CISWH Project Resources

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.

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.

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. 

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.

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 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

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.

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.

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. 

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.

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. 

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.

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. 

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.

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.