Vermont Uses an Accountable Care Organization Model to Promote Developmental Screenings during Well-Child Visits
Without early identification and treatment of development delays, children may face long-lasting and costly consequences. With more states reporting their developmental screening Child Core Set measures and new federal initiatives promoting value-based payment for children’s health, Vermont’s innovative affordable care organization’s approach can provide valuable insights. This fact sheet describes Vermont’s strategy to prioritize developmental screenings of children covered by Medicaid during well-child visits.
- View or download: Vermont Uses an Accountable Care Organization Model to Prioritize Developmental Screenings during Well-Child Visits, May 2019
- To learn about other state initiatives, visit NASHP’s Healthy Child Development State Resource Center.
- To learn more about states’ Medicaid Incentives and Measures for Developmental Screening, view NASHP’s map.
State Policy Levers for Advancing Quality Improvements in Primary Care
States, as major purchasers of health care, have a compelling interest to spur primary care providers to adopt the latest research to improve the quality and cost-effectiveness of care. This new report, the third in the EvidenceNOW: Insights for State Health Policymakers Series, highlights policy levers states can use to support the adoption of evidence-based care.
Read/download: State Policy Levers for Advancing Quality Improvements in Primary Care, April 2019
Read/download NASHP’s other two EvidenceNOW: Insights for State Health Series reports:
Resources to Help States Fund Health-Related Social and Economic Needs
Federal funding can help states improve housing, employment, and other life conditions for their vulnerable residents. This table highlights new programs, including public-private investment opportunities from the US Treasury, integrated care models from the Center for Medicare & Medicaid Innovation, and recent federal initiatives to combat the opioid crisis. It also features key longstanding sources, such as tax-exempt hospitals’ community benefits dollars, Medicaid investments, and health promotion funds from the US Centers for Disease Control and Prevention. This table updates and complements NASHP’s chart, Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States.
Print this chart.
| Funding Sources | Agency or Entity | Awarded to: | Needs Addressed | Notes and Sources |
| Social Impact Partnerships to Pay for Results Act | Treasury | States and localities | A goal of this act is to “facilitate the creation of public-private partnerships that bundle philanthropic or other private resources with existing public spending.” Social benefits that could be funded include: – Increasing employment and earnings, increasing financial stability for a range of populations, improving birth outcomes; |
Half the funding goes to programs that benefit children Most of the fund’s $100 million is allocated for outcomes payments, awarded to projects that are considered feasible and have an implementation plan. A Notice of Funding Availability (NOFA) was published in the Feb. 21, 2019 Federal Register. Award announcements are expected by November 2019. A separate NOFA for feasibility study grants for projects in the early stages is expected later in 2019. Legislation: Title VIII of the Bipartisan Budget Act of 2018 Projects are funded for up to 10 years Urban Institute explainer |
| Opportunity Zones | Treasury/ Internal Revenue Service (IRS)
Created by the Tax Cuts and Jobs Act of Dec. 22, 2017 |
Private investors defer taxes on capital gains by investing in Opportunity Funds, which invest in businesses located in an Opportunity Zone. State departments of economic development, commerce, housing development, and others can also be involved. The “CEOs” or leaders of each state nominates census tracts to be designated as opportunity zones. |
Economic development and job creation in certain low-income communities The proposed FY 2020 White House budget prioritizes the development of affordable housing in opportunity zones. The Kresge Foundation is partnering with two impact fund managers on Opportunity Zone investments, guided by community advisory boards that prioritize affordable housing without displacement and jobs that pay living wages. |
Proposed rules on investments in qualified opportunity zones were issued in October 2018 and April 2019. The first set of opportunity zones were designated in April 2018. IRS FAQs, Jan. 2019 State legislation enacted to support opportunity zones is available here This Executive Order established the White House Opportunity and Revitalization Council to support opportunity zone investment. The National Opportunity Zones’ Ranking Report from Smart Growth America ranks designated opportunity zones on their potential to improve social equity and foster walkable communities. Center on Budget and Policy Priorities’ blog, Potential Flaws of Opportunity Zones Loom, as Do Risks of Large-Scale Tax Avoidance |
| Funding Sources | Agency or Entity | Awarded to: | Needs Addressed | Notes and Sources |
| Integrated Care for Kids (InCK) | Center for Medicare & Medicaid Innovation (CMMI) | State Medicaid agency or lead organization | Children’s health-related needs, including adverse childhood experiences | NASHP Issue Hub: Resources to Help States Improve Integrated Care for Children |
| Maternal Opioid Misuse (MOM) model | CMMI | State Medicaid agencies | The model will include referrals to community services, such as housing and supported employment. | NASHP Issue Hub: Resources to Help States Improve Integrated Care for Children (includes MOM information) |
(See NASHP’s Snapshot of Major Federal Opioid Funding by State, December 2018)
| Funding Sources | Agency or Entity | Awarded to: | Needs Addressed | Notes and Sources |
| Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act | US Department of Health and Urban Development (HUD) | States are to distribute housing pilot funds “giving priority to entities with the greatest need and ability to deliver effective assistance in a timely manner.” | Housing: The act establishes a pilot program for states to provide temporary housing (for no more than two years) to people recovering from substance use disorder (SUD). | Section 8071 of the act, enacted in October 2018, authorizes funds for housing pilots to be appropriated FY 2019 through FY 2023. Funds will be allocated according to a needs-based funding formula established by HUD. Funds are to be treated as though they were Community Development Block grants (CDBG) funds. Read NASHP’s blog, New Funding and Flexibility for States to Address Substance Use Disorder. |
| State Opioid Response (SOR) Grants | Substance Abuse and Mental Health Services Administration (SAMHSA) | States and territories; single-state agencies delivering substance abuse services (generally departments of health, human services, or social services) | States can use it for:
– Recovery housing
|
No match required Each state gets at least $4 million Applications were due August 2018 Programs funded for up to two years See NASHP’s chart of federal opioid funding by state Pennsylvania is using SOR funds for pilot projects to help people with opioid use disorder become and remain housed. |
| Opioid State Targeted Response to the Opioid Crisis (STR) Grants | SAMHSA, created by the 21st Century Cures Act | Single-state agencies based on unmet need for opioid use disorder treatment and drug poisoning deaths. | States are using it for:
– Recovery housing
|
Example: Colorado and Pennsylvania are using it to fund co-location pilots and bi-directional referrals for women and children. Two-year program Funding was awarded for Year One and Two 2017 Funding Opportunity Announcement An FY18 supplement was available for 10 states with highest overdose rates See NASHP chart |
| Funding Sources | Agency or Entity | Awarded to: | Needs Addressed | Notes and Sources |
| Tax-Exempt Hospital Community Benefits | Tax-exempt hospitals, pursuant to Treasury/IRS requirements | Community organizations or programs. Policies overseen by state attorneys general and/or public health agencies |
A range of community health improvement services and community benefit activities, guided by the hospital’s community health needs assessment. They can include community building activities, such as housing, economic development, child care, and mentoring programs for vulnerable populations or neighborhoods. Hospitals report this information on Form 990 Schedule H. | States can create reporting and investment requirements that go beyond those established by the federal government. See NASHP’s infographic How 10 States Keep the ‘Community’ in Hospitals’ Community Health Needs Assessments, and blog States Work to Hold Hospitals Accountable for Community Benefits Spending. Sara Rosenbaum, et al., Improving Community Health through Hospital Community Benefit Spending: Charting a Path to Reform, December 2016 Robert Wood Johnson Foundation’s Community Benefit Insight tool The Hilltop Institute, Community Benefit State Law Profiles Comparison |
| Hospital Certificate of Need (CoN) requirements | Tax-exempt hospitals in states with a CoN requirement | Community organizations or programs Policies overseen by state attorneys general and/or public health agencies |
Community health needs, often identified by the hospital’s community health needs assessment | State CoN requirements are generally triggered by hospital projects and expansions, such as capital improvements. NASHP’s State Strategies to Address Rising Prices Caused by Health Care Consolidations |
| Funding Sources | Agency or Entity | Awarded to: | Needs Addressed | Notes and Sources |
| US Centers for Disease Control and Prevention (CDC) Chronic Disease Prevention and Health Promotion funding | CDC | State and local public health agencies | CDC funding supports a range of state chronic disease and violence prevention activities, as well as condition-specific funding. | CDC FY 2018 grant funding by state |
| Funding Sources | Agency or Entity | Awarded to: | Needs Addressed | Notes and Sources |
| Medicaid Section 1115 Demonstrations
|
Centers for Medicare & Medicaid Services (CMS) | State Medicaid agencies
Agencies involved could include State Innovation Model (SIM) or transformation offices. |
Housing services, transportation, education, social isolation, employment, investment in community partnerships, and other issues | NASHP’s State Delivery System and Payment Reform Map (Delivery System Reform and Incentive Payment tab) NASHP’s State Strategies to Improve Health Through Housing Services Center for Health Care Strategies (CHCS), Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations |
| Medicaid managed care contracting | CMS | State Medicaid agencies | States can encourage or require managed care organizations to invest in a range of non-clinical needs, including nutrition, physical activity, and housing. | NASHP’s How States Address Social Determinants of Health in their Medicaid Contracts and Contract Guidance Documents Sara Rosenbaum, et al., How Are States Addressing Primary Care Quality in Medicaid Managed Care? |
| Medicaid Section 1915(c) Home and Community Based Services waivers and 1915(i) state plan amendments | CMS | State Medicaid agencies | Housing and employment supports and others | NASHP’s Housing-Related Service Definitions in 1915(i) State Plan Amendments, 1915(c) Waivers, and Section 1115 Demonstrations NASHP’s Tenancy Supports in Three States’ Medicaid Waivers NASHP’s State Housing and Services Options in 1915(c) Waivers for People with Developmental Disabilities |
Additional resources to help states meet health-related needs, by authoring organization:
NASHP Resources
Meeting the Health-Related Social Needs of Low-Income Persons: Funding Sources Available to States, 2016. Table provides an overview of funding sources.
State Strategies to Improve Health through Housing Services, 2016. Chart contains funding mechanisms.
Financing Prevention, 2014
Blending, Braiding, and Block-Granting Funds for Public Health and Prevention: Implications for States, December 2017. Two tables: featuring block grants and state examples of Medicaid authorities to address non-clinical needs.
For New Governors: Snapshot of Major Federal Opioid Funding by State, December 2018:
Toolkit: Upstream Health Priorities for New Governors, December 2018.
*For additional information on funding health-related services, explore NASHP’s Population and Public Health resource list.
Academy Health/Nemours
Innovative Medicaid Payment Strategies for Upstream Prevention and Population Health, May 2018.
Center for Health Care Strategies
Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations, December 2018.
Addressing Social Determinants of Health through Medicaid Accountable Care Organizations, April 2018.
Commonwealth Fund
Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools, January 2018.
Addressing the Social Determinants of Health through Medicaid Managed Care, November 2017.
Georgia Health Policy Center
Bridging for Health: Improving Community Health through Innovations in Financing, February 2019.
Kaiser Family Foundation
Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, May 2018.
National Academy of Social Insurance
Strengthening Medicaid as a Critical Lever in Building a Culture of Health, January 2017.
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.
State Initiatives Using Purchasing Power to Achieve Drug Cost Containment
This report focuses on several state purchasing strategies designed to achieve concessions in negotiations with drug manufacturers and in other parts of the prescription drug supply chain. The highlighted strategies include intrastate actions, which combine state agencies’ purchases of drugs to improve their negotiating clout, and interstate activities, such as multi-state organizations that unite to purchase drugs for their Medicaid programs.
Read or download: State Initiatives Using Purchasing Power to Achieve Drug Cost Containment
Read or download a related report: Cross-Agency Strategies to Curb Health Care Costs: Leveraging State Purchasing Power This report highlights the unique approaches states across the country have taken to limit health care cost increases, ranging from limiting hospital rates increases to cross-agency collaboration to lower drug and health care costs.
Cross-Agency Strategies to Curb Health Care Costs: Leveraging State Purchasing Power
Rising health care costs are an intractable problem in the United States, but states, faced with balanced budget requirements and growing voter concern, aren’t waiting for a federal solution.
This report explores state initiatives to curb health care costs by:
- Leveraging Medicare’s well-established reimbursement rates as reference prices for state employee plans to address rising health costs;
- Harnessing collective buying power of state purchasers across agency and state lines to lower drug costs; and
- Establishing state authority to limit hospital rate increases, promote cost transparency, and limit spending growth.
States are increasingly looking beyond individual agencies and programs to harness the significant potential of their collective buying power.
State dollars fund Medicaid, state employee health plans, health services in mental health and correctional facilities, and public hospitals, and coverage for university, municipal, and school employees. When acting together, state agencies exert considerable buying power in an increasingly consolidated health care system. This report highlights the new wave of state initiatives that leverage collective purchasing clout to lower the cost trajectory.
Read or download: Cross-Agency Strategies to Curb Health Care Costs: Leveraging State Purchasing Power
New Report Highlights Successful, Cross-Agency Strategies to Address Substance Use Disorder
States are realigning policies, funding, staffing, and data across agencies to better meet the needs of people living with or at risk of developing substance use disorder (SUD). In 2018, NASHP and the Association of State and Territorial Health Officials (ASTHO) convened a group of Medicaid and public health leaders to discuss state strategies for working across agencies to address SUD. Their new report highlights recommendations for structuring and advancing cross-agency approaches to SUD prevention and treatment.
Read or download: Cross-Agency Approaches to Substance Use Disorder Prevention and Treatment – National Recommendations
Watch the NASHP-ASTHO webinar Cross-Agency Approaches to Substance Use Disorder Prevention and Treatment, recorded March 20, 2019, which explores this topic.
States Use Policy Levers and Emerging Research to Address Antipsychotic Use in Children in Foster Care
State policymakers must often take action during an emerging crisis even when evidence identifying the best policy approach is not be available. This report, Evidence-Based Policymaking Is an Iterative Process: A Case Study of Antipsychotic Use among Children in the Foster Care System, explores successful state responses to dramatic increases in antipsychotic prescription rates in Medicaid-enrolled children in foster care. It highlights several strategies, including payment reforms, delivery system innovations, and quality supports for clinical care.
The report results from a convening by the National Academy for State Health Policy of researchers and state officials with expertise in financing and operating Children’s Health Insurance Program and Medicaid programs, children’s health, and health policy and pharmacy research. The meeting preceded the release of a Patient-Centered Outcomes Research Institute-funded study, which examines the comparative effectiveness of state oversight systems in Ohio, Texas, Washington, and Wisconsin.
Read or download: Evidence-Based Policymaking Is an Iterative Process: A Case Study of Antipsychotic Use among Children in the Foster Care System
Fact Sheet Highlights Medicaid’s Critical Role in Screening for Maternal Depression
Despite evidence that maternal depression is common and can impede the development of young children, it is often undiagnosed and untreated. Medicaid can play a leading role in identifying at-risk mothers and connecting them to treatment. NASHP’s new fact sheet provides background on maternal depression while also presenting a summary of state Medicaid policies for screening for maternal depression in the context of well-child visits.
Read or Download the Fact Sheet
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
