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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Strategies for State Title V and Medicaid Programs to Promote Health Equity for Children of Color with Special Health Care Needs

Authors The National Academy for State Health Policy (NASHP)

Date 2021

Project Catalyst Center

Keywords CYSHCN, Financing, Health Equity, Medicaid/CHIP

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.

State Definitions of Medical Necessity Under the Medicaid EPSDT Benefit

Authors NASHP

Date 2021

Project Catalyst Center

Keywords CYSHCN, Financing, Health Benefits, Medicaid/CHIP

State Medicaid programs are required to provide Medicaid enrollees under age 21 with comprehensive and preventive health care services through the Early Screening and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Federal law requires states to cover “medically necessary services” under the EPSDT benefit “whether or not such services are covered under the State plan.”  The federal statute does not define “medical necessity” but instead describes a broad standard for coverage. States can, therefore, establish their own parameters for medical necessity decisions so long as those parameters are not more restrictive than the federal statute. In March 2021, with support from the Catalyst Center, The National Academy for State Health Policy (NASHP) conducted a 50-state scan of medical necessity definitions used by state Medicaid programs for their EPSDT benefit, updating a previous scan conducted in 2013. This resource presents definitions of medical necessity from all 50 states and the District of Columbia.

Spotlight: Power Job Club

Authors Silvia Moscariello, Bryce McKinzie, Julia Kantner Doherty

Date 2021

Project The HIV, Housing & Employment Project

Keywords HIV/AIDS, Supportive Services

Employment and economic self-sufficiency play a key role in health. With the effectiveness of early antiretroviral treatment (ART), many people with HIV can (and do) participate in the country’s workforce. When community-based organizations, HIV/AIDS service organizations, and health care centers provide employment services to their clients, a thoughtful approach is required to address the potential barriers to employment on the individual, organizational, and structural levels. POWER (Pursuing Opportunities with Employment & Resources) is an innovative intervention developed in New Haven, CT, based on the job club model. It seeks to bridge the gap between barriers and employment through peer support and community partnerships to prepare participants for success. Learn how Liberty Community Services, Inc. successfully integrated employment into their existing services through the POWER intervention. 

Shared Care Planning Handbook and Pediatric to Adult Care Transition (PACT) Workbook

Authors Oregon CoIIN Team

Date 2021

Project CoIIN to Advance Care for CMC

Keywords Oregon, Shared Plan of Care

The Shared Care Planning Handbook describes the process of creating a Shared Plan of Care, and is designed to be used alongside the Pediatric to Adult Care Transition workbook. The transition workbook includes information about 1) Introduction to the Medical Home; 2) Discussion of Medical Conditions and Medications; and 3) Transferring Care to use as a resource and workbook with the primary care provider on an ongoing basis during transition preparation, and to support a new patient visit with an adult primary care physician.

Pediatric Primary Care Provider Concerns and Preparation for Adult Healthcare Transfer of Medically Complex Young Adults

Authors Alison J. Martin, PhD, MA, Reyna Lindert, Ana M.D. Valdez, Family leader BranDee Trejo, Family leader Tamara Bakewell, MA, Family leader Shreya Roy, PhD, Marilyn Berardinelli, BS, Sheryl Gallarde-Kim, MSc, Reem Hasan, MD, PhD

Date 2021

Project CoIIN to Advance Care for CMC

Keywords Medical Home, Oregon

Findings from Oregon team’s CoIIN QI project presented at the Adolescent Health Initiative virtual meeting 2021.

Resources:

“All circuits ended”: Family experiences of transitioning from pediatric to adult healthcare for young adults with medical complexity in Oregon

Authors Shreya Roy, Ana M.D. Valdez, BranDee Trejo, Tamara Bakewell, Alison J. Martin

Date 2021

Project CoIIN to Advance Care for CMC

Keywords Oregon, Unmet Need

This study aimed to explore the experiences of Oregon families of YAMC who had recently transitioned to adult health care providers, and obtain recommendations for transition from family members, to inform the development of the CoIIN quality improvement project.

Resources:

Complex Care Program Welcome Letter

Authors CoIIN Team Minnesota

Date 2021

Project CoIIN to Advance Care for CMC

Keywords Medical Home, Minnesota

Part of a ‘new to program’ packet sent to new complex care program patients/families several weeks ahead of their first complex care program clinic visit.

Resources:

Access Plan Template

Authors CoIIN Team Minnesota

Date 2021

Project CoIIN to Advance Care for CMC

Keywords Minnesota, Shared Plan of Care

A manual Word document that captures what parents identified as critical components of the shared plan of care. Team Minnesota considers this an ‘interim solution’ until an EMR-based application is built.

Resources:

Improving Care Coordination for Children with Medical Complexity: Exploring Medicaid Health Home State Options

Authors Veronnica Thompson, Kate Honsberger

Date 2021

Project Catalyst Center

Keywords CYSHCN, Financing, Medicaid/CHIP

States are increasingly interested in care coordination as a strategy for improving systems of care for children with medical complexity (CMC) and their families. The Section 2703 Medicaid Health Home State Option and the new Advancing Care for Exceptional (ACE) Kids Act Health Home State Option present opportunities to enhance and expand care coordination for CMC in Medicaid. This new brief compares the two approaches and presents key considerations for states as they explore implementing health home options. Additionally, the brief presents New York as a case study in implementing the Section 2703 Medicaid Health Home State Option to provide care coordination for CMC. 

Helping Clients During COVID-19: Strategies from the Field

Authors

Date 2021

Project The HIV, Housing & Employment Project

Keywords Covid-19, HIV/AIDS

Learn strategies to help Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program clients during the COVID-19 pandemic. These approaches are applicable today and many have broader application for hard-to-reach populations in need of social support services during times of uncertainty. Topics include food insecurity, telehealth, medication access, and more.