States that control their own insurance marketplaces – called state-based marketplaces (SBMs) – are leaders in providing affordability and choice, outperforming the federal marketplace on notable markers including higher enrollment, lower premium rate hikes, more participating issuers, and successfully attracting a young consumer base. These accomplishments are especially notable given recent federal policy actions that have unsettled insurance markets and a national rise in uninsured rates.
The success of SBMs results from years of hard work spent cultivating their markets while building operational and technical systems tailored to serve their states’ consumers. Thanks to the work of these SBMs and the evolution of new technology, it is now easier (and cheaper) for states currently using the federal platform to switch and adopt the SBM model.
As new states express interest in the SBM model, they can learn much from the leaders who have pioneered implementation of this model.
Earlier this month, the National Academy for State Health Policy (NASHP) hosted a webinar with SBM leaders from Idaho, Nevada, Massachusetts, and Washington, DC to showcase some of their lessons. Highlights are featured below, and a recording and slides from the webinar are available here.
Focus on the Basics (and Avoid Scope Creep)
SBMs provide more than “shop-and-compare” websites for consumers shopping for health insurance — SBMs are dynamic business enterprises. While their main objective is to make sure that individuals have “easy access to health coverage,” SBMs must also:
- Perform a series of complicated eligibility and enrollment functions easily;
- Work with the systems of partner organizations, including carriers, Medicaid, and outreach partners; and
- Be financially sustainable.
Rather than get carried away by bells, whistles, and complex policy aspirations, SBM leaders advise that future SBMs must first focus on building a functional, sustainable system. Once a working SBM is established with a long-term financing strategy, it can always grow and evolve to perform new functions.
Prioritize the Consumer Experience
Much of an SBM’s success depends on its ability to attract and retain consumers. Over the years, SBMs have worked diligently to improve the experience of its consumers. As Massachusetts Health Connector Chief of Policy and Strategy Audrey Gasteier explained, “Marketplaces require a lot of activity on the part of a consumer,” and it is important that consumers feel empowered. Outreach is a major component of this work — from providing educational materials to in-person assistance provided by brokers, Navigators, and certified application counselors. Earned press coverage and social media are also effective tools for SBMs to quickly spread the word about their products and policy changes at low cost. Speakers also noted the importance of call centers and recommended that states equip their centers with self-service capabilities so that consumers can easily resolve common issues over the phone.
Set Clear Expectations and Timelines
Heather Korbulic, executive director of Nevada’s SBM, presented an 18-month timeline for implementation of an SBM — from passage of enabling legislation to the marketplace’s first open enrollment period. While “out-of-the box” technology and adaptable systems make it easier than ever to for a state to build an SBM leaders cautioned states not to be too aggressive in their planning and timetables. As with any large-scale project, states should anticipate delays and challenges. For example, from the start states need to work closely with federal officials from the Center Consumer Information and Insurance Oversight (CCIIO) to establish their marketplace “blueprint.” While CCIIO experts serve as an important resource for states — providing years of technical and policy expertise to help guide states — implementation of an SBM requires strict federal oversight and approvals that may cause delays that are outside of the control of a state.
Throughout the SBM implementation process, leaders emphasized the importance of maintaining transparency so that stakeholders are not deterred by unexpected delays or issues. By keeping stakeholders informed of progress and expectations, an SBM will cultivate trust and maintain relationships critical to the marketplace’s long-term success.
Relationships Are the Foundation of an SBM
Any marketplace cannot function without engagement across a mix of stakeholders, which include:
- State policymakers who will establish the marketplace;
- Federal officials who will oversee and approve its implementation;
- Insurance carriers who will sell products through the marketplace; and
- Consumers whom the marketplace will serve.
Stakeholders will have different — and sometimes conflicting — interests and it is the job of the marketplace to balance those interests in pursuit of mutual goals. Leaders underscored the importance of insurer engagement, recognizing the central role of health plans in the success of the marketplace. Establishment of an SBM will require insurers in the state to establish new business practices. A state should not underestimate the uniqueness of how each carrier operates and the time it may take for each to adapt to the new SBM system.
Establish Clear Leadership that Can Take Quick Action
A state has the flexibility to choose how to establish its SBM — either as a state agency, a non-profit, or a quasi-public-private entity. Because an SBM must be responsive to changing consumer and insurer markets and be able to readily contract with vendors to develop needed services, it is best that an SBM assume a governance structure that can enable it to act quickly. Moreover, leaders directors noted the importance of leadership to any marketplace. While operation of an SBM takes a team, it is important to have one person who is clearly designated to establish priorities, take accountability, and make decisions to get the SBM “across the finish line.”
SBMs Serve as a “Hub” for Health Reform across State Agencies.
Regardless of the specific model chosen, SBMs must be able to work across existing state agencies including Medicaid, insurance departments, and other health policy agencies. SBMs are uniquely positioned to serve consumers who range from those on the cusp of Medicaid eligibility to those accustomed to various types of commercial market coverage. To ensure smooth processes for consumers, SBMs must be able to navigate between agencies to ensure that its policies and operations are consistent with what is being promulgated by its sister agencies.
For instance, SBMs are required to generate many different types of notices to consumers, such as information related to a consumer’s eligibility for coverage programs. SBMs coordinate closely with their Medicaid agencies on the language and process for sending these notices to help reduce confusion for consumers who might otherwise receive duplicative or misaligned information from both agencies. Additionally, because SBMs serve consumers who are eligible for federal tax credits, they serve an important role in informing state and federal policymakers about how policy changes may directly impact their consumers. To serve this role, it is important that SBMs have sufficient analytic capacity to process data on their consumers and advise on the implications of changing federal and state policies.
Let SBMs Adapt Over Time
Insurance markets and marketplace consumers are not static, and SBMs must be able to adjust to changing needs and consumers. They must constantly work to engage new consumers who may be coming in and out of other coverage programs (e.g., leaving parental coverage, employer-sponsored insurance, or Medicaid), while also adapting to evolving expectations as consumers interact more and more with e-commerce and advanced technology. Through consumer surveys and testing, SBMs are constantly learning and adapting their services. One benefit of their flexible structure is that SBMs are also becoming more sophisticated and efficient in navigating this process. Some have even been able to cut operational expenses and lower the assessments they charge to carriers who sell on their exchanges, which, in turn, results in lower consumer premiums. For example, Mila Kofman, executive director of DC Health Link, estimates her SBM was able to save approximately $2 million annually by moving its data servers to a cloud-based system in 2016.
Most notably, leaders point out that each SBM has taken a unique approach in how it has operationalized its marketplace. In the process, each has learned lessons from their SBM peers — from simply sharing effective marketing strategies to full partnerships, like Massachusetts’ adoption of Washington, DC’s technology for its small business marketplace. In this spirit, speakers advised states to learn from their peers as they work through their own challenges on the road to implementing SBMs.
NASHP and the SBMs are ready and eager to help support states as they contemplate establishing their own SBMs. For additional resources about SBM models and implementation, explore NASHP’s State Exchange Resource Hub.
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.
Prevention and collaboration were the key themes as state policymakers explored innovative and cost-effective strategies to integrate oral health and primary care during #NASHPCONF18’s session, Cross Currents: Integration of Oral Health and Primary Care.
Speakers underscored the importance of high-quality and regular dental care in preventing major oral and physical health problems and delivering cost savings to state Medicaid budgets. Mary Fliss, deputy of Clinical Strategy and Operations at Washington’s State Health Care Authority, reviewed her state’s Oral Health Connections Pilot Project. The project, recently authorized by the state legislature, will track how providing enhanced dental benefits to adult Medicaid clients in three counties impacts access to dental care, health outcomes, and medical costs. The project will specifically target individuals with diabetes — because of the links between periodontal health and chronic conditions — and pregnant women because improved periodontal health also benefits overall health.
Dentists who treat those two populations will receive enhanced reimbursement for periodontal treatment of Medicaid beneficiaries. The project is funded by the Arcora Foundation and state general funds. The state will seek federal approval for the project through a Medicaid state plan amendment.
One critical element of the project will be increased coordination between medical and dental providers. A referral tool, DentistLink, will provide a collaborative approach to documenting patient information and facilitating patient referrals and scheduling appointments.
California is also making strides toward medical-dental collaboration. Alani Jackson, chief of the Medi-Cal Dental Services Division within the California Department of Health Care Services, spoke about Local Dental Pilot Programs (LDPPs) that are testing new types of collaboration. The LDPPs are a component of the state’s Dental Transformation Initiative, which was authorized by a Medicaid 1115 waiver. Many of the LDPPs train primary care providers to conduct dental assessments to look for oral health risk factors and to administer basic preventive dental care like fluoride varnish.
For example, the LDPP run by the California Rural Indian Health Board places an oral health coordinator into primary care settings to complete dental decay risk assessments. By placing coordinators in primary care settings or in other venues such as after-school programs, California’s LDPPs are meeting people where they already are to improve access.
Another innovator takes a reverse approach by placing a physical health care provider in dental offices. Maria Dolce, associate professor at Stony Brook University School of Nursing, described the Nurse Practitioner and Dentist (NPD) Model for Primary Care, implemented by the Harvard School of Dental Medicine in partnership with Northeastern University School of Nursing. The NPD model places a nurse practitioner in a dental setting to act as a gateway to comprehensive care and to deliver primary care.
The program ensures that patients receive an annual wellness visit in combination with a dental visit for an integrated approach to care. The wellness visit is conducted by the nurse practitioner and includes a check on health and mental health risk factors as well as a review of a patient’s current health care providers.
These nurse practitioners already have the training to carry out these assessments in primary care offices – but under this program they conduct them in dental office settings. This unique model provides a personalized and patient-centric approach at potentially lower costs. To maximize resources, states considering this model could review their nurse practitioner scope-of-practice regulations to, for example, allow nurse practitioners to practice independently of physicians if they are not currently permitted under existing regulations.
Preliminary results suggest the NPD model is effective in improving overall health and managing chronic conditions. Because the wellness visit takes place in the dentist’s office, both dental and medical preventive services are provided.
The NPD model also addresses another critical theme raised during the session: how to secure long-term funding for these initiatives. Emphasis on the cost-saving benefits of these prevention initiatives could be key to moving them forward, as state policymakers contend with making these innovative practices, which emphasize cross-sector collaboration and prevention, a sustained program under Medicaid.
To learn more about strategies to incorporate oral health into medical care for chronic conditions, read State Strategies to Incorporate Oral Health into Medicaid Payment and Delivery Models for People with Chronic Medical Conditions. Both the report and this conference session were supported by the DentaQuest Foundation.
Washington state has enacted a groundbreaking law to help stabilize its individual insurance market and prevent “bare counties,” areas of the state without an insurance option on its exchange.
Sponsored by longtime National Academy for State Health Policy (NASHP) member, state Rep. Eileen Cody, HB 2408 requires insurance plans covering state or school employees to offer at least one silver and one gold plan on the Washington Health Benefit Exchange beginning in 2020. Because state and school employees work in every county of the state, by leveraging the procurements for insurers to serve those employees, the bill aims to assure statewide coverage.
The new law protects the distinct risk pools in the public and school employee plans by requiring that qualified health plans offered through the new program are self-supporting and that public and school employee insurance programs will not bear any of the actuarial risk or administrative costs of the program. This provision addressed concerns that the legislation might result in a program that pooled the new exchange enrollees with state or school employees and increase the costs of covering those employees. The new legislation provides a significant test of the efficacy of leveraging public purchasing tools.
“Washington state has been working for years to use our state-purchased health care to effectively improve the quality of care for all residents and businesses in the state,” explained Rep. Cody. “Using our purchasing power to ensure access for the entire state was a logical next step.”
Washington has the experience to test this innovation. For years, its public health insurance programs have closely collaborated and been co-located with the Washington State Health Care Authority (HCA), which administers both the state’s Medicaid program and the Public Employees’ Benefit Plan. A nine-member board currently approves contracts and benefits for public employees. Beginning in 2020, HCA will take on a similar responsibility for the School Employees Benefits Board, which will oversee plans for public school employees.
Because the new program will not be in place until 2020, the new law provides an immediate back-up plan through the Washington State Health Insurance Pool (WSHIP), an independent, non-profit health plan that serves as the state’s high-risk pool. Until Dec. 31, 2019, anyone unable to secure coverage in the individual market will be eligible to purchase coverage in the high-risk pool at discounted rates.
High-risk pools, by virtue of their enrollment, tend to charge very high premiums. The new bill provides subsidies, financed through WSHIP assessments, that will significantly reduce the cost of coverage for those earning less than 400 percent of the federal poverty level (FPL) based on a sliding scale. For example, those earning less than 400 percent of FPL will have 30 percent discounts on premiums while those earning 200 percent of FPL will have premiums discounted by 80 percent.
This provision expires Jan. 1, 2020, when new options become available through the public employee and school plans. However, there is no guarantee that WSHIP would qualify as an Affordable Care Act qualified health plan that can take advantage of the federal subsidies, making this a problematic long-term option. State officials report that the recent announcement by the insurance company Premera that it will offer coverage statewide in 2019 is expected to avoid the need to deploy WSHIP as a back-up plan.
Signed into law by Gov. Jay Inslee on March 22, 2018, Washington’s innovation comes at a critical time. States face uncertainty about proposed federal changes to ACA and the impact they could have on individual state markets. States are already confronting the elimination of the individual mandate and awaiting final action on Administration proposals to allow the sale of lower-cost, lower-benefit plans through association health plans and the extension of short-term duration plans.
Both of these plans would be exempt from many of the rules now in place in the market. Coupled with the elimination of the individual mandate, these changes could result in fewer younger, healthier people purchasing coverage in the regulated market. The result? Higher coverage costs would again raise the risk of insurers exiting the individual market and leaving consumers without affordable options. Washington’s program offers a model that could bring stability to the market and will be closely watched as a harbinger of new approaches states could take to maintain coverage in a changing marketplace.
As states reach the midway point of their 2018 legislative sessions, many are looking for ways to stabilize their insurance marketplaces now that Congress has effectively eliminated the individual mandate that required all residents to be insured or pay a penalty. Without guaranteed participation by healthier consumers, marketplaces risk having more high-cost consumers in their pools, which will drive up premiums and destabilize markets.
|How would a state individual mandate work?
View the Feb. 7, 2018, webinar featuring Massachusetts officials explaining how they did it here.
Several states are considering implementing a state-based mandate, with bills proposed in Hawaii, Maryland, New Jersey, Vermont, and Washington. Connecticut recently released a study about the effect of a mandate and a Washington, DC, working group has adopted a recommendation to implement a mandate. Policymakers are looking carefully at how Massachusetts, which has the lowest uninsured rate in the country, implemented its mandate 11 years ago.
Key Lessons Learned from Massachusetts
Earlier this month, the National Academy for State Health Policy (NASHP) hosted a webinar to explore implementation of a state-based mandate. During the event, Massachusetts officials described their mandate and identified three key elements that state policymakers should consider. (View Massachusetts’ webinar slides here.)
- Coverage standards: What is the minimum standard of coverage that individuals must purchase in order to be considered insured and avoid a penalty?
- Affordability standards: Are there limits that should be put in place to exempt consumers from having to purchase coverage that is unaffordable?
- Penalties/exemptions: What should the penalty be for individuals who do not purchase coverage? What exemptions should be offered to avoid the penalty? How should penalty revenue be used?
State officials also discussed operational considerations when crafting a mandate, including:
- Cost and governance: What agencies should have authority over monitoring and enforcement, and at what cost?
- Outreach and education: What educational and outreach efforts are required to ensure that consumers are adequately informed about the mandate? When and how should educational efforts occur?
Massachusetts officials described the mandate as an “integral” part of their overall coverage strategy. They explained that the mandate has provided many indirect benefits to their state. Notably, the detailed information the program has provided about consumers who lack coverage has enabled the state to design effective policies and fine-tune outreach strategies to reach these consumers and enroll them in affordable programs.
Officials also described the benefits of instituting a common benefit “floor” for coverage, which has helped Massachusetts:
- Provide a quality standard of coverage that benefits all consumers; and
- Insulate the state’s insurance market from detrimental fragmentation, and consumer gaming that can be exacerbated by the existence of limited coverage options.
Such system gaming may be of particular concern pending recently proposed federal actions to grant greater flexibility over short-term and association health plans.
Massachusetts officials acknowledged the difficulty of measuring the direct impact of the mandate on reducing the number of uninsured. The state’s mandate evolved over time and did not occur in isolation. It was part of a package of reforms designed to improve affordability and access in Massachusetts. Collectively, these policy decisions have resulted in Massachusetts achieving the lowest uninsured rate in the country (currently at 2.5 percent). Recent data released by Massachusetts’ Health Policy Commission show that Massachusetts has the second-lowest average premium costs for benchmark plans sold through its exchange, a clear sign of market stability.
Ultimately, any state considering a mandate must decide how to balance each of these considerations based on its intent to:
- Improve affordability and stability;
- Establish a quality standard for required coverage; and
- Ensure the program is not overly burdensome on consumers or state systems.
Maryland’s Proposed Health Insurance Escrow Fund
Democratic state legislators in Maryland have sponsored legislation (SB 1011/HB 1167) that would use Maryland’s health insurance exchange to automatically enroll individuals in health insurance plans. The proposal is based on a concept developed by Stan Dorn, a senior fellow at Families USA, under which Maryland would institute an individual mandate and imposepenalties for lack of coverage. Under this model, consumers could use the penalties they owe to purchase future coverage. As described by Dorn, the intent of this proposal is to ensure that penalties are used to help individuals purchase coverage to the maximum extent possible. During NASHP’s webinar, Dorn outlined four phases of this plan:
- Open enrollment “pre-payment:” During the open enrollment season, consumers would come into the exchange and estimate the amount of penalty they would owe during their next tax filing for not purchasing coverage. The consumer can then opt to “pre-pay” this penalty to the exchange, and apply that payment toward the purchase of insurance coverage.
- Tax season: Upon filing tax returns, consumers would be asked to self-identify whether or not they were insured on their tax form. If they were uninsured and owed a penalty, consumers could choose to have the penalty used to purchase insurance. At this point, the exchange would check to see if the consumer was eligible for coverage at zero-cost, meaning that when tax credits and the penalty are applied, the consumer would owe zero in monthly premiums for the plan. If a zero-cost plan is available, the consumer would be automatically enrolled in that plan.
- Post-tax season: If consumers do not qualify for a zero-cost plan, their penalty would be held in escrow until the next open enrollment period. At that point, consumers can apply the penalty toward the purchase of coverage for the following year.
- Continuation of coverage: If consumers decide to drop coverage before the full year, the state keeps any amount of the penalty left after payments are made to insurers for whatever months the consumer was covered. Any penalty funds collected would be used to finance operation of this program, and to help fund a reinsurance program to help defray the cost of insuring high-cost consumers.
The Maryland proposal raises questions about consumer behaviors, underscoring that successful implementation requires the development of sufficient tools and resources to ensure that consumers can adequately make decisions about whether to use of their penalty toward the purchase of coverage. The legislation proposes an ambitious timeline for implementation, mandating that it become fully operational by Jan. 1, 2020. The Maryland exchange have not officially taken a position on the model, though legislators are consulting with them to assess the feasibility of the plan.
More than 200 state health officials crowded into a National Academy for State Health Policy’s (NASHP) annual conference session recently to learn about strategies to improve population health and reduce costs while simultaneously transforming their state’s health care finance and delivery models.
|An Accountable Community for Health (ACH) is:
They came to hear representatives from California, Michigan, Oregon, and Washington State discuss their approaches to building population health priorities into their health system transformations through “accountable health” organizations. These entities invest in population health improvement through Accountable Communities for Health (ACHs) and care delivery structures that are accountable for population health, such as Accountable Care Organizations and Coordinated Care Organizations (CCO).
During the standing-room-only session, the four state presenters described their unique models, including financing and measurement strategies and relationships to broader health system transformation. Officials shared examples of how these new delivery models invest in social determinants of health to increase health and well-being and control costs. Examples include:
- Several of California’s Accountable Communities for Health have chosen to focus on reducing violence and trauma as a priority. One conference participant observed, “It doesn’t matter how many times people who are victims of domestic violence see a doctor, it won’t improve their health until the violence stops.”
- Michigan’s Community Health Innovation Regions identified the intersection of housing, homelessness, and health as a priority area. Its goal is to strengthen collaboration between health and housing agencies and develop solutions for Medicaid beneficiaries whose housing needs put their health at risk.
- Oregon CCOs’ global budgets give them flexibility to provide non-medical services that result in better health and lower costs, such as supporting home improvements and rental assistance, embedding mental health professionals in school systems, and promoting gym memberships.
- Washington state’s Accountable Communities of Health are addressing the opioid use public health crisis.
During the conference, NASHP also facilitated a half-day convening of state policymakers from 10 states, across departments and agencies, to advance state accountable health models. During the session, state officials discussed models, shared strategies, and identified multi-sectoral funding to support their focus on population health, health disparities, and social determinants of health. This cross-sector convening included officials from Medicaid and public health agencies and state health transformation offices, along with some key partners.
NASHP will continue to convene meetings, analyze, and report on the evolution of these state models, and build on previous analysis of State Levers to Advance Accountable Communities for Health, to help states advance these transformational efforts. Stay tuned for an upcoming cross-state comparison chart and accompanying issue brief that share lessons and themes related to accountable health models gathered during the NASHP annual conference.
For more information about NASHP’s work on state accountable health models, e-mail NASHP Senior Program Director Jill Rosenthal at firstname.lastname@example.org.
As states transform their health systems, many are turning to community health workers (CHWs) to improve health outcomes and access to care, address social determinants of health, and help control costs of care. While state definitions vary, CHWs are typically frontline workers who are trusted members of and/or have a unique and intimate understanding of the communities they serve. NASHP has produced a number of resources, below, to support state efforts to incorporate CHWs into their health and health equity improvement work. If you would like to suggest a resource or share your state’s efforts, please contact Elinor Higgins.
- Innovative Community Health Worker Strategies: Medicaid Payment Models for Community Health Worker Home Visits, December 2017. This case study examines Medicaid payment models from Minnesota, New York, Utah, and Washington for CHWs providing in-home services that address healthy home environments.
- Innovative Community Health Worker Strategies: My Health GPS in Washington, DC, Seeks to Achieve Sustainable Funding and Whole-Person Care, November 2017. This case study explores the financing and roles of CHWs in My Health GPS, the District of Columbia’s health home program.
- Community Health Workers: Policy Opportunities for Population Health and Patient-Centered Health Care, October 2017. This NASHP conference session highlighted state strategies and experiences in CHW financing, training, and oversight. Speakers from Oregon, Texas, and Wisconsin discussed the national CHW landscape and policy opportunities that could be explored to advance the CHW workforce in states. Please click on the speakers’ names to access their conference slides.
- State Community Health Worker Models Map, last updated August 2017. This map highlights state-level activities and policies to integrate CHWs into evolving health care systems in key areas such as financing, education and training, certification, and state definitions, roles and scope of practice. The map includes enacted state CHW legislation and provides links to state CHW associations, state agencies, and other leading organizations working on CHW policy in states. An instructional video, designed with support from the National Center for Healthy Housing (NCHH) and the W.K. Kellogg Foundation, is available to facilitate use of the map.
- Community Health Workers in the Wake of Health Care Reform: Considerations for State and Federal Policymakers, December 2015. This brief captures key themes that emerged during an October 2015 meeting of state and federal leaders to identify areas in which state and federal policy can align around the use of CHWs in transforming health systems to achieve better care, lower costs, and improved population health.
These resources were produced and updated with support from the Robert Wood Johnson Foundation, The W.K. Kellogg Foundation, the National Center for Healthy Housing, and The Commonwealth Fund.
Ensuring women receive prenatal care during their first trimester is important to supporting healthy mothers, children, and families. States and federal agencies, including the Health Resources and Services Administration (HRSA), are increasingly focused on improving rates of early entry into prenatal care as well as improving other measures of maternal and child health quality and access.
This series of fact sheets showcases state policies and programs in four states—California, Illinois, Massachusetts, Washington—that support improvement in early entry into prenatal care. The fact sheets also highlight how federally qualified health centers (FQHCs) in these states are leveraging the state policies and programs to promote early entry into prenatal care as part of a patient-centered medical home.
The series includes spotlights on Washington and California.
- State and Safety Net Provider Policies, Programs, and Practices
- Spotlight on California’s Comprehensive Perinatal Services Program
- Spotlight on Washington’s First Steps Program
This fact sheet series was made possible through the support of HRSA.
State Medicaid programs offer a variety of treatment services to meet the needs of children with physical and behavioral health conditions. Under federal law, Medicaid programs must cover services for children, as long as the treatments are necessary to correct or ameliorate the child’s condition, even if the services are not covered for adults. This NASHP webinar provides a federal perspective from the Centers for Medicare & Medicaid Services on how states can leverage the Medicaid benefit for children and adolescents (also known as EPSDT) to meet the treatment needs of children. This is followed by a conversation with presenters from Colorado and Washington about treatment services under the EPSDT benefit and their processes for determining service coverage.
This webinar is the fourth in a series on the Medicaid benefit for children and adolescents: the final webinar in the series will focus on care coordination services for children. In conjunction with this webinar series, NASHP launched a Resource Map to disseminate state-specific resources and information about strategies that state policymakers and Medicaid officials can use to deliver the Medicaid benefit for children and adolescents.
- Laurie Norris, Senior Policy Adviser, Centers for Medicare & Medicaid Services
- Gail Kreiger, Section Manager, Washington Health Care Authority
- Gina Robinson, Program Administrator, Colorado Department of Healthcare Policy and Financing