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Role of States in National Health Care Reform

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Much of the failure or success of federal health reform will depend on the ability of states to implement its key provisions. NASHP strives to help state policymakers understand the implications of federal reforms and the sometimes complex implications of seemingly simple federal provisions. We are building tools to facilitate and accelerate peer-to-peer learning among states implementing federal reform provisions. We also cultivate opportunities to make state perspectives heard in Washington, where implementation guidelines are being developed.
 
Our work is generously supported by the Robert Wood Johnson Foundation, The Commonwealth Fund, David and Lucile Packard Foundation, Public Welfare Foundation, and The Scan Foundation.
 
Alan Weil’s California Health Hearing Testimony As Delivered May 2010
 

Child Development

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Research indicates that children’s healthy development is essential to school readiness, academic success, and overall well-being. Services that support young children’s healthy development can reduce the prevalence of developmental and behavioral disorders that have high costs and long-term consequences for health, education, child welfare, and juvenile justice systems. Additionally, a growing body of evidence suggests that prevention and early intervention are substantially less costly than life-long special education and treatment.
NASHP is at the forefront of examining how states identify, implement, test and spread policy and system changes that promote healthy development for children.  Since 2000, the Assuring Better Child Health and Development (ABCD) program has helped 27 states create models of service delivery and financing through a laboratory for program development and innovation. NASHP’s child development areas focus particularly on preventive care of children, whose health care is covered by state health care programs, especially Medicaid.
NASHP’s ABCD Resource Center, which provides state policymakers, primary care providers and other child and family service providers with easy access to research and resources that they can use to promote early childhood health and development is available at the ABCD Resource Center link to the right. The resource center was funded by The Commonwealth Fund.


 

Assisted Living

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Assisted living has become an important residential care option within many states’ home and community based services systems, providing supportive and health-related services and assistance with activities of daily living.  Since assisted living services are not typically funded by the Medicaid program except through state-designed waiver programs, the definition, regulation and oversight of this community based residential service option is determined exclusively through state policy.
NASHP has supported state policy decision-making by tracking policy developments, growth trends, changing regulatory models, approaches to quality, and licensure standards.  Our reports have provided detailed comparisons of crucial elements of assisted living policies across states and summary profiles of each state’s regulatory framework.
In addition to regulating assisted living services, some states have chosen to include them as a covered benefit under their Medicaid home and community based services waiver programs. NASHP’s work has documented state Medicaid payment policies to enable states to draw upon the methodologies developed by their counterparts across the country.
NASHP’s work in assisted living policy has been supported the Office of the Assistant Secretary for Planning and Evaluation and the Agency for Healthcare Research and Quality, both part of the U. S. Department of Health and Human Services.
 

Oral Health

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In 2000, the first-ever Surgeon General’s report on oral health documented widespread disparities in oral health and access to oral health care among Americans. The report also drew attention to the important connection between oral health and overall health.  Although the oral health of most Americans has improved dramatically in recent decades, several high-profile, tragic, unnecessary deaths of children to preventable dental problems make clear that a significant portion of the population still has persistent, unmet oral health needs.  Racial and ethnic minorities, rural populations, the developmentally disabled, young children, and pregnant women are just some of the vulnerable populations in need of improved access to oral health care.
NASHP’s work on oral health includes:
•    State oral health policy and infrastructure, particularly under Medicaid;
•    State strategies for improving access to care for young children and other vulnerable populations; and
•    State experience with workforce and scope of practice issues, especially with regard to emerging alternative dental providers.
With the support of The Pew Charitable Trusts, NASHP is currently researching state efforts to engage primary care medical providers in children’s oral health by, for example, reimbursing these providers for preventive services such as fluoride varnish application under Medicaid. NASHP also is collaborating with leading organizations (e.g. the Association of Maternal and Child Health Programs, the Association of State and Territorial Dental Directors, and the Medicaid/SCHIP Dental Association) on the Children’s Dental Health Project’s National Oral Health Policy Center, which seeks to promote a better understanding of effective policy options to address disparities in children’s oral health.

Long Term & Chronic Care

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Persons who require assistance with daily activities over the long term due to disability or chronic health conditions often have complex needs that must be addressed by multiple providers and delivery systems. NASHP’s work in long term services and supports is aimed at assisting state policymakers to assess their current systems and  advance reforms in the way services are organized, financed and delivered. Specifically, states are providing more opportunities for individuals to receive services and supports in their own homes and communities.  In chronic care, NASHP supports states’ efforts to improve the treatment and a management of chronic conditions, enhance care coordination, and integrate the delivery of health and long term care services.
 

A Multi-Agency Approach to Using Medicaid to Meet the Health Needs of Juvenile Justice-Involved Youth

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Juvenile justice, mental health, and Medicaid agencies have a common interest in meeting the health needs of youth in the juvenile justice system. However, these three agencies have different, yet overlapping, program objectives, funding sources, target populations, and partners. This situation creates both barriers and opportunities in using these agencies’ resources to meet the health and behavioral health needs of children involved with the juvenile justice system. Improving coordination among state agencies overseeing the juvenile justice, mental health, and Medicaid systems is crucial to improving access to quality health services for juvenile justice-involved youth. Some states are developing mechanisms to plan and implement more coordinated and integrated health services for juvenile justice-involved youth.
The National Academy for State Health Policy (NASHP), with the support of the John D. and Catherine T. MacArthur Foundation, is working with the Models for Change grantee organizations and state policy makers to address the health needs of youth in the juvenile justice system. This paper:

  • Describes the core concepts of the three state-administered programs with major responsibilities for serving these children juvenile justice, mental health, and Medicaid.

 

  • Highlights both the barriers and opportunities for working across agencies to use Medicaid to meet these children’s health needs, as identified in interviews with stakeholders in five states, including four Models for Change states.

 

Medicaid and Juvenile Justice 331.2 KB

 

State Policy Options to Improve Delivery of Child Development Services: Strategies from the Eight ABCD States

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Since 2000, the National Academy for State Health Policy (NASHP) and The Commonwealth Fund have conducted two state learning consortia dedicated to improving the delivery of child development services to young children who are Medicaid beneficiaries. The work of the states involved in the Assuring Better Child Health and Development (ABCD) initiative has shown that state policies, especially Medicaid policies, can effectively promote improvements in the quality of preventive and developmental services provided to young children. This report provides a starting point for states seeking to identify and implement policy improvements to achieve two main objectives:
• improve the identification of young children with or at risk for developmental delays through promoting use of an objective, standardized screening tool; and
• improve families’ access to follow-up services, including assessment, referral, and care coordination.
The policies that govern the operation of any state program can be divided into three groups – policies that define what services the program will cover for which people (coverage), those that establish how much the program will pay for a qualified service (reimbursement), and those that establish how services will be delivered (performance). State Policy Options to Improve Delivery of Child Development Services presents specific policy improvements that emerged from efforts of the eight ABCD states that can serve as models and inspiration for states interested in improving developmental services for young children.

ABCD_state_policy_options.pdf 500.5 KB

 

Transitioning to Medicaid Managed Care: Children with Special Health Needs

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In an effort to identify key issues in Medicaid managed care for children with special health care needs and examine the ways that states have addressed those issues, the National Academy for State Health Policy (NASHP) convened a symposium in June of 1999 of state Medicaid officials and representatives of managed care organizations (MCOs), provider associations, advocates, research organizations, and the federal government. The symposium was co-sponsored by The Henry J. Kaiser Family FOundation and the Health Care Financing Administration (HCFA). This paper offers a summary of the symposium discussion.

1999.Oct_.transitioning.medicaid.managed.care_.children.special.health.care_.needs_.pdf 1.9 MB

 

Emerging Practices and Policy in Medicaid Managed Care for People with HIV/AIDS: Case Studies of Six Programs

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As treatment strategies for HIV/AIDS undergo rapid change, states struggle with the dual challenges of providing quality health care and containing costs. By June 1996, in an effort to meet those challenges, 35 states (including the District of Columbia) reported enrolling at least some people living with HIV/AIDS (PLWHIV) in their risk-based Medicaid managed care programs.
The six Medicaid managed care programs studied for this report – Massachusettes, New Jersey, Tennessee, Texas, San Francisco (California) and Orange County (California) — cope with overseeing changes in HIV/AIDS treatment in different ways. These programs treat PLWHIV the same as other populations in certian areas, including: marketing/enrollment, consumer involvement, and capitated benefits.

1998.Aug_.emerging.practices.policy.medicaid.managed.care_.hiv_.aids_.case_.studies.pdf 3.9 MB

 

Outreach, Marketing, Enrollment and Disenrollment Policies in Medicaid Managed Care: A Summary of a 1996 Survey of Medicaid Agencies

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The focus of this paper is on enrollment and disenrollment policy and practice in Medicaid managed care. Specifically, this paper examines policies and practices in risk-based programs with attention to Primary Care Case Management (PCCM) program policies only as they specifically interact with risk-based enrollment policies. In risk-based managed care, a Medicaid agency contracts with an entity (the contractor) to provide or arrange for the provision of an agreed upon set of services in exchange for a set fee per person enrolled per month where the prepaid fee does no vary month to month based on services used by the individual enrollee. In other words, in risk-based managed care the contractor assumes some level of financial risk for providing care to enrollees. A PCCM program in this discussion refers to a fee-for-service system where Medicaid pays a nominal amount per PCCM enrollee per month to the provider/care manager in addition to per service fees.

1997.Dec_.outreach.marketing.enrollment.policies.medicaid.managed.care_.survey.1996.pdf 710 KB

 

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