Resources produced by our team include hundreds of papers, peer-reviewed articles, manuals, and other products on a range of topics related to health and social needs services and supports.

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Unwinding the Maintenance of Effort Requirement at the end of the Public Health Emergency (PHE): The Role of Title V Programs

Authors Catalyst Center

Date 2022

Project Catalyst Center

Keywords Covid-19, CYSHCN, Financing, Medicaid/CHIP

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 Role of Title V Programs in Increasing Access to School-Based Health Services: Opportunities for Bolstering Medicaid Reimbursement

Authors Catalyst Center

Date 2022

Project Catalyst Center

Keywords CYSHCN, Financing, Medicaid/CHIP

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.

CMC CoIIN Family Focus Group Infographics – Telehealth and COVID-19

Authors Rubina Veerakone

Date 2022

Project CoIIN to Advance Care for CMC

Keywords Covid-19

The infographics share the experiences of families in the CMC CoIIN focus groups related to the impact of COVID-19 on their child and family and the benefits and challenges of telehealth. 

Resources:

Beyond COVID-19: Perspectives on Telehealth from CMC CoIIN Providers and Families

Authors Candace Jarzombek, Rubina Veerakone

Date 2022

Project CoIIN to Advance Care for CMC

Keywords Covid-19, Health Equity, Kentucky

The Collaborative Improvement and Innovation Network to Advance Care for Children with Medical Complexity (CMC CoIIN) had the unique opportunity to study the experiences of health care providers and families of CMC in 2020 as care delivery quickly transitioned to telehealth. Now, as in-person services have returned, reflecting on what we have learned can help shape the future of telehealth for CMC.

This package includes:

  1. A telehealth learnings infographic on strategies for success, family perspectives, and centering equity.
  2. A short podcast interview with the Kentucky CMC CoIIN Team about their experience expanding telehealth during the COVID-19 shut down and the benefits of telehealth for children and families they serve.
    1. Podcast Producer/Host: Candace Jarzombek, Graduate Research Fellow
    2. Featuring:
      1. Donna Croslin, Nurse Administrator
      2. Davenna Bales, Nurse Administrator
      3. Sondra Gilbert, Director, Family 2 Family Information Center & Parent Consultant
  •  

Policy Brief: A Perspective on Cost Effectiveness in Pediatric Comprehensive Complex Care Service Models

Authors Steve Fitton

Date 2022

Project CoIIN to Advance Care for CMC

Keywords

This brief presents evidence on the cost effectiveness of comprehensive service delivery models to improve care for children with medical complexity (CMC) and describes the unique challenges in cost effectiveness evaluations for this population. It also points to Medicaid policy opportunities that provide financial support for a developmental period, whether focused on model development or systems building expansion. This information is offered as a resource to help make the financial case for further development and expansion of service delivery models for CMC.

Resources:

Medical Necessity Webinar Series

Authors Catalyst Center , National Coordinating Center for the Regional Genetics Networks

Date 2022

Project Catalyst Center

Keywords CYSHCN, Financing

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. 

Medicaid’s Transportation Benefit and Children and Youth with Special Health Care Needs (CYSHCN)

Authors NASHP

Date 2022

Project Catalyst Center

Keywords CYSHCN, Financing, Health Benefits, Medicaid/CHIP

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.

Medicaid Reimbursement of Title V Care Coordination Services

Authors NASHP

Date 2022

Project Catalyst Center

Keywords CYSHCN, Financing, Medicaid/CHIP

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.

Medicaid 101 Webinar

Authors

Date 2022

Project Catalyst Center

Keywords CYSHCN, Financial Hardship, Financing, Maternal and Child Health, Medicaid Buy-In Programs, Medicaid/CHIP

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. 

 

 

PPT Slide Deck: Paths to Financial Sustainability for Comprehensive Pediatric Complex Care Programs: A Medicaid Policy Toolkit for Title V Programs

Authors Steve Fitton, Meg Comeau, MHA , Bethlyn Houlihan, MSW, MPH

Date 2022

Project CoIIN to Advance Care for CMC

Keywords

This slide deck, originally presented at the Association of Maternal and Child Health Programs’ 2021 virtual conference, outlines a number of policy opportunities for Title V programs to utilize in sustaining funding for pediatric complex care. The presentation breaks down these policy opportunities into broad, targeted, eligibility, and reimbursement based strategies. For more in-depth information on each, review “Strategies for Changing State Medicaid Policy to Improve Services to Children with Medical Complexity”.

Resources: