Transportation is essential for children and youth with special health care needs (CYSHCN) to regularly access health care and support chronic health conditions that require ongoing treatment. However, CYSHCN are significantly more likely to delay care due to transportation barriers than children and youth without a special health care need. State Medicaid agencies are required to administer the non-emergency medical transportation (NEMT) benefit, which provides coverage for rides to and from medical appointments for all Medicaid beneficiaries. States determine when a ride is necessary (e.g., a beneficiary has a mental or physical disability). Knowledge of the NEMT benefit can assist state health officials, including state Title V program staff, in supporting access to care for CYSHCN enrolled in Medicaid.
In April, May, and June of 2022, the Catalyst Center and the National Coordinating Center for the Regional Genetics Networks, two programs supported by the Health Resources and Services Administration (HRSA), hosted a three-part webinar series to help the genetics community and other interested parties better understand how to navigate medical necessity and the prior authorization process. The webinars utilize a therapeutic case study as well as family and provider perspectives.
Part one of the series explores the definition of medical necessity and shows how evidence is used to help inform medical necessity criteria and policy.
Part two discusses EPSDT, the Title V and Medicaid relationship, and defines the first steps in the process of getting prior authorization for medically necessary services.
Part three provides a practical application of medical necessity, including understanding the prior authorization process, requesting authorizations, and navigating denials and appeals.
Click below to access the recordings, slides, and Q&A from each of the three webinars.
If you are interested in Continuing Medical Education (CME) credits The Medical Necessity Webinar Series is also available through the Genetics Academy, until May 31, 2024. Credits offered include: 3 CME (AMA) Credits, 3 CME (Other) Credits, and 3 Certificate of Participation Credits. Please see the course page on the Genetics Academy website for more information.
Care coordination can help children and youth with special health care needs (CYSHCN) and their families navigate the health care system while avoiding unnecessary costs and duplicative services. States have longstanding efforts to finance care coordination services for CYSHCN and their families through Medicaid, the state Title V Maternal and Child Health Services Block Grant (Title V), and other federal and state programs. Some states have leveraged these programs as part of unique health care delivery systems and financing structures, including Medicaid reimbursement of care coordination administered by Title V programs.
This brief, developed by the National Academy for State Health Policy (NASHP) in collaboration with the Catalyst Center, describes how State Title V and Medicaid programs in Arkansas, Illinois, and Iowa have partnered to finance and deliver care coordination for CYSHCN.
As the single largest source of health coverage for Children and Youth with Special Health Care Needs (CYSCHN), with robust benefits and cost-sharing limits, Medicaid provides critical coverage of health care services to CYSHCN. State Title V programs are uniquely positioned to collaborate with Medicaid to promote access to the system of services for CYSHCN.
The Catalyst Center hosted a webinar on June 14, 2022, that presented foundational knowledge about Medicaid for Title V staff and their allies. Catalyst Center staff explained the basics of Medicaid including the eligibility pathways to Medicaid coverage for kids and a benefit for children unique to Medicaid called EPSDT that is crucial for access to care for CYSHCN.
Please click the links below to access the webinar recording, slide deck, and a document with follow-up resources and Q&A responses.
The Catalyst Center curated a collection of COVID-19 resources from numerous reputable organizations on a variety of financing and coverage related topics. This resource library previously was available as a unique page on the Catalyst Center website. In April 2022, the Catalyst Center decided to archive these resources and highlight information related to the end of the COVID-19 Public Health Emergency, available here. The resources in this archive document were last reviewed on April 26, 2022.
In 2014, the Centers for Medicare and Medicaid Services (CMS) reversed the 1997 Medicaid policy known as the Free Care Rule, which limited the ability of schools to bill Medicaid for student health care services. In this explainer, the Catalyst Center provides an overview of the Free Care Rule reversal, outlines actions states have taken to implement the policy change resulting from the reversal, and describes how State Title V Maternal and Child Health (MCH) and CYSHCN programs can collaborate with stakeholders to expand access to services in schools through Medicaid reimbursement.
Under the Families First Coronavirus Response Act, state Medicaid programs are eligible to receive an additional 6.2 percent federal funding match provided they meet certain Maintenance of Effort (MOE) requirements. One of these requirements includes providing continuous eligibility to enrollees through the end of the month in which the Public Health Emergency (PHE) ends. After the PHE expires, states will need to redetermine the eligibility of over 80 million Medicaid enrollees, including an estimated 37.3 million children.
This Catalyst Center explainer describes how the end of the MOE requirement under the PHE could impact children and youth with special health care needs (CYSHCN), and outlines specific actions state Title V programs can take to help ensure continuous coverage for CYSHCN.
The American Rescue Plan Act (ARPA) was signed into law on March 11, 2021. Provisions in this legislation have the potential to expand and strengthen Home- and Community-Based Services (HCBS) for children enrolled in Medicaid, in turn strengthening the systems of services for children and youth with special health care needs (CYSHCN).
The ARPA gives states the option of receiving extra financial support for providing HCBS to Medicaid beneficiaries. Specifically, the law provides for a 10-percentage point increase in the state’s Federal Medical Assistance Percentage, or FMAP. States must use the additional funds they receive under the ARP FMAP increase to expand and enhance HCBS for Medicaid beneficiaries.
This Catalyst Center explainer provides an overview of the ARPA HCBS provision and its potential implications for CYSHCN.
State Title V and Medicaid programs provide services for children and youth with special health care needs (CYSHCN) to support their physical, behavioral, and developmental care. States are also advancing health equity goals to address disparate outcomes experienced by people of color. With evidence of existing inequities laid bare by the COVID-19 pandemic, states are finding opportunities to unite these efforts to improve care for CYSHCN of color.
This mini-brief, developed by the National Academy for State Health Policy (NASHP) in partnership with the Catalyst Center, describes key areas where states are strengthening health equity for CYSHCN, including initiatives in family partnership, Medicaid managed care (MMC) programs, quality measurement and performance reporting, and cross-sector partnerships.
Forty-seven states use some form of managed care to serve children and youth with special health care needs (CYSHCN) enrolled in Medicaid. State Title V programs, which are required to use 30 percent of their funds for programs for CYSHCN and their families, may also serve these same children. By working collaboratively, Medicaid agencies, Medicaid managed care organizations (MCOs), and state Title V programs can expand their individual capacities to strengthen the system of services for CYSHCN.
This mini-brief, written in partnership with the National Academy for State Health Policy (NASHP), describes how such partnerships can contribute to reductions in duplication of services, enhanced care coordination efforts, and the development of cross-agency programmatic supports to meet the physical, social, emotional, behavioral, and socioeconomic needs of Medicaid-enrolled CYSHCN and their families.