Search Results: MCHLine

Annotation: This brief highlights ten key things about Medicaid. It provides information on the number of Medicaid beneficiaries, coverage, and financing; Medicaid’s share of all health care and long-term care spending and how Medicaid spending is divided among children vs. those who qualify based on age or disability; and the effect of state Medicaid spending on cost per beneficiary across states. Also discussed are the share of beneficiaries who receive care through managed care organizations, how Medicaid coverage impacts beneficiaries, section 1115 demonstration waivers, and public views on Medicaid.

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Keywords: Costs, Health insurance, Long term care, Low income groups, Managed care, Medicaid

Annotation: This report provides a guide to telehealth-related policies, laws, and regulations for all states and the District of Columbia. The report contains information about Medicaid policy trends, including common telehealth Medicaid policy expansions. Also discussed are professional practice standards, private payer reimbursement, online prescribing, and consent laws and requirements. Information about licensure requirements by state for health professionals providing telehealth is incuded.

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Keywords: Legislation, Managed care, Medicaid, Oral health, Public policy, Regulations, Telemedicine

Annotation: This brief explains how state Medicaid programs can be used to address social determinants of health, including economic stability, education, neighborhood and physical environments, employment, social support networks, and access to health care. It describes how states have been given flexibility through managed care programs and Section 1115 demonstration waivers to address non-clinical aspects of care such as case management, housing supports, employment supports, and peer support services. Included is a summary of the new guidance issued by the Centers for Medicare and Medicaid (CMS) in 2023 on the expansion of opportunities to address health related social needs.

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Keywords: Managed care, Medicaid, Social determinants of health, State programs

Annotation: This workbook for Title V program staff focuses on the importance of Medicaid in the system of services for children and youth with special health care needs (CYSHCN). It provides an overview of the Medicaid program, including chapters on Medicaid managed care; the Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit; and pathways to Medicaid coverage for children who require an institutional level of care. The purpose of the resource is to increase Title V program staff identification and knowledge of finance-related services for CYSHCN, particularly Medicaid. It includes questions to guide users through the process of mapping a Medicaid system and building a strategy for their own state.

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• Online Version

Keywords: Adolescents with special health care needs, Children with special health care needs, Children's Health Insurance Program, Medicaid, Medicaid managed care, Title V, Youth

Annotation: This report examines the performance of Medicaid managed care organizations in addressing the maternal mortality crisis and racial health disparities among pregnant and postpartum women with low incomes. It presents findings from a scan of 12 states conducted in 2023 that analyzed the transparency of publicly available performance metrics and reports from state maternal mortality review committees. The document identifies significant gaps in public data regarding individual organization accountability and the lack of coordination between state health agencies. Substantial recommendations are provided for federal and state policymakers to improve transparency through the use of data dashboards, beneficiary-facing scorecards, and standardized performance improvement projects.

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Keywords: Data, Managed care, Maternal health, Maternal mortality, Medicaid, Racial factors, State health agencies, Statistical analysis, health care disparities

Annotation: This fact sheet discusses social determinants of health screening and referrals for children and youth with special health care needs and their families, particularly in reference to Medicaid and Medicaid managed care contracts. The document provides examples of state-level programs.

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Keywords: Adolescents with special health care needs, Child health, Children with special health care needs, Managed care, Medicaid, Social factors

Annotation: This fact sheet discusses strategies for implementing medical homes for children and youth with special health care needs (CYSHCN) through Medicaid managed care. The document provides examples of state-level programs that have implemented a range of strategies to support medical homes for CYSHCN. These strategies include developing partnerships to connect children to medical homes, incorporating the medical home model in managed care contract language, and using incentives for providers to use a medical home approach. The fact sheet also provides links to additional resources.

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Keywords: Adolescents with special health care needs, Child health, Children with special health care needs, Health care delivery, Managed care, Medicaid, Medical home

Annotation: This fact sheet provides examples of state actions to use the National Standards for Children and Youth with Special Health Care Needs (CYSHCN) to strengthen their managed care systems for CYSHCN. Topics include analyzing and enhancing specialized managed care plans, providing a framework to design and strengthen care delivery systems, strengthening contract language to address the needs of CYSHCN, and improving care coordination and transition to adult care. The various state examples outlined here resulted from a 12-month learning collaborative facilitated by NASHP, in partnership with the Association of Maternal & Child Health Programs (AMCHP), with support from the Lucile Packard Foundation for Children’s Health (LPFCH).

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Keywords: Adolescents with special health care needs, Children with special health care needs, Managed care, Medicaid, Standards, State programs, Title V programs, Young adults

Annotation: Based on a review of the literature and interviews with stakeholders and policy experts, this article provides actionable recommendations for improving care coordination programs for children with special healthcare needs (CSHCN) in Medicaid managed care.

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Keywords: Care coordination, Children with special health care needs, Managed care, Medicaid, Medicare

Annotation: This comprehensive guide, authored by Kate Honsberger, MPH, examines the complex landscape of healthcare delivery for Children and Youth with Special Health Care Needs (CYSHCN) in the context of evolving Medicaid managed care systems. The text addresses several key aspects of the issue, including the prevalence of CYSHCN (approximately 14 million U.S. children), their unique challenges in accessing coordinated care across multiple sectors, and significant disparities in healthcare access particularly affecting low-income and minority populations. The guide outlines two major frameworks - the National Standards for Systems of Care for CYSHCN and the NCQA Primary Care Medical Home Recognition program - and describes a crosswalk tool developed to align these standards within Medicaid managed care systems. The document emphasizes the critical importance of integrating CYSHCN-specific needs into healthcare policy and practice, highlighting how states and health plans can utilize the crosswalk tool to enhance care quality while maintaining compliance with NCQA standards, ultimately promoting more effective healthcare delivery for this vulnerable population.

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Keywords: Title V programs, CHSCN programs, Medical home, Medicaid, Managed care, Children's Health

Annotation: This report discusses the role of Medicaid managed care in serving children and youth with special health care needs (CYSHCN), highlighting the fact that over 40 states now enroll at least some CYSHCN in managed care plans as they seek to control costs and improve care quality. The document examines how four states (Texas, Virginia, Michigan, and Maryland) use specific contract language and management strategies to ensure managed care organizations (MCOs) effectively serve CYSHCN populations. Also discussed are key provisions around identification/assessment, access to care, medical homes, care coordination, and quality assurance, with detailed examples from each state's contracts. The document emphasizes that both strong contract language and active contract management are essential for ensuring MCOs meet the unique needs of CYSHCN, who comprise about 15% of U.S. children and require more frequent provider access, increased hospitalizations, and multiple medications compared to typical children.

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Keywords: Title V programs, CHSCN programs, Medical home, Medicaid, Managed care, Children's Health, Regulations, Texas, Maryland, Virginia, Michigan

Annotation: This report provides a snapshot of Title V Children and Youth with Special Health Care Needs (CYSHCN) programs across the United States. Contents include background and history of CYSHCN programs, recent changes affecting CYSHCN programs, and methods and results from an electronic survey of Title V CYSHCN directors to assess key characteristics of each state's CYSHCN program. Topics include program structure and strengths, roles in systems of care, CYSHCN program partnerships, financing of care for CYSHCN populations and emerging issues for CYSHCN programs.

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Keywords: Advocacy, Children with special health care needs, Community based services, Consultation, Cultural competency, Data, Family centered care, Financing, Health care delivery, Health care reform, Health care systems, Health insurance, Leadership, Medicaid managed care, Models, Networking, Pediatric care, Policy development, Program coordination, Program development, Public health infrastructure, Public private partnerships, Quality assurance, Reimbursement, Role, Standards, State MCH programs, Title V programs

Annotation: This report describes a study that estimated the impact of the Perinatal and Infant Oral Health Quality Improvement Project on oral health services utilization by pregnant women in Connecticut’s HUSKY Program, the state’s health care coverage program that provides low-cost or free comprehensive coverage for families or single adults with low incomes. The report provides background about Medicaid eligibility, the Medicaid dental benefit, managed care, and perinatal outreach in Connecticut. The report also discusses study methods, data, and the analytic approach and presents results. [Funded by the Maternal and Child Health Bureau]

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Keywords: Connecticut, Health care utilization, Low income groups, Managed care, Medicaid, Oral health, Oral health care, Perinatal care, Pregnant women, State programs

Annotation: This report shows the progress made by the U.S. Department of Health and Human Services and states to systematically measure and report on the quality of care that children enrolled in Medicaid and the Children's Health Insurance Program (CHIP) receive. Contents include information about state-specific findings on quality and access in Medicaid and CHIP and monitoring and improving care for children enrolled in managed care. Topics include primary care access and preventive care, management of acute and chronic conditions, childhood obesity, oral health care, prenatal and postpartum care, and adolescent well care.

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• Earlier Editions

Keywords: Access to health care, Adolescent health, Child health, Children's Health Insurance Program, Federal programs, High risk children, Managed care, Measures, Medicaid, Nutrition, Oral health, Perinatal health, Preventive health services, Primary care, Program improvement, Progress reports, Quality assurance, State programs

Annotation: This report provides state-specific findings on children's use of dental services in Medicaid and the Children's Health Insurance Program. It includes state-specific performance data for two measures: preventive dental services and dental treatment services. The report also summarizes information on managed care quality-monitoring and qaulity-improvement efforts related to oral health care that were reported in states' external quality review technical reports.

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Keywords: Children, Children’s Health Insurance Program, Health care utilization, Managed care, Medicaid, Oral health, Preventive health services, Program improvement, Quality assurance, State programs, Statistical data, Trends

Annotation: This report summarizes information on the quality of health care provided to adults covered by Medicaid, including pregnant women. The report discusses the status of quality measurement and reporting efforts using the Medicaid Adult Core Set and summarizes information on managed care performance measures and performance-improvement projects reported in external quality-review technical reports that states submitted to the Centers for Medicare & Medicaid Services. Topics include diabetes care, hospital readmissions, emergency department visits, and substance use disorders.

• Current Report
• Earlier Editions

Keywords: Access to health care, Adults, Federal programs, Managed care, Measures, Medicaid, Pregnant women, Program improvement, Progress reports, Quality assurance, Reports, State programs

Annotation: This toolkit contains information that details five high impact opportunities for states and local school districts to support communities through collaboration between the education and health sectors, highlighting best practices and key research in both areas. Contents include resources, programs, and services offered by non-governmental organizations.

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Keywords: Case management, Collaboration, Communities, Community action, Educational reform, Eligibility, Health care reform, Health education, Health insurance, Health services delivery, Hospitals, Medicaid managed care, Needs assessment, Nutrition, Physical activity, Public private partnerships, Reimbursement, Role, School districts, State government, Students

Annotation: This policy brief is intended to serve as a resource for managed care entities looking to better understand homelessness, for health professionals seeking to be more aware of managed care and its interests, and for both groups to better understand the common goals each brings to a partnership. The brief includes the health care needs of people who are homeless, describes Health Care for the Homeless projects and the patients receiving care in these venues, a description of managed care, common goals between both entities, and issues that both providers and plans should consider when creating or strengthening partnerships.

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Keywords: Health insurance, Homeless persons, Homelessness, Managed care, Medicaid managed care, Public private partnerships

Annotation: This brief reviews implementation requirements governing access to reproductive health services in Medicaid managed care. Topics include network adequacy and access to services, travel time and distance standards, timely availability of services, direct access to providers, information requirements, and utilization controls. Recommendations for states are also included.

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Keywords: Access to health care, Barriers, Health care utilization, Health services delivery, Medicaid managed care, Provider networks, Regulations, Reproductive health, Standards, Third party payers, Women's health

Annotation: This report provides state-specific findings on perinatal care in Medicaid and the Children's Health Insurance Program. Contents include state-specific performance data on 5 of the 10 perinatal care measures in the Child and Adult Core Sets. The report also summarizes information on managed care quality monitoring and improvement efforts related to prenatal and postpartum care that were reported in states' external quality review technical reports. Topics include timeliness of prenatal care, frequency of ongoing prenatal care, postpartum care rate, live births weighing less than 2,500 grams (low birthweight), and central-line-associated blood stream infections in neonatal intensive care units.

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Keywords: Children's Health Insurance Program, Health care utilization, Measures, Medicaid managed care, Perinatal care, Postpartum care, Prenatal care, Program improvement, Progress reports, Quality assurance, State programs, Statistical data, Utilization review