Archive for: Charts

Comparison of Estimated Annual Consumer Premiums: In Single County in a State

Comparison of Estimated Annual Consumer Premiums: Low and High Cost County

June 28, 2017/in Policy Charts Cost, Payment, and Delivery Reform, Essential Health Benefits, Health Coverage and Access, State Insurance Marketplaces /by NASHP Staff

Estimated AHCA and ACA Premiums and Tax Credits by State, Income, Age, and Select Counties

June 8, 2017/in Policy Charts Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, Medicaid Expansion, Medicaid Managed Care, Quality and Measurement, State Insurance Marketplaces /by NASHP Staff

These sheets supplement NASHP’s brief, Health Care is Local: Impact of Income and Geography on Premiums and Premium Support. Using data and modeling from the Kaiser Family Foundation, we present estimated premiums and tax credits under current law created by the Affordable Care Act (ACA) and under the American Health Care Act (AHCA), as passed by the House. Estimates are organized by age, income, and select high- and low-cost counties within states.
Note that these estimates only consider premium costs – they do not incorporate any analysis of predicted out-of-pocket expenses due to cost-sharing. Thus, this analysis only provides a partial picture of how consumer costs may shift due to changes incurred under the AHCA. The AHCA’s proposed elimination of Cost Sharing Reduction payments (CSR) and predicted stimulation of high-deductible health plans, for example, are expected to increase out-of-pocket spending, with especially significant increases predicted for consumers in states that opt to waive Essential Health Benefits requirements under the AHCA.
View map of county-by-county premium variation
State Fact Sheets:

Acknowledgements:
Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. We are also grateful for the work of the Kaiser Family Foundation whose data we leveraged for this analysis (available at: https://www.kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/). We send special thanks to the policy team at Covered California for their analytic assistance, especially Andrew Feher, Isaac Menashe, and Katie Ravel.

County-by-County Premium Variation

June 8, 2017/in Policy Charts, Maps Cost, Payment, and Delivery Reform, Health Coverage and Access, Health System Costs, State Insurance Marketplaces /by NASHP Writers

The State of State Health Policy: Governors’ 2017 State of the State Addresses

March 2, 2017/in Policy Charts Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, Health Coverage and Access, Maternal, Child, and Adolescent Health /by NASHP Staff

State of the State speeches provide governors with an opportunity to highlight recent policy successes as well as
outline key plans and issue areas of focus for the coming year. These speeches are generally strong indicators of governors’ main priorities and sometimes also include specific proposal suggestions and funding recommendations for deliberation by legislatures.
Currently, there are 33 Republican governors, 16 Democrats and one Independent. Nine states—Delaware, Indiana, Missouri, New Hampshire, North Carolina, North Dakota, South Carolina, Vermont and West Virginia—swore in new governors in 2017. As of March 1, 2017, 46 governors have outlined policy priorities through State of the State speeches, budget, or inaugural addresses.[1] The description and chart below summarize some of the main health-related themes from these speeches.
See a state-by-state comparison
Key Health Themes
The vast majority of governors—42 of the 46—addressed health issues in their speeches, with behavioral health and Medicaid as the most common topics. This is the highest number of governors commenting on health issues since NASHP began tracking governors’ speeches in 2015.

Health issues related to mental health and substance use disorders were the most commonly cited by governors in their speeches, with 33 mentioning these issues in some way. Governors frequently highlighted strategies that have been implemented or that they plan to implement to increase access to behavioral health services.

Alabama	Plans to increase funding for home-based behavioral health services for low-income children.
Arkansas	Proposed budget requests $5 million for mental health stabilization centers and crisis intervention training to identify and assist individuals with mental illnesses.
Colorado	State has expanded access to mental health care and improved integration of physical and behavioral health services. Interest in developing a comprehensive behavioral health plan to promote a more efficient and effective system.
Georgia	Proposed budget includes $2.5 million to improve access to community behavioral health services for the state’s full child population in Medicaid and CHIP. Requests legislature to remove barriers related to mental health treatment for veterans, with funding proposed for state employee training on services for veterans (this funding complements current budget for $3 million in bonds for a sub-acute rehab facility for behavioral health services for veterans with PTSD or traumatic brain injuries). Proposed budget also allocates for a women’s veterans coordinator position to work with female veterans who experienced military sexual trauma.
Idaho	State has successful Behavioral Health Crisis Center program, with three community facilities operating as alternatives for jail or emergency room visits for individuals with mental health and substance abuse issues. Proposed budget includes funding to cover remaining costs of fully implementing other planned facilities, and $10.3 million for an adolescent mental health facility and remodeling of an existing secure mental health facility.
Iowa	State has successfully transitioned to a community-based mental health system.
Montana	Noted greater commitment to providing full spectrum of mental health services and autism services; expanded mental health services to National Guard members and veterans. Requests legislature to continue funding for full spectrum of mental health services, including individuals covered by Medicaid expansion. Noted the state leads the nation in youth suicide and proposing $1 million to implement evidence-based pilot programs.
New Hampshire	Proposed budget increases funding for behavioral health workers by $3 million to improve community mental health safety net.
New Jersey	State invested an additional $127 million for mental health and substance abuse treatment and expanded successful recovery coach program, which places counselors in emergency rooms for individuals in need of treatment; proposing additional funding again. While individuals have increased access to substance use disorder treatment through Medicaid, legislature should ensure that individuals who do not qualify for Medicaid and cannot afford private coverage for behavioral health treatment or face insurance denials receive at least six months of drug rehabilitation treatment. Budget also proposes $5 million to expand pediatric behavioral health pilot program.
Pennsylvania	State has invested over $20 million in expanding addiction treatment options.
South Dakota	Have invested significantly in behavioral health services, and substance abuse treatment programs have been successful. Mentioned state’s methamphetamine (meth) epidemic; working to prevent meth from being transported into the state and providing education and treatment services.
Utah	Highlighted issues of drug addiction and homelessness and importance of state role in addressing the drug trade. Also plans to focus on underage drinking, alcohol abuse, and impaired driving; as well as teen suicide.
Virginia	State’s Healthy Virginia initiative has expanded services to individuals with serious mental illnesses. Plans to fund community service boards to provide immediate services for individuals experiencing behavioral health crises.
Washington	Mental health system needs to be more prevention-focused, patient-centered and community-based to provide individuals with more appropriate treatment.
Wyoming	Held symposium on suicide prevention, which will become an annual event.

The issue of heroin and other types of opioid abuse and overdoses were specifically mentioned by 21.

Alabama	State is highest painkiller prescribing state, but addressing opioid abuse issue through laws passed in 2012 and 2013 and a state council to build on existing efforts. Also noted state has joined in a compact with other governors to fight opioid addiction.
Alaska	Mentioned the opioid epidemic as an extreme challenge, and while naloxone bill was helpful, state also developing a comprehensive plan focusing on five key strategies: limits on prescriptions; strengthening prescription drug monitoring program; reclassification of opioids; restricting transport of opioids and heroin; and provider education.
Arizona	Implemented efforts such as limiting prescriptions, providing better treatment and confiscating trafficked drugs; requesting medical board to require continuing provider education on the topic.
Georgia	Signed executive order for Department of Health to permit naloxone to be provided over the counter, and state pharmacy board has reclassified naloxone as a Schedule V exempt drug. Requests legislature to codify executive order provisions, strengthen prescription drug monitoring program, and educate healthcare providers on the issue.
Indiana	Overdose deaths have increased by 500% since 2000 because of opioid epidemic. Effective syringe exchange program being coordinated by public health nurses and plans to allow counties to establish more of these programs. Plans to promote prevention, treatment and enforcement, and has assigned a senior staff person to focus on the issue. Will be limiting amount controlled substances, prescriptions and refills along with enhancing penalties for pharmacy robberies and upgrading police labs.
Kentucky	Allocated $12 million over next two years to address heroin and substance abuse issues.
Maine	Law enforcement efforts to address the opioid crisis have been effective. Proposed budget provides an additional $2.4 million in opioid addiction treatment services for the uninsured that will fund 359 openings for therapy and medication-assisted treatment.
Maryland	One of the first actions as governor was to create a task force to address opioid crisis, and state is in the process of implementing their recommendations that address the issue from all angles: education, treatment, interdiction and law enforcement. Requested legislature pass additional bills related to prescription limits. Also noted that majority of governors from both parties would like to see federal government engagement in collaboration with state and local partners to address what has become a national crisis.
Massachusetts	Progress in addressing the opioid epidemic, with schools for health and dental providers mandating classes and continuing education about opioid therapy and pain management. Opioid prescriptions are down by 15% and providers are using new prescription drug monitoring program. State has expanded addiction services spending by 50%and distributed NARCAN kits to first responders. Budget proposes to add $2 million to enhance law enforcement drug trafficking efforts and have joined into a compact with other governors about addressing the opioid issue.
Michigan	Heroin overdoses have doubled since 2009 and state needs to better address the issue. Acknowledged work of a legislative task force and passage of a Good Samaritan law to promote individuals to seek assistance for themselves or others without concern for prosecution. Mentioned plans to invest in an automated prescription system. Expanding state police program where individuals can go to certain stations and seek treatment help.
New Hampshire	Opioid crisis is the most critical public health and safety issue for the state, and should continue investing in law enforcement (reinstating Granite Hammer initiative to enhance law enforcement responses), prevention, and especially treatment/recovery services. Will provide loan forgiveness for providers working on front lines of opioid crisis.
Nevada	Highlighted that one state resident dies of opioid overdose each day, with the problem growing over the past decade and now reaching epidemic proportions. Acknowledged passage of a Good Samaritan overdose prevention act, which helped increase enrollment in the prescription drug monitoring program from 16% to 81% and expanded access to overdose reversal medications. Summit held involving over 500 stakeholders, and introducing legislation based on their recommendations to provide additional training and protocols for providers.
New Jersey	Implementing new rules to reduce prescription limit for opioid-based pain medications from current 30 days to 5 days without additional patient assessment to address the issue of prescription painkillers leading to opioid abuse. Facing Addiction Task Force created to address prevention, treatment and recovery and will also create a Governor’s Task Force on Drug Abuse Control to coordinate efforts among state agencies. Called for federal government to remove substance abuse treatment barriers such as the prohibition of using federal Medicaid funds for inpatient treatment in Institutes for Mental Diseases. Noted need to reduce barriers for supportive housing for individuals in recovery and increasing funding by $1 million for college housing programs for students in recovery. Also adding specific curriculum in all schools on opioids.
North Dakota	Opioid crisis needs to be treated as a chronic disease and requires collaborative action at the state and local levels, involving law enforcement, faith-based organizations, nonprofits and the judiciary.
Pennsylvania	Proposed budget includes funding to assist communities affected by heroin and opioid abuse and state is taking a more aggressive and effective approach to address the issue. Provided law enforcement with greater resources to address drug trafficking, have given first responders access to naloxone, have destroyed unused prescription drugs, redesigned prescription drug monitoring program, and enhanced education efforts and treatment services.
Rhode Island	Budget proposes funding increase for treatment and prevention to address overdose crisis and funding to support addiction recovery housing.
Tennessee	Plans to expand substance abuse and crisis intervention treatment services and supports to address drug and opioid addiction.
Vermont	Addressing opioid abuse is one of the state’s main priorities and will establish an opioid coordination council and a director of drug abuse prevention position, along with convening a state convention on the issue. Plans include providing enhanced treatment, prevention measures and stricter enforcement.
Virginia	Proposed budget includes $5.3 million for increased substance abuse disorder services and tools to prevent opioid overdoses. Planned reforms include limiting opioid prescriptions written in emergency rooms to 3 days, new requirements for all prescription narcotics and allowing community organizations to distribute naloxone.
Washington	Noted need to address root causes of chronic homelessness, such as opioid addiction and mental illness.
West Virginia	Mentioned need to address the state’s drug problem in particular related to abuse of prescription drugs and to invest in treatment facilities.

Twelve governors also spoke about the issue of behavioral health within the context of better addressing the needs of justice-involved individuals as they transition back into communities and/or providing mental health and substance use treatment services rather than incarceration when appropriate.

Alabama	Will be investing in improved and more comprehensive rehabilitation programs in prisons, which will include enhanced substance abuse re-entry treatment services.
Arizona	Noted signed executive order so that people reentering community from prison have the opportunity to be treated with drug that can block painkiller addictions.
Illinois	Noted need to address underlying behavioral health issues of justice-involved individuals as they transition back into communities.
Kentucky	Noted increased treatment options for justice-involved individuals transitioning back to communities.
Massachusetts	Progress on providing behavioral health treatment rather than incarceration when appropriate. Plans to implement improvements at corrections-supervised mental health hospital and expand the clinical program offered by $37 million.
Nebraska	Corrections department implemented new risks/needs assessment tool, enhanced mental health services and developed a health plan for incarcerated individuals.
New Jersey	First certified drug abuse treatment facility for prison inmates will open in spring 2017.
New York	Commented that jails have become the mental health system of last resort.
North Dakota	Highlighted that many individuals are incarcerated due to drug offenses and that treatment services should be enhanced to both assist individuals and reduce state costs.
Oklahoma	Noted that 75% of new prison admissions are for nonviolent offenses that are often drug related. Proposed budget includes new funding for substance abuse treatment for justice-involved individuals, including a $50 million bond issue to build substance abuse rehabilitation wings on existing prisons.
South Dakota	Have expanded alternative sentencing options for drug offenses and will expand treatment for justice-involved individuals, with reduced charges if treatment completed. State criminal justice and mental health task force found mental illnesses need to be identified sooner in jails; will promote legislation to help law enforcement use crisis intervention services, reduce unnecessary jail admissions, and increase number of providers available to screen for mental illnesses in jails.
Virginia	Noted that because many individuals with behavioral health issues are ending up in jails, is proposing increased funding to expand mental health screenings at local correctional facilities.

In total, 21 governors mentioned the issue of Medicaid and/or Medicaid expansion in their speeches. Specifically, 15 governors provided general comments about their states’ Medicaid programs, such as commenting on recent program improvements, the growth of overall program costs, or cost savings achieved through program reforms.

Alaska	Mentioned the need to rein in Medicaid costs, and noted that legislature had passed a Medicaid reform bill designed to address rising costs.
Colorado	Over the last 6 years the state has pursued programs designed to control Medicaid costs, in particular by emphasizing preventive care and disease management tools. Hospital provider fee could potentially be modified to control costs and better serve rural hospitals and clinics.
Georgia	Working with legislators to improve Medicaid coverage of autism treatments for individuals up to age 21. Also mentioned major funding source for Medicaid is the hospital provider fee and that legislative action is needed for its reauthorization.
Illinois	Focusing on reducing fraud and abuse has saved hundreds of millions of dollars in Medicaid.
Iowa	Modernizations have been implemented in the state’s Medicaid program, such as the addition of value-added services and more coordinated care, and these types of reforms and innovations along with a focus on health outcomes resulted in a savings of $110 million.
Kansas	State’s move to Medicaid managed care has resulted in improved health outcomes and a savings of $1.4 billion; will be launching KanCare 2.0.
Maine	State’s Medicaid program has been realigned to prioritize needs of elderly and disabled individuals. Also noted that waitlist for home and community based services for individuals with intellectual disabilities or autism is too long.
Michigan	Noted success of Medicaid’s Healthy Kids Dental program; enrollment has grown from over 400,000 kids in 2010 to more than 1 million, with reach in every part of the state.
Minnesota	Wants to continue the provider tax, which funds health coverage for thousands; proposes to repeal the 2019 sunset of the tax because it provides essential funding for health care and is especially important now with federal uncertainty around health care.
Nevada	Proposed budget is larger in part due to increases in Medicaid caseload and includes $11.5 million in new funding to expand the home and community based/frail elderly waiver to provide more services for seniors in their homes.
New Hampshire	Advocating for an accounting of the Medicaid program to reconcile payments with actual costs.
New Mexico	Mentioned state has connected more families to services such as Medicaid.
South Dakota	Priority is Medicaid payment reform for individuals who are Medicaid eligible and also Indian Health Services eligible.
Tennessee	Noted that non-discretionary increases in TennCare have been caused by general health care cost increases and in particular higher pharmacy costs. Plans to open more places in the CHOICES program for individuals with developmental and intellectual disabilities.
Wisconsin	Mentioned state covered all individuals under the poverty level in Medicaid through the state’s own efforts and the state has high rates of coverage.

Twelve governors specifically mentioned Medicaid expansion in their speeches. Seven, Alaska, Iowa, Michigan, Minnesota, Montana, New Jersey, and Pennsylvania, commented positively on expansion. Four others were governors that have not implemented expansion, with two governors (Kansas and Wisconsin) expressing continued opposition to expansion and two others (North Carolina and Virginia) indicating support for pursuing expansion. Kentucky’s governor noted that the state’s pending expansion waiver to move from a traditional to an alternative model could lead future state efforts.

Alaska	Described personal stories of residents that benefited from increased access to care through expansion, and that state received over $316 million in federal funding through the expansion, which has allowed the state to reduce Medicaid spending by more than $15 million.
Iowa	State’s 1115 waiver for Medicaid expansion has resulted in more individuals receiving health coverage and in reductions in uncompensated care.
Kansas	Indicated that not implementing Medicaid expansion was the right choice for the state, especially given that ACA repeal is likely
Kentucky	State’s Medicaid waiver request will be an opportunity to lead within the context of ACA changes and in terms of long-term viability of the program.
Michigan	Highlighted the success of the state’s Medicaid expansion waiver in providing over 400,000 preventive care visits and 2.8 million primary care visits, while saving the state hundreds of millions of dollars and hospitals’ uncompensated care costs decreasing by nearly 44% on average. Also noted that state’s expansion model could inform federal-level health care changes.
Minnesota	Noted state’s success in health coverage, with over 250,000 gaining coverage and now 96% of individuals are covered, and that Medicaid expansion has helped rural hospitals and it should be preserved.
Montana	Mentioned that rate of uninsured has dropped from 20% in 2013 to only 7%, with 67,000 residents now having regular access to health and mental health care, in large part due to expansion. Expansion has financially supported rural hospitals.
New Jersey	Medicaid expansion has resulted in a five-fold increase in access to substance use disorder treatment since 2013.
North Carolina	Highlighted the issue of uninsured individuals and that state should implement the ACA’s Medicaid expansion because it will provide coverage, create jobs and prevent closures of rural hospitals.
Pennsylvania	Noted that Medicaid expansion has increased access to substance use disorder treatment.
Virginia	Highlighted that while the future of the ACA is uncertain, the option to expand Medicaid currently remains and it could provide approximately $300 million annually to cover behavioral health services. Proposed budget allows for the governor to expand Medicaid if enhanced federal funding continues beyond 10/1/17, and even if it does not, state policymakers should all agree that 400,000 individuals without care is a problem.
Wisconsin	Noted that had warned that using federal Medicaid expansion funds would hurt state taxpayers and believes state made the right decision in not implementing expansion.

In addition to mentioning health care costs within the context of Medicaid, 17 governors also spoke about state health care costs more broadly; often mentioning costs associated with state employee health benefits.

Alabama	Concern about the impact of the rising cost of health care on the entire health care system.
Alaska	Cuts in the Department of Health and Social Services resulted in the closure of six public health centers. Mentioned need to address the broader challenge of rising health costs and that state employees are paying more for health care coverage. Envisions a future where the cost of health care is not out of reach for small businesses and individuals.
California	Noted that because California has fully “embraced” the ACA, the tens of billions of federal dollars that could be lost if the law is repealed would significantly impact the budget.
Colorado	Mentioned the importance of individuals receiving care in appropriate settings to help reduce costs and that state is examining the underlying drivers of health care costs.
Idaho	Proposed budget includes $15 million to help school districts cover the costs of higher employee health insurance premiums.
Illinois	Commented that past inappropriate spending devastated human service organizations that serve vulnerable residents such as individuals with behavioral health issues and disabilities.
Indiana	Highlighted that the opioid epidemic impacts every sector, including increasing health care system costs.
Iowa	Health care costs are a priority as the second largest driver of the state budget is health and human services spending. To address the rising cost of health benefits for public employees recommend replacing current model with one statewide health care contract with a uniform benefit system that would reward individuals for participating in healthy behavior promotion activities.
Michigan	Will be forming a workgroup to address the issue of retiree health care and pensions that have $14 billion in unfunded liabilities.
Montana	Created Governor’s Council on Health Care Innovation which engages industry leaders to focus on improving health outcomes and reducing costs.
Nebraska	New efficiencies in health and human service application processing have been implemented and resulted in state savings.
Nevada	Proposed budget includes increased funding for state employee health benefits.
New Hampshire	Proposed budget addresses rising state employee retiree health costs by having both state and retirees share in the increase.
North Dakota	Highlighted the potential of harnessing technological forces to improve health outcomes and lower costs.
Oklahoma	Wants to raise cigarette tax to address current health care needs and the $1.62 billion in health care costs caused by smoking. Also convened leaders from health care industry and the state to strategize on ways to promote prevention and improve health outcomes.
Rhode Island	Mentioned state was successful in cutting $100M in health care costs without cutting eligibility or benefits.
Tennessee	Noted the state’s $1.2 billion obligation for retiree health care and increased health insurance costs for state employees.

Eight governors noted issues related to the health care workforce, primarily commenting on strategies to address provider shortages.

Alabama	In 65 of the state’s 67 counties there is a physician shortage and state is 40^th in the number of physicians per capita and last in the ranking for dentists. Highlighted that state expanded funding for loan repayment program for healthcare providers.
Georgia	State nearing completion of three-year plan to align physician reimbursement rates with Medicare rates to help retain high quality providers in state’s Medicaid program.
Idaho	State ranks low in the number of providers per capita, and many are nearing retirement. Stakeholder groups are developing plans to address physician shortage by increasing medical residencies and proposed budget includes $2.4 million to fund residency programs in graduate medical education. Also a new college of osteopathic medicine is scheduled to open in 2018.
Kansas	Noted that 92 of state’s 105 counties are considered medically underserved and 87 counties are underserved for dentists. Will invest $5 million in new residency programs to address these shortages and plans to establish a new privately funded osteopathic school. Proposed budget includes funding for a dental school because state does not currently have one.
Maine	Commented that state may be losing doctors, dentists and psychiatrists due to state’s tax policies.
New Hampshire	State has serious workforce issues in nearly all areas of health care; creating a $5 million workforce initiative program to identify how to address issue.
Rhode Island	Proposed budget includes increase in pay for home health workers who care for individuals with developmental disabilities.
South Dakota	Health care workers are especially needed in state’s rural areas; Recruitment Assistance Program helps communities attract and retain providers and Frontier and Rural Medicine program gives medical students clinical training in rural areas.

Eight governors mentioned the issue of more broadly addressing population health and building healthy communities.

Alabama	Great State 2019 plan addresses a wide range of social issues, including health care, such as focusing on reducing preventable diseases in rural areas and investing in autism services for low-income children.
Colorado	Would like Colorado be the healthiest state in the nation; promoting healthier behaviors such as involving children in outdoor activities and building new school fitness centers.
Delaware	Noted that need to break the “poverty to prison pipeline” to make the capital city healthy again.
Illinois	Governor’s Cabinet on Children and Youth brings together all state agencies that serve children to ensure youth are healthy, safe, well-educated, moving toward self-sufficiency, and have opportunities to succeed.
Michigan	Mentioned concept of “place making” to make the state a great place to live, work, and play.
Montana	Noted that a healthy economy depends on health of state residents.
New York	Wants to make Brooklyn new model for healthcare by incorporating prevention strategies related to lifestyle and community development (e.g. access to healthier foods, more recreation facilities, and community based clinics).
Utah	Highlighted need to address issues of intergenerational poverty and homelessness.

Many governors mentioned other specific health topics in their speeches, either as recent accomplishments or as future plans. These included topics such as supports for seniors, disabled individuals, and/or children, as well as efforts to address broader social issues affecting health.

Alaska	Strengthened partnerships with tribal health organizations to provide enhanced services at a cost savings to the state.
Arkansas	Requests that legislature direct some of the tobacco settlement funds to help reduce the disability waiting list and additional funding should be provided to better address needs of children in foster care.
Hawaii	Noted residents are among the healthiest in the nation, and that state has long supported health care access. Proposing $10 million over two years to support the state’s cancer center and promote health care innovation.
Illinois	Mentions reducing lead in drinking water is a social justice issue.
Maryland	Given that some individuals do not have sick leave from their jobs, suggests a compromise policy of requiring larger companies to provide paid sick leave and encouraging small businesses to do so by providing them tax incentives to offset costs.
Massachusetts	Plans to sign executive order on creating a Council on Older Adults focused on helping seniors live more vibrant and purposeful lives. Also proposing to fund a down payment toward increasing state support for municipal health insurance.
Michigan	Created public health advisory commission to strengthen state and local public health services and provide recommendations. Noted efforts to reduce waiting list for in-home senior services; were successful but now have another waiting list. In Flint, progress has been made to make the water safe again but not done; provided $27 million to help with lead pipe replacements, over 600 pipes replaced, and over 24,000 individuals affected are now enrolled in Medicaid.
Minnesota	Proposed budget includes increases to support young children, including visiting nurses for teen parents. Also noted need to improve water treatment systems to ensure water is safe and citizens’ health is protected.
Mississippi	Noted new medical schools and research centers in the state and improvements made to foster care system.
Montana	Created Office of American Indian Health to improve health outcomes for Native Americans. Proposing to provide funding for respite care to help seniors remain in their homes and questions why legislature is considering reducing community nursing home funding.
Nevada	Noted more individuals have health insurance than ever before.
New Hampshire	Mentioned that health care remains a critical need; another critical area of public health and safety is drinking water, and state should invest in infrastructure improvements. Also mentioned significant waiting list for services for developmentally disabled individuals; includes funding increase of $57 million. Also state should make long-term care services part of managed care and promote home and community services.
New Mexico	State has increased investments in early childhood home visiting services.
New York	Noted medical research industry is advancing through public private partnerships.
North Carolina	Noted the high cost of health insurance generally for families.
Pennsylvania	Mentioned state passed medical marijuana law for children. Proposed budget includes funding to help seniors receive care at home and is continuing to focus on improving these services including through new Community HealthChoices program. Other recent actions for seniors included state court case to protect their coverage, lottery funds for community centers and improved access to nutrition assistance.
Rhode Island	Noted all workers should have access to sick leave.
South Dakota	Plans to reorganize administration of long-term care services for all populations in one division to provide a more integrated approach to care delivery, along with increased efforts to promote home and community based services.
Virginia	Noted state funded two new veterans’ health care centers.
Washington	Noted state will ensure women have access to care and family planning services.
Wisconsin	Fostering Future’s initiative trains state employees to provide trauma-informed care for youth in the child welfare system.
Wyoming	While state leaders need to be budget conscious, need to keep in mind justice-involved individuals, disabled persons, the health care that is being provided or not provided to state residents, and the next generation.

With the transition to a new presidential administration, 13 governors commented about their perspectives on potential changes that may occur to the Affordable Care Act (ACA) and Medicaid financing. Some governors indicated interest in potentially gaining more flexibility and authority in Medicaid, whereas others expressed concern about possible coverage losses that could occur due to federal health policy changes.

Alabama	With the new federal administration states will likely have an important role in the repair/replacement of the ACA and stressed that states are best equipped to address their healthcare needs.
Arkansas	As more authority is returned to states in certain areas such as healthcare, states have a unique opportunity to innovate and reinforce values of work and responsibility.
California	Highlighted that state has provided health coverage to 5 million more residents and will work to protect this health coverage.
Colorado	Noted that 94% of residents are now insured and that basic health care should be a right and not a privilege.
Georgia	Cautioned against implementing any significant health policy changes until know more about any federal-level changes, and noted that would like some of those changes to include greater state flexibility in Medicaid program design.
Idaho	Mentioned need to assist individuals who fall in the ACA coverage gap, but encouraged legislature that while waiting on potential federal-level policy changes, the state should look to local partnerships and marketplace innovations to improve health care access and affordability.
Kansas	Believes state made right choice by not implementing key provisions of ACA, saying that majority of exchanges have “failed”.
Kentucky	Commented that Medicaid should be preserved for those it was intended to cover—medically frail, children, pregnant women, those with dependents, and those truly in need.
Minnesota	Noted that ACA has been successful but has fallen short in providing affordable health care for all, with premiums costing more but often offering less coverage and those not qualifying for subsidies facing high deductibles and other costs and not being able to retain providers of choice. With any federal-level changes, believes that coverage of pre-existing conditions and young adult dependent coverage should continue, along with Medicaid expansion. Stated that that essential health benefits are important in providing complete coverage. Urged legislature to pass a premium relief bill and implement reforms to avoid 2018 increases. Urged legislature to carefully consider effects of their proposed change on the state’s existing policies and practices; should seek stakeholder input. Would support reinsurance if carefully designed. Noted state exchange’s significant operational improvements. Wants legislature to consider options for increasing competition in the individual market. One option would be to offer a public option (sold through state exchange, with subsidized premiums for lower-income individuals); encouraged legislature to pass a measure by April so it possibly could be available for 2018.
New York	Believes that progress on affordable health care is at risk; believes individual health is public health, that good quality and affordable health care is a right, and will work to protect coverage, Medicaid and overall health care system.
Oklahoma	Believes the ACA has contributed to making health care unaffordable. Intends to submit a plan to federal officials that will focus on reducing regulations to create cheaper plans, encouraging investments in private health accounts and utilizing successful local programs like Insure OK.
South Dakota	In response to potential changes to Medicaid financing, will advocate for equitable federal allocation and for resolution to the Indian Health Service funding issue, along with more flexibility in the program.
Washington	Noted success of providing hundreds of thousands of residents with health care and will work to protect coverage gains of the ACA.

[1] As of late February 2017, the governors of FL, LA, OH and OR have not announced the date of their addresses or have not yet held their speeches.

View the 2016 State of the State Chart here.

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation

Latest Data on SBEs & SBM-FPs Enrollment

February 28, 2017/in Policy Charts Health Coverage and Access, State Insurance Marketplaces /by NASHP Staff

The 2017 open enrollment period for individual coverage has now ended. The figures below represent the latest data on exchange enrollment for states that operate State-based Marketplaces (SBMs) or State-based Marketplaces on the federal platform (SBM-FPs).

[i] “Covered California Finishes Fourth Open Enrollment with More Than 412, 000 New Consumers and Strong Participation from Young Enrollees” February 6, 2017 at https://news.coveredca.com/2017/02/covered-california-finishes-fourth-open.html
[ii]As reported to NASHP by Connect for Health Colorado
[iii] Access Health CT 2017 Enrollment Report. Data as of January 31, 2017. Report submitted to NASHP on February 6, 2017
[iv] As reported to NASHP by DC Health Link on February 7, 2017.
[v] Your Health Idaho, “Your Health Idaho Finishes 2017 Open Enrollment with Record Numbers.” February 8, 2017 at https://www.yourhealthidaho.org/wp-content/uploads/News-Release_End-of-2017-OE.pdf
[vi]Maryland Healthbenefit Exchange “Nearly 158,000 Marylanders Enrolled in Health Coverage through the State Marketplace.” February 1, 2017 https://www.marylandhbe.com/wp-content/uploads/2017/01/020117_OE4Count.pdf
[vii] As reported to the CCA Connector Board and to NASHP by the Massachusetts Health Connector, February 3, 2017
[viii] MNsure, as reported during press conference February 9, 2017
[ix] NY State of Health, “NY State of Health Announces Enrollment Surges: More Than 3.6 Million New Yorkers Secure Health Coverage.” February 1, 2017 at https://www.health.ny.gov/press/releases/2017/2017-02-01_nysoh_enrollment_surges.htm
[x] Number of plan selections as reported by HealthSource RI on February 10, 2017. Rhode Island anticipates these number will change as payments are made through the February 23 payment deadline and also as HealthSource RI remedies account issues incurred during the open enrollment period partially due to system issues that prevented customers from enrolling during the Open Enrollment period. Just before the start of open enrollment, Rhode Island launched a new integrated eligibility system to improve the way it delivers health and human services programs. In the long run, the new system will make it easier for Rhode Islanders to get the benefits they need, but in the short term, this new technology presented challenges. HealthSource RI is continuing to help customers enroll if they experienced a technical or access issue due to this new system. It is expected that when those issues are resolved there will be a rise in HealthSource RI’s total enrollment numbers.
[xi] ASPE “2017 Marketplace Open Enrollment Period: January Health Plan Selections by Zip Code.” January 10, 2017 at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/Plan_Selection_ZIP.html
[xii] Washington Healthplanfinder, “Washington Healthplanfinder Surpasses 225,000 Sign-Ups, Biggest Year on Record,” February 2, 2017 at https://www.wahbexchange.org/washington-healthplanfinder-surpasses-225000-sign-ups-biggest-year-record/
[xiii] Center for Medicare and Medicaid Services “Biweekly enrollment snapshot” February 3, 2017 at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-02-03.html

State Checklist: Medicaid-Related Provisions Impacted by an ACA Repeal

January 31, 2017/in Policy Charts CHIP, Cost, Payment, and Delivery Reform, Essential Health Benefits, Health Coverage and Access, Health System Costs, Medicaid Managed Care, State Insurance Marketplaces /by NASHP Staff

This worksheet, originally created by the Virginia Department of Medical Assistance Services (DMAS), identifies key requirements of the ACA that impact state Medicaid and CHIP programs and poses questions for state officials to consider in preparing for actions that may need to be taken upon repeal. NASHP is pleased to share this tool allowing other states to preliminarily assess the impact of repeal on state Medicaid programs and identify efforts that would need to be taken upon repeal.

State Officials can use this tool to help answer the following questions:

What administrative challenges will be posed to states?
What operational changes will need to be addressed?
How will technology systems be impacted?
Could any of the programmatic, policy or systems changes result in cost savings to the state?

Please also see NASHP’s recently released An Overview of ACA Provisions and Their Repeal Implications for States.

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

An Overview of ACA Provisions and Their Repeal Implications for States

January 24, 2017/in Policy Charts Cost, Payment, and Delivery Reform, Essential Health Benefits, Health Coverage and Access, Health System Costs, Population Health, State Insurance Marketplaces /by NASHP Staff

Much has been written about the impact of ACA repeal on consumers and health insurance markets. With this chart NASHP provides an overview of ACA provisions and snapshot of the implications to states if the ACA is repealed. States are the primary regulator of insurance and as such had laws in place prior to the enactment of ACA. Some states repealed those laws and replaced them with ACA provisions, while other states revised their laws but left other old, preempted laws on the books. Sorting through these laws and regulations to have a coherent system of insurance regulation after an ACA repeal will be a complex undertaking in every state. There is a need to proceed thoughtfully with enough predictability to enable insurance carriers to develop rates and plan designs in a timely fashion. This chart looks at what states would likely need to do to comply if the ACA is repealed. Because no clear agreement exists on what a replacement strategy would look like, this chart makes no assumptions about the impact of possible replacement that might address state challenges. Also important to note, the budget reconciliation process can repeal only provisions that directly impact the federal budget. So, using budget reconciliation to repeal ACA could leave other provisions intact, particularly those related to insurance regulation. As a result, the timing of when any ACA provisions are repealed is important to states.

See the chart.

Support for this work was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Selected State Initiatives on Medicaid Financing of Perinatal Regionalization

January 5, 2017/in Policy California, Florida, Georgia, Illinois, South Carolina Charts 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 /by Alexandra King

Today, nearly 40 states have a system of risk appropriate perinatal care. As the payer for nearly half of all births nationwide, Medicaid is a key partner in the financing of perinatal regionalization. Medicaid covers specific services that can maximize access to risk-appropriate care for mothers and infants, including the coverage of pre- and post-natal care, delivery, and other services such as transportation. Medicaid coverage of neonatal transportation is a critical component of timely provision of care and overall patient health, specifically for high-risk mothers and infants, and a core element of a comprehensive perinatal regionalization system. This chart includes selected state initiatives and highlights Medicaid as a key partner in financing perinatal regionalization systems.

For more information on Medicaid funding opportunities in support of perinatal regionalization systems, read the blog post and issue brief that further explore Medicaid’s role as an important partner in developing perinatal regionalization policies and strategies given its significant investments in a disproportionate share of high-risk births and flexibility in the range and scope of services covered. Case studies of California and Georgia demonstrate how state Medicaid agencies have developed various approaches to support risk appropriate perinatal care.

This resource was developed by NASHP in partnership with the National Institute for Children’s Health Quality (NICHQ) as part of the Health Resources and Services Administration’s Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN).

California	The Regional Perinatal Programs of California (RPPC) were established in 1979 due to the need for a more comprehensive network of healthcare providers within specific geographic areas to promote access to high quality levels of maternal and infant care.^[ii] Today, the RPPC has divided California into 9 separate regions, each of which include between 18-38 hospitals each.^[iii]The California Perinatal Transport Systems (CPeTS) act of 1976 appropriated funds for the development of a dispatch service to facilitate transportation of mother and infants to NICUs.^[iv] It also provides collection and analysis of perinatal and neonatal transportation data.
Florida	Developed in the 1970’s, Florida’s eleven Regional Perinatal Intensive Care Centers (RPICCs) provide access to high-risk perinatal care and are managed by FL’s Department of Health. Each facility provides community outreach education, and consultative support to other obstetricians and Level II and III NICUs in their areas, in addition to inpatient and outpatient services.[x]
Georgia	The Georgia Regional Perinatal Care Network Project (GRPCN) is a statewide initiative funded by the state Medicaid agency and state general funds appropriated to the Georgia Department of Public Health. Georgia’s six regional care centers are designated based on regional need and available funding.[xiii]
Illinois[xv]	First adopted in 1976, Title 77 created a perinatal regionalization system through Illinois Administrative code. [xvi] The Illinois Department of Public Health oversees the system and works with a Perinatal Advisory Committee (PAC) that offers recommendations relating to perinatal care. Today, Illinois’ perinatal regionalization system includes 10 administration Perinatal Centers that supervise 122 obstetric hospitals. In additional to a supervisory role, each Regional Perinatal Center has both clinical and administrative responsibilities.[xvii]
South Carolina	Established in the 1970’s, South Carolina’s regionalized perinatal system of care, is now made up of five perinatal centers in four regions that contract with the SC Department of Health. Key elements of the system include early risk assessment and referral to appropriate care; coordination and communication between hospitals and community providers; monitoring systems through data; and ensuring access to services from preconception through the first year of life.[xx]

California	Medi-Cal works with a variety of different partner programs to ensure coverage and access to services for pregnant women and neonates. These programs include the California Children’s Services Program (CCS),[v] The California Medi-cal Access Program (CMAP),[vi] and the Comprehensive Perinatal Services Program (CPSP).[vii] Through these programs, Medi-cal provides a variety of benefits, but the most notable is reimbursement for transportation services.[viii]
Florida	All RPICC Program patients are potential Medicaid Recipients. RPICC Medicaid reimbursement is inclusive for all services provided by the neonatology or obstetrical groups. [xi] The Agency for HealthCare Administration pays claims for inpatient-only services provided to Medicaid recipients by neonatologists and obstetricians enrolled in RPICC with Medicaid funds.
Georgia	Georgia Department of Public Health services for Medicaid members include: Perinatal Health Partners (PHP), Perinatal Case management, and Presumptive Eligibility Determination. [xiv]
Illinois[xv]	Two main programs offering coverage are available for pregnant women: Medicaid Presumptive Eligibility (MPE) which offers immediate temporary coverage for pregnant women who meet income requirements (outpatient care) and Moms & Babies, which covers healthcare during pregnancy and 60 days post-partum (inpatient, outpatient, and transportation).[xviii] Illinois’ Medicaid managed care plans are required to pay for and ensure the same level of care for pregnant women as in the fee-for-service benefit package.
South Carolina	Overall, the ability to link and contract with Medicaid providers has been difficult due to variations in policies and services of the Medicaid managed care plans. [xxi]

California	Funding for the RPPC and CPeTS is provided via Federal Title V Maternal and Child Health (MCH) Block Grant Funds.[ix]
Florida	The RPICC program is funded through a combination of Federal Title V MCH Block Grant Funds and Medicaid dollars. [xii]
Georgia	GRPCN is jointly funded by Georgia Medicaid and the Georgia Department of Public Health.
Illinois[xv]	IDPH allocates state funds to target preventative services, and provide grants to designated APCs responsible for the administration and implementation of the perinatal program.[xix]
South Carolina	Majority of the funding is through SC Department of Health and Hospitals. Additional funds are provided by the Title V MCH Block Grant.[xxii]

California	There is a neonatal transportation policy and it includes maternal transportation. Medicaid reimbursement policy exists for neonatal transportation.
Florida	There is a neonatal transportation policy and it includes maternal transportation and inter-hospital transportation. Medicaid reimbursement policy exists for neonatal transportation.
Georgia	There is a neonatal transportation policy and it includes maternal transportation, back transportation for infants, and inter-hospital transportation. Medicaid reimbursement policy exists for neonatal transportation.
Illinois[xv]	There is a neonatal transportation policy and it includes maternal transportation, back transportation for infants and mothers, and inter-hospital transportation.
South Carolina	There is a neonatal transportation policy and it includes maternal transportation, back-transportation for infants, and inter-hospital transportation.

[i] E. M. Okoroh, C.D. Kroelinger, S.M. Lasswell, D.A. Goodman, A.M. Williams, and W.D. Barfield, “United States and Territorial Policies Supporting Maternal and Neonatal Transfer: Review of Transport and Reimbursement,” Journal of Perinatology 36 (2016):30, doi:10.1038/jp2015.109

[ii] “Regional Perinatal Programs of California Fact Sheet,” California Department of Public Health, Accessed August 24, 2016, https://www.cdph.ca.gov/healthinfo/healthyliving/childfamily/Pages/RPPC.aspx [i] E. M. Okoroh, C.D. Kroelinger, S.M. Lasswell, D.A. Goodman, A.M. Williams, and W.D. Barfield, “United States and Territorial Policies Supporting Maternal and Neonatal Transfer: Review of Transport and Reimbursement,” Journal of Perinatology 36 (2016):30, doi:10.1038/jp2015.109

[iii] California Department of Public Health- Maternal, Child, and Adolescent Health Program – Epidemiology, Assessment, and Program Development Branch, “Regional Perinatal Programs of California (RPPC),” October 2015, https://www.cdph.ca.gov/programs/rppc/Documents/RPPC_Regions_Oct2015.pdf

[iv] California Perinatal Transport System, “California Perinatal Transport System,” Accessed August 24, 2016, https://www.perinatal.org/

[v] California Department of Health Care Services, “Program Overview – California Children’s Services,” Accessed August, 29, 2016, https://www.dhcs.ca.gov/services/ccs/Pages/ProgramOverview.aspx

[vi] California Department of Health Care Services, Medi-Cal Access Program, “What Services are Covered in MCAP?,” Accessed August 24, 2016, https://mcap.dhcs.ca.gov/Services/?lang=en

[vii] County of Los Angeles Public Health, “Comprehensive Perinatal Services Program,” Accessed August 24, 2016, https://publichealth.lacounty.gov/mch/cpsp/CPSPwebpages/cpsp_rev.htm

[viii] “Medical Transportation – Ground,” in: California Code of Regulations, 2015, https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwi7_PmV7trOAhXDHx4KHScUBtkQFggeMAA&url=https%3A%2F%2Ffiles.medi-cal.ca.gov%2Fpubsdoco%2Fpublications%2Fmasters-mtp%2Fpart2%2Fmctrangndcd_a05.doc&usg=AFQjCNFzBYxIjWfYOw5gAKxm32BkzRkHug&sig2=QFlVSnGrnpIL6_Y7Sjbd2Q

[ix] California Department of Public Health, “Maternal and Child Health Services Title V Block Grant – California,” 2015, https://www.cdph.ca.gov/programs/mcah/Documents/Title%20V%202016%20Application%202014%20Report%20final.pdf

[x] Children’s Medical Services (CMS), “Regional Perinatal Intensive Care Centers,” Accessed August 29, 2016, https://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/rpicc.html

[xi]Florida Department of Health, Regional Perinatal Intensive Care Centers Handbook, August 2010, https://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/documents/rpicc_handbook.pdf

[xii] Ibid.

[xiii] National Perinatal Information Center, “Medicaid Funding – The Georgia Regional Perinatal Care Network, Accessed August 24, 2016, https://www.npic.org/projects/MedicaidFunding.php

[xiv] Georgia Department of Community Health, “Georgia Public Health Services Available for Medicaid Members,” Accessed August 29, 2016, https://dch.georgia.gov/sites/dch.georgia.gov/files/Georgia_Public_Health_Services_for_Medicaid_Members.pdf

[xv] Bruce Rauner, Felicia F. Noorwood, and Teresa Hursey, Report to the General Assembly, January 2016 – Public Act 93-0536, (2016), https://www.illinois.gov/hfs/SiteCollectionDocuments/perinatalreport2016.pdf

[xvi] Joint Committee on Administrative Rules, Title 77, Chapter 1, Subchapter 1, Part 640: Regionalized Perinatal Health Care Code, Accessed August 29, 2016, https://www.ilga.gov/commission/jcar/admincode/077/07700640sections.html

[xvii] Illinois Department of Public Health, “Perinatal Regionalization,” Accessed August 29, 2016, https://www.dph.illinois.gov/topics-services/life-stages-populations/infant-mortality/perinatal-regionalization

[xviii] Illinois Department of Healthcare and Family Services, “Moms and Babies,” Accessed August 29, 2016, https://www.illinois.gov/hfs/MedicalPrograms/AllKids/Pages/MomsAndBabies.aspx#momsbabies

[xix]Joint Committee on Administrative Rules, Title 77, Chapter 1, Subchapter 1, Part 640, Section 640.80: Regional Perinatal Networks – Composition and Funding, Accessed August 29, 2016, https://www.ilga.gov/commission/jcar/admincode/077/077006400000800R.html

[xx] Association of State and Territorial Health Officials, “South Carolina’s Perinatal Regionalized System of Care: Reducing Premature Births and Infant Mortality,” (2013), https://www.astho.org/Presidents-Challenge-2013/SouthCarolina/

[xxi] South Carolina Department of health and Environmental Control, Healthy Mothers, Healthy Babies: South Carolina’s Plan to Reduce Infant Mortality & Premature Births, (October 2013), https://www.scdhec.gov/library/cr-010842.pdf

[xxii] The Title V Maternal and Child Health Block Grant funded components include: obstetric and neonatal outreach education, transport coordination, and physician consult and follow-up.
Association of Maternal and Child Health Programs, “South Carolina – Maternal and Child Health Block Grant 2016 State Profile,” Accessed August 29, 2016, https://www.amchp.org/Policy-Advocacy/MCHAdvocacy/Documents/South%20Carolina%202016.pdf

State Financing and Delivery Innovations to Address Disparities in Uncontrolled Childhood Asthma

September 9, 2016/in Policy Charts Behavioral/Mental Health and SUD, Care Coordination, CHIP, CHIP, Chronic and Complex Populations, Cost, Payment, and Delivery Reform, Eligibility and Enrollment, EPSDT, Health Coverage and Access, Health System Costs, Healthy Child Development, Maternal, Child, and Adolescent Health, Medicaid Managed Care, Medicaid Managed Care, Physical and Behavioral Health Integration, Population Health, Safety Net Providers and Rural Health /by Taylor Kniffin and Felicia Heider

The high prevalence of uncontrolled asthma among child populations served by Medicaid programs and the associated rising costs often are the impetus for states to improve the quality of care provided to children with asthma. New opportunities to comprehensively address asthma and its triggers are emerging through state and national health care delivery system and payment reform initiatives. NASHP identified state initiatives underway in Arkansas, Iowa, Michigan, North Carolina, Oregon, and Rhode Island that aim to address disparities and improve outcomes for children with uncontrolled asthma through innovative health care—particularly Medicaid—financing or delivery system strategies. The initiatives originate at either the state or community level and address the disease through a combination of clinic and community-based interventions, some of which focus on social determinants of health. The below table provides a cross-state analysis of the key strategies these six states are implementing to address childhood asthma and the accompanying case studies offer a more in-depth examination of each model. These resources are excerpts from a recent report released by MDRC in partnership with NASHP, “The Effectiveness of Interventions to Address Childhood Asthma,” which has more information on state and local efforts to improve asthma management among children in low-income families.

Comparison of Key State Asthma Program Features

		Arkansas Health Care Payment Initiative (episodes of care and PCMHs)	Iowa Health Homes Program	Michigan Asthma Network of West Michigan	North Carolina CCNC Asthma Disease Management Program	Oregon Healthy Homes	Rhode Island Home Asthma Response Program
Intervention Elements	Setting (Community or Clinic-based)	Clinic	Clinic	Both	Both	Community	Both
	Asthma action planning, education, care coordination	✓	✓	✓	✓	✓	✓
	Home visits			✓(up to 32)	✓	✓	✓ (3)
	Referrals	✓(e.g., smoking cessation)	✓ (e.g., smoking cessation)	✓(e.g., housing, transportation, counseling, prescriptions)	✓(e.g., child care, health consultants, transportation)	✓(e.g., food, housing, weatherization, legal, transportation, medical and mental health)	✓(e.g., WIC, adult education, weatherization, smoking cessation, mental health)
	Other services			Visits to school, child care, extended family		Supplies (e.g., vacuums, humidifiers, encasements, green cleaning kits)	Supplies (e.g., vacuums, filters, bed coverings, green cleaning kits)
Program Overview	Target population	Children and adults with qualifying events (episode of care); all Medicaid patients (PCMH)	Medicaid-eligible adults and children with 2 chronic conditions or 1 and at risk for second	Children and adults with moderate-severe uncontrolled asthma	Medicaid-eligible children and adults with asthma, prioritizing high-risk patients	Children <19 with asthma diagnosis, living in specific county, meeting Medicaid income requirements	Children ages 2-8 with recent ED visit or hospitalization residing in 3 specific cities
	Providers	Hospital physicians, PCP, or Pulmonologist	Designated practitioner, care coordinator, health coach and clinic support staff	Certified asthma educator (RN or respiratory therapist), licensed master social worker	Care manager (e.g., nurse, social worker, pharmacist), PCP	Nurse, CHW, environmental health and safety worker	Nurse educator, CHW
	Strategies to address disparities	Medicaid population focus; specific strategies vary	Medicaid population focus; specific strategies vary	Interpreters available; action plan in native language; target inner cities	Medicaid population focus; educational materials available in Spanish and English	Low-income population focus; bilingual staff, interpreters available; CHWs in disadvantaged areas	Diverse staff who receive cultural awareness training, offered in English and Spanish
Financing	Medicaid reimbursement	Retrospective episode-based payment	Tiered PMPM payment	Skilled nursing visits (4 Medicaid managed care plans)	PMPM payment	Targeted Case Management (specific counties)	N/A
	Medicaid reimbursement	PCMH PMPM payment	Tiered PMPM payment	Skilled nursing visits (4 Medicaid managed care plans)	PMPM payment	Targeted Case Management (specific counties)	N/A
	Other sources	Private insurer (separate episode of care initiative)	N/A	Local grants	Varies by Network	County funds; federal grants	Federal grants

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