States are increasingly utilizing Medicaid managed care (MMC) to serve children and youth with special health care needs (CYSHCN), who often require a complex array of services. Many states are finding that forging partnerships between their MMC systems and Title V CYSHCN programs improves care coordination, transitions from pediatric to adult care systems, quality of care measurements, and other services provided to CYSHCN.
As of June 2017, a NASHP analysis of state Medicaid programs found 47 states and Washington, DC used managed care delivery to serve CYSHCN. While MMC gives states opportunities to improve health care delivery systems to meet the unique needs of CYSHCN, it also presents new challenges.
Medicaid and state Title V CYSHCN programs have a long history of providing health care services and supports to CYSHCN and their families. Medicaid and CHIP currently cover about 44 percent of all CYSHCN. The federal Title V Maternal and Child Health (MCH) Services Block grant program plays a critical role in promoting and improving the health and well-being of women, children including CYSHCN, and their families. State Title V CYSHCN programs support a wide range of activities, including assisting in the development of family-centered, community-based systems of care for CYSHCN, providing care coordination services, and gathering data documenting the needs of CYSHCN and their families.
Many states are currently changing how their Medicaid managed care programs serve CYSHCN. In some cases, these changes have been spurred by new federal requirements outlined in the Medicaid and CHIP Managed Care Final Rule, and in some cases states have initiated improvements during new procurement cycles. Due to the critical role that state Title V CYSHCN programs play for these children and their families, many states are discovering that newly-forged collaborations between Medicaid and Title V are improving their Medicaid managed care systems for CYSHCN.
A recent NASHP issue brief identified a number of effective, collaborative strategies used by state Medicaid and Title V CYSHCN programs to ensure that their MMC meets the needs of CYSHCN and their families. These strategies include:
- Use MMC contract language to require coordination between managed care organizations (MCOs) and state Title V CYSHCN programs. To support the coordinated delivery of services and supports for CYSHCN, a number of states include language in their Medicaid managed care contracts that require MCOs to collaborate with Title V CYSHCN programs. For example, Washington State, Kansas, and Mississippi MMC contracts require MCOs to establish policies and procedures to ensure enrollees have access to Title V CYSHCN program services and supports.
- Leverage state Title V CYSHCN care coordination services and expertise. State Title V CYSHCN programs have extensive experience providing care coordination services to CYSHCN. This expertise can be valuable to MMC programs that want to strengthen their care coordination. For example, in Maryland, state Title V program staff provide evidence-based care coordination training to Medicaid MCOs’ care coordination staff. To reduce duplication of effort and ensure care coordinators are experienced in the needs of CYSHCN, New Mexico’s Title V program has a contractual agreement with each of the state’s Medicaid MCOs to provide care coordination for CYSHCN enrolled in Medicaid in collaboration with the MCO care coordinators.
- Establish policies to transition CYSHCN from pediatric to adult health care delivery systems. State Title V programs are aligning with MMC to increase the number of CYSHCN who participate in transition planning — the process of preparing individuals to change from their current pediatric program to an adult health care system. For example, Texas and New Mexico’s Title V programs are working with Medicaid to include requirements in their MMC contracts that MCOs engage in transition planning for CYSHCN.
- Coordinate efforts to measure and promote quality of care for CYSHCN. State Title V and Medicaid programs are working together to measure the quality of care provided to CYSHCN not only to ensure CYSHCN’s unique needs are met, but to also reward managed care plans that deliver high-quality and cost-effective care. For example, Colorado’s Title V program assisted the state’s Medicaid agency with selecting certain quality measures, including developmental screening and pediatric asthma treatment, for their managed care program.
- Use state Title V program expertise to ensure MMC systems effectively serve CYSHCN. Many states utilize Title V’s extensive experience serving CYSHCN when designing, implementing, or monitoring MMC programs. For example, in New Mexico, state Title V CYSHCN program staff has regular meetings with the state’s Medicaid agency and MCOs to advise them on care coordination and transitions from pediatric to adult care, and discuss provider network needs. State Title V programs also work with state Medicaid programs and MCOs to ensure that families provide feedback about their experiences with Medicaid and health plans. For example, Delaware’s state Title V CYSHCN program convenes monthly calls between MCO representatives and Delaware Family Voices, an organization that represents the families of CYSHCN.
Medicaid and Title V both play integral roles in serving CYSHCN. By aligning and integrating their efforts, and leveraging Title V’s expertise, states can improve their systems of care for CYSHCN. For more information about how state Medicaid and Title V programs are partnering to meet the needs of CYSHCN and their families, read NASHP’s recently-published State Strategies to Leverage Medicaid and Title V Programs to Improve Care for Children with Special Health Care Needs in Medicaid Managed Care. NASHP has also recently studied and reported on how six states organized their MMC programs to better serve CYSHCN. To learn more about improving systems of care for CYSHCN, read the Standards for Systems of Care for Children and Youth with Special Health Care Needs.
Attend NASHP’s Annual Health Policy Conference session: Growing Pains, Seeing Gains: Improving Youth Transitions
10-11:30 a.m. Thursday, Aug. 16, 2018
Transitioning from youth to adulthood requires increased responsibility for many areas of life, including managing one’s health. This can be particularly challenging for children with a range of social and health care needs, particularly children with special health care needs. Policymakers from several states, including Georgia and Wisconsin, discuss innovative approaches to support young adults’ transitions to adult health care services and programs through managed care, quality improvement, family engagement, care coordination, and interagency collaboration and cooperation.
This session is supported by the Lucile Packard Foundation for Children’s Health