancies, states are turning to Medicaid to increase access to long-acting reversible contraception (LARC). LARC implants and devices are safe and effective options for women to avoid unplanned pregnancies. Studies show intrauterine devices (IUDs), the most common form of LARC, have a less than one percent failure rate with one year of typical use. Despite their effectiveness, LARC remains underutilized, with only 10 percent of women of reproductive age reporting use. Some of the most significant barriers to greater LARC use are the high upfront costs to stock these devices, which prevent providers from offering same-day LARC insertion, and inadequate reimbursement strategies for providers.
States are using several Medicaid payment strategies to improve women’s access to LARC. Some of the most noted efforts include policies that enable immediate, postpartum LARC insertion, and payment strategies that reduce the burden for doctors seeking to stock LARC devices in outpatient settings.
Read the full blog here.

State Levers to Advance Accountable Communities for Health

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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

Updated HHS Guidance on Improving Health Care Access for Justice-Involved Individuals

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Last Thursday, the Department of Health and Human Services (HHS) released new guidance to clarify and update policies related to how states can improve access to Medicaid coverage and services for incarcerated individuals transitioning back into communities. Based on data from a newly published HHS report, currently 2.2 million individuals are incarcerated and an additional 4.7 million are on probation or parole in the U.S. Further, over 95 percent of incarcerated individuals will eventually be released to the community. As many of these individuals are now eligible for Medicaid through the ACA, these new federal guidelines provide important parameters for states to help connect justice-involved individuals to physical and behavioral health services critical to their successful reentry into the community.
Previous federal guidance did indicate that Medicaid-eligible individuals who become incarcerated retain their eligibility and can be enrolled in the program. (Existing federal law prohibits using federal Medicaid funds to pay for medical care provided to incarcerated individuals, unless the individual is admitted to an inpatient facility for at least 24 hours.) However the newly issued guidance explicitly defines who is considered to be an inmate of a public institution. It also clearly delineates that states must accept Medicaid applications from incarcerated individuals, and if they are determined to be eligible they may be enrolled in Medicaid while they are inmates of a public institution. States can either place the enrolled individual in a suspended eligibility status during the incarceration period, or can create claims processing markers to limit Medicaid billing to only qualifying inpatient services.
The guidance also reinforces that individuals who are on parole, probation, under home confinement, or are in the community awaiting trial are not considered to be inmates of a public institution. Consequently these individuals can receive Medicaid-covered services and Federal Financial Participation (FFP) is available for these services.
Other key points from the guidance include:

  • FFP and Medicaid coverage are available for eligible individuals residing in state or local corrections-related community residential facilities (such as halfway houses), as long as individuals have freedom of movement while living at the facility, defined by criteria identified in the guidance.
  • FFP is not available for health care services provided to individuals in residential reentry centers that are operated by the Department of Justice’s Bureau of Prisons.
  • FFP is not available for mental health or substance use disorder services provided to inmates involuntarily residing in residential treatment facilities, as these are considered to be correctional institutions.

The guidance strongly encourages state Medicaid agencies and correctional institutions to work together to enroll eligible justice-involved individuals in Medicaid. It also provides clarification on interstate Medicaid application processes, such as how state agencies should handle Medicaid coverage when incarcerated individuals are transferred to other states or move to another state upon release.
HHS also notes that states can encourage or require Medicaid managed care entities to coordinate with corrections agencies to promote access to care for individuals reentering the community. Further, the guidance indicates that federal matching funds are available to states for application assistance, eligibility determination, and enrollment system upgrades, as well as to transfer medical records from correctional institutions to community health care providers to promote care continuity.
For more information, see the HHS press release here. For resources about justice-involved individuals and health coverage, see NASHP’s toolkit featuring states’ efforts to enroll justice-involved individuals in Medicaid.

State Strategies to Improve Health Through Housing Services

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States are increasingly looking at housing as a component of health and well-being, particularly for individuals who are homeless or at risk of becoming homeless. Numerous studies show that housing supports for certain populations can improve health and reduce hospital expenditures and other costs for state and local governments. Some states are leveraging federal health care reform initiatives and Medicaid waivers to pay for housing services and supports; others are exploring private investment to support state efforts or examining successful local initiatives. In fact, the Centers for Medicare and Medicaid Services (CMS) Center for Medicaid and CHIP Services (CMCS) recently issued a bulletin describing state options for using Medicaid funding to support housing-related activities. Watch for additional NASHP projects on health and housing, as we bring our cross-agency Medicaid, public health, and behavioral health policy experience to bear on the pressing issues of health care and homelessness.
This chart contains state strategies to support health through housing services. The information is derived from state and federal documents, program descriptions, and other sources you will find linked in the text below. Special thanks to the Corporation for Supportive Housing, whose resources on Medicaid and housing have been invaluable.
Do you know of any state activities or emerging strategies that belong in this chart? Are you eager to update a fact we’ve included? Please send your suggestions, corrections or additions to aclary@oldsite.nashp.org. We rely on your contributions to keep our community’s real-time learning fresh and relevant. Thank you!

Initiative Name Funding Mechanism What is Paid For Target Population Notes Partners Status
California California Bridge to Health Reform 1115 waiver proposal Rental subsidies, housing-based case management services, recuperative care. Individuals who:

  • Are currently homeless, or will be homeless after discharge from a prison, hospital, or other facility, AND
  • Have repeated ED, hospital, or nursing facility use, OR have two or more chronic conditions, or have mental health or substance use disorders.
 Concepts: “Health plans could use a portion of capitation payments to pay a case rate for housing-based case management services for eligible populations.”The Integrated Care Savings Pool [plans, counties, local donors contribute] would be used to fund rental subsidies, housing-based case management services, and recuperative care for eligible populations.”Alternatively, the State would allow health plans to fund housing costs as allowable costs for eligible populations.” Regional partnerships of managed care organizations, city and county governments, hospitals, and housing and social service providers. Proposal submitted March 2015; pending
California ACA Section 2703 Health Homes A care manager will facilitate referrals to supportive housing and social services. High-cost, high-risk individuals with chronic conditions and/or serious and persistent mental illness. Community-based care management entities (FQHCs, hospitals, clinics) and community support services. Intends to submit 2703 SPA application in summer/fall 2015.
California Los Angeles County Housing for Health County funding–Housed within the LA County Department of Health Services (DHS)
  • Program negotiates directly with housing providers to obtain housing units and pays for supportive services. (See ASPE report)
  • The Flexible Housing Subsidy Poolsubsidizes rent and links tenants to services.
 High utilizers of DHS services with complex medical and behavioral conditions. Housing for Health is a county-run program that integrates health and behavioral health care with stable housing. Case managers, health care providers, housing finance agencies, housing developers, philanthropic entities. Active
District of Columbia 1915 (c) waiver One-time transitional services, including security deposits, furniture and linens, set-up fees or deposits for utilities. Lifetime max. of $5000 per individual. Individuals with intellectual and developmental disabilities. Providers of services including supportive employment, habilitative, and shared living services. Active
District of Columbia DC Permanent Supportive Housing Program District Department of Mental Health funding Permanent housing and supportive services Homeless individuals and families who:

  • have a disabling condition, and
  • have been continually homeless for a year or more, or
  • who have had at least 4 episodes of homeless- ness in the past 3 years

.

 Housed in Department of Human Services; Department of Mental Health uses its own funds to subsidize rent, and works with the DC housing authority to get rent subsidies. District shelters or homeless service providers assess potential beneficiaries. Active
Illinois The Path to Transformation 1115 waiver proposal Performance incentive payments to MCOs could be reinvested into supportive housing capital, rental assistance, or services. Individuals with serious mental illness and/or substance use disorders, including those who are homeless. Illinois’s 1115 waiver would incentivize Medicaid health plans, Accountable Care Entities, and Care Coordination Entities who are at risk financially to invest in housing and housing supports for their patients by establishing an incentive-based bonus pool. MCOs Pending
Louisiana 1915 (c) [and other 1915 waivers] Home and Community- Based Services waivers Support for acquiring and securing housing, budgeting, establishing credit, and meeting tenancy obligations. Communicating with landlords about necessary accom- modations for disability. Also provides assistance when housing is jeopardized. Individuals with a significant, long-term physical disability, and disabilities related to behavioral health and who meet low-income requirements. Permanent supportive housing is part of the Community Choices 1915 (c) waiver. Louisiana Housing Corporation Active
Massachusetts Pay for Success Social impact investment:

  • Philanthropy,
  • Private capital investments,
  • State Housing and Community Develop- ment rental vouchers,
  • Mass. Medicaid.
 Supportive housing Chronically homeless individuals The initiative aims to provide up to 500 units of housing over six years. Corporation for Supportive Housing, Mass. Housing & Shelter Alliance, United Way Launched in December 2014
Minnesota Hennepin Health (Hennepin County) Medicaid ACOs Housing and transportation assistance, work and financial support, care coordination. Housing navigation services to prioritized population. Medicaid recipients who are enrolled in the Hennepin Health Managed Care Organization, including adults, families and children who are: homeless or unstably housed, identified as high risk for future costs, and whose health is directly impacted by their housing. A 2014 Health Affairs article on Hennepin Health found that the program shifted care from hospitals to outpatient settings. County Human Services and Public Health Departments; Metropolitan Health Plan, NorthPoint Health and Wellness Center; Hennepin County Human Services. Active
New York Health Home SPA Comprehensive case management; health home networks partner with supportive housing providers. Individuals with chronic conditions, including mental health or substance use disorders. More information available here, here, and here. Supportive housing providers, shelters, corrections systems. Active
New York DSRIP/1115 waiver Supportive housing services Medical or behavioral health patients who are at risk during transitions into the community. Select DSRIP projects address supportive housing. Community housing providers home care service providers, others. Active
Oregon 1115 waiver
  • Support to locate and obtain housing;
  • care coordination.
  • Transitional services to a supported environment;
  • case manage- ment.
  • Room and board.
  • Adults with serious mental illness.
  • Individuals with SMI and possibly SUD who are homeless or at risk of being homeless.
 Community organizations; state and county agencies. Active
Oregon Oregon Congregate Housing with Services (Pilot sites) SIM Social, support, and health services provided to individuals living in low-income housing or communities. Low income single adults and people with disabilities in subsidized low-income housing or other low-income communities. More information in the SIM grant narrative. State agencies; housing, mental health, CCO constituent service organizations. Active
Texas DSRIP/1115 waiver Varies by regional project:Supportive housing services; transitional housing services; patient navigators.

  • Austin will increase psychiatric services for the homeless.
  • Houston will provide financial support, physical and behavioral health care, permanent supportive housing services to 200 chronically homeless individuals.
 Varies by regional project: Adults with SMI, HIV or TB; teens and young adults; chronically homeless individuals. Other providers; community organizations. Active
Texas The Money Follows the Person (MFP) behavioral health pilot. Money Follows the Person A local relocation specialist works with the Texas Department of State Health Services to secure housing for individuals transitioning into the community. Individuals transitioning from nursing facilities to the community. See the June 2015 CMCS bulletin for more information on the Texas MFP program. State and local housing agencies and organizations. Active
Washington Roads to Community Living Money Follows the Person Individualized housing-related services, including one-time-only moving expenditures. The program pays for services for one year after the person has moved into the community. People with complex long-term care needs transitioning into the community from facilities See the June 2015 CMCS bulletin for more information on Washington MFP program. State and local housing agencies; human service agencies. Active
Washington Section 2703 Health Home SPA Care coordination including referrals to housing resources. Individuals with at least one chronic illness and at risk for another. More information is available in the December 2014 interim report. Community housing organizations; the state housing finance commission. Active
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Advancing Health Care Transformation Through a State Surgeon General Model: Opportunities and Challenges

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Implementation of the Affordable Care Act (ACA) has opened the door to new opportunities for health policymakers to address the nation’s growing chronic disease epidemic through integrated solutions that begin to bridge the health care, public health, and social services sectors. To take advantage of these opportunities, state policymakers have incorporated a greater focus on advancing “population health,” meaning the health outcomes of groups of individuals and the determinants and policies impacting their health, in delivery system reform initiatives. A leadership position located within or aligned with the state public health agency that is charged with directing cross-sector population health improvement efforts may be beneficial to states in this new era. Among possible models for such leadership is a concept for a State Surgeon General (SSG), a position with responsibilities largely mirroring those of the U.S. Surgeon General, to provide executive-level physician leadership and contribute to the development and implementation of effective population health policies. The experiences of four states that implemented a SSG prior to passage of the ACA highlight new opportunities and challenges for the model at this juncture in time.

Read the full brief.

Accountable Health Community Models: What’s the State Role?

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With growing recognition that the health care delivery system alone cannot improve population health, there is increasing movement at the state and local levels to create new relationships between systems that focus on traditional health care delivery and those that extend to work, housing, family, and community life.
CMMI recently announced an initiative to test whether an Accountable Health Community model that systematically identifies health-related social needs and connects beneficiaries to services can impact total health care costs, overall health, and quality of care. Although focused at the local level, applicants are required to partner with state Medicaid agencies. This relationship makes sense, as states focus payment and delivery reforms on improving care, reducing costs, and improving health by implementing global or bundled payments and shared savings that provide opportunities for communities to channel resources in new directions (e.g. housing supports, food security).
States can participate in such initiatives by providing flexible funding through value-based payments, data sharing arrangements and expertise. State policymakers, who set policies and develop programs related to housing, transportation, safety, education, economic development, public health, and health care delivery, have significant opportunities to set policies that foster health.
Indeed, some states (California, Colorado, Minnesota, New York, Oregon, Vermont, and Washington state to name a few) are actively promoting or exploring models to integrate public health, social services, and delivery and payment systems, and are developing partnerships needed to make these strategies successful. Sometimes referred to as Accountable Communities for Health, these new models are intended to create community environments that promote health and well-being.
These states are aligning Medicaid delivery system reform efforts with prevention agendas, providing financial incentives to address social needs, developing requirements for provider networks to partner with community organizations and consumers to address locally identified priorities, and creating synergy among programs. They are integrating Community Health Workers (CHWs) into evolving health care systems to facilitate care coordination and enhance access to community-based services.
Some of these initiatives are just getting off the ground, and others already have early results. Oregon, for instance, set up a community prevention grant program that requires joint applications between Coordinated Care Organizations (CCOs) and local public health departments to address community needs identified through local needs assessments. They must address both community and health system interventions. Preliminary results are already available; for example, opiate prevention programs report 877 opiate overdose reversals from community members receiving naloxone and a 29% decrease in heroin-related deaths.
As new models are tested through local innovation, engaging states is equally important in order to ensure an adequate infrastructure that can support sustainability and bring innovative local initiatives to scale to benefit residents no matter where in the state they live. States have opportunities to reach beyond traditional health care system reform initiatives to use their policy levers and system changes to address social determinants of health and strengthen the capacity of communities to create health. To assist state policymakers seeking to maximize their leverage, NASHP has compiled a table of funding sources that state agencies use to address social determinants. Stay tuned as NASHP tracks state-level initiatives that explore and promote ACH developments.

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