Medicaid Pathways to Asthma Reimbursement
This chart describes various strategies that Medicaid offers for expanding effective community-based asthma programs for low-income
and medically underserved populations available to states as they seek ways of supporting community asthma management. [pdf; Childhood Asthma Leadership Coalition]
Pathways to Reimbursement: Understanding and Expanding Medicaid Services in Your StateThis technical brief provides and overview of options for financing healthy homes services through your state's Medicaid program, including waivers, managed care contracts, state plan amendments, and more. [pdf; NCHH]
Reimbursement for Healthy Homes Services: A Case Study of Leveraging Existing Medicaid
Authority in TexasThis brief outlines the steps that the Texas Childhood Lead Poisoning Prevention Program took to set up the system for reimbursement, describes how the claims are currently supporting program activities, and offers tips for exploring reimbursement opportunities in other states. [pdf; NCHH]
Using Medicaid to Advance Community‐Based Childhood Asthma Interventions: A Review of Innovative Medicaid Programs in Massachusetts and Opportunities for Expansion under Medicaid NationwideThis report reviews community asthma interventions, describes new initiatives underway in Massachusetts to promote community‐based asthma prevention for children, and discusses opportunities for state Medicaid programs to incorporate these interventions into Medicaid and the Children’s Health Insurance Program (CHIP) programs nationwide. [pdf; Childhood Asthma Leadership Coalition]
Medicaid Funding of Community-Based Prevention: Myths, State Successes Overcoming Barriers
and the Promise of Integrated Payment ModelsMedicaid funding for community-based prevention services has an important role to play in achieving the transformation of our healthcare financing and delivery system necessary to achieve the Three Part Aim. The findings in this paper reveal that federal and state policymakers can benefit from dispelling long-held myths, learning how states have been successful in supporting community-based prevention through Medicaid, and recognizing their challenges. [pdf; Nemours]
Integrating Housing in State Medicaid PolicyAs evidence continues to establish supportive housing as an intervention that stabilizes people with chronic
illnesses and/or behavioral health conditions and reduces health system costs, states are exploring ways to better utilize healthcare financing for the services that supportive housing residents need. CSH is working with and tracking state efforts to pursue the changes needed to finance through Medicaid the services that supportive housing residents need to achieve both housing and health stability.This brief describes these mechanisms and provides examples of state and local jurisdictions taking advantage of these opportunities.
[pdf; CSH]
WaiversWaivers are vehicles states can use to test new or existing ways to deliver and pay for healthcare services in Medicaid and the Children's Health Insurance Program (CHIP). For instance, a state may submit a waiver under
Section 1115, Research and Demonstration Projects, to expand eligibility criteria, propose new services not typically covered by Medicaid or test new or innovative delivery systems to improve care, increase efficiency, and reduce costs. In general, Section 1115 demonstrations are approved for a five-year period and can be renewed, typically for an additional three years. Demonstrations must be "budget neutral" to the Federal Government, which means that, during the course of the project, federal Medicaid expenditures will not be more than federal spending without the waiver. [url; Centers for Medicare and Medicaid Services]
Medicaid 1115 Waivers: How Are They Transforming the Health System?
This webinar provides an opportunity for public health lawyers, health practitioners, and other stakeholders to learn about Medicaid 1115 waivers and their role in health system transformation. Presenters provide an overview of Section 1115 Medicaid waivers, how states have used them, and how they are impacted by health reform. Representatives from Arkansas and Texas discuss their state’s approach of utilizing Medicaid 1115 waivers and highlight how they have chosen to address population health and Medicaid Expansion. [webinar; The Network for Public Health Law]
Medicaid Managed Care ContractsStates have traditionally provided people Medicaid benefits using a fee-for-service system. However, in the past 15 years, states have more frequently implemented a managed care delivery system for Medicaid benefits. In a managed care delivery system, people get most or all of their Medicaid services from an organization under contract with the state. [url; Centers for Medicare and Medicaid Services]
State Plan Amendments (SPA)A
state plan is a contract between a state and the Federal Government describing how that state administers its Medicaid program. It describes groups of individuals to be covered, services to be provided, methodologies for providers to be reimbursed, and the administrative requirements that states must meet to participate. Many of the financing mechanisms described on this page would require a state to submit a state plan amendment, otherwise referred to as a SPA, to the Centers for Medicare and Medicaid Services (CMS) for review and approval. [url; Centers for Medicare and Medicaid Services]
Health HomesThe Affordable Care Act created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions. Health Homes providers are expected to integrate and coordinate all primary, acute, behavioral health, and long-term services and supports to treat the whole person. [url; Centers for Medicare and Medicaid Services]
Targeted Case Management (TCM)Case management includes services that assist eligible individuals to gain access to needed medical, social, educational, and other services. Targeted case management are case management services provided only to specific classes of individuals, or to individuals who reside in specified areas of the state (or both). These definitions were refined in Section 6052 of the Deficit Reduction Act of 2005, and this FAQ provides additional guidance on eligible activities. [url; Centers for Medicare and Medicaid Services]
State-by-state information on Targeted Case Management
This portal provides data related to Medicaid benefits covered in each state (including Targeted Case Management), limitations applied to those benefits, cost-sharing charges, and the reimbursement methodologies used for those benefits in effect at six specific points in time, the most recent being October 1, 2012. In general, the data presented represents a state’s policies applicable to adult Medicaid beneficiaries receiving care on a fee-for-service basis. [url; Kaiser Family Foundation]
Medicaid Administrative ClaimingMedicaid program costs can be classified as service or administrative. Administrative costs cover activities like enrolling individuals and coordinating and monitoring services for Medicaid recipients. Some of these administrative costs for healthy homes services may be reimbursable. [url; Centers for Medicare and Medicaid Services]
State Plan Amendments and Waivers: How States Can Change Their Medicaid Programs
It is helpful to understand the basics of both State Plan Amendments and waivers, because the best plan of action will depend on which process their state is pursuing. This brief provides an overview of and comparison between State Plan Amendments and waivers. [pdf; Families USA]