CISWH Project Resources

Reflections on barriers observed for families of color, with cultural and language differences, and ways to mitigate the disparities in care observed based on the interventions tried.

This paper introduces a number of existing Medicaid policy instruments and explains how to use them more effectively for programs and providers dedicated to serving CMC. Because Medicaid programs are so variable across the nation, we also provide a diagnostic approach to understanding each state’s Medicaid policy and service delivery system environment. Finally, we offer strategies of different scale to demonstrate how to change policy incrementally from the targeted to transformative.

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.

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”.

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

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.