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Care Coordination for California’s Children and Youth with Special Health Care Needs: Building Blocks from other States

July 15, 2014

Lucile Packard Foundation for Children's Health

For the more than one million children and youth with special health care needs (CYSHCN) in California, care coordination can be critical for linking them and their families to needed medical, developmental, behavioral, educational, and social services, and for providing logistical assistance and emotional support. A review of care coordination programs around the country revealed that while there is no single accepted model for care coordination, the essential building blocks are similar across programs: eligibility guidelines and determination, services and standards, payment/reimbursement mechanisms, financing, and oversight/monitoring. These represent decision points for California policymakers, officials, and other stakeholders as they consider ways to improve care coordination for CYSHCN. This report presents options for each building block based on seven care coordination programs in six other states, considerations given California’s unique environment, and lessons from other programs about key “ingredients” for an effective, sustainable care coordination system.

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Medicaid Enrollment Snapshot: December 2013

June 5, 2014

Kaiser Commission on Medicaid and the Uninsured

On June 3, the Kaiser Commission on Medicaid and the Uninsured released its “Medicaid Enrollment Snapshot: December 2013” issue brief.

Authored by Kaiser’s Laura Snyder and Robin Rudowitz and HMA’s Eileen Ellis and Dennis Roberts, the report indicates that as of December 2013, nearly 55.4 million people were enrolled in Medicaid. That’s an increase of 585,000 enrollees from the prior year, but the slowest growth since before the Great Recession.

The report examines changes in monthly Medicaid enrollment from December 2012 to December 2013 and the factors that influenced those changes in a variety of ways.

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CHIP Enrollment Snapshot: December 2013

June 5, 2014

Kaiser Commission on Medicaid and the Uninsured

On June 3, the Kaiser Commission on Medicaid and the Uninsured released its “CHIP Enrollment Snapshot: December 2013” issue brief.

Authored by HMA’s Vern Smith and Kaiser’s Laura Snyder and Robin Rudowitz, the report shows nearly 5.8 million children were enrolled in the Children’s Health Insurance Program (CHIP) in December 2013. That represents a 3.1 percent increase from 2012.

This report examines changes in monthly CHIP enrollment between December 2012 and December 2013.

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Transitioning the California Children’s Services Program to a New System of Care: Stakeholder Issues and Considerations

May 19, 2014

The Lucille Packard Foundation for Children’s Health

The Lucille Packard Foundation for Children’s Health recently released its report “Transitioning the California Children’s Services Program to a New System of Care: Stakeholder Issues and Considerations.”

Health Management Associates interviewed more than 50 stakeholders with an array of perspectives about the program, including families, state officials, advocates and insurers. These stakeholders offered their thoughts about potential changes to the California Children’s Services (CCS) program when its carve-out from Medi-Cal managed care ends in December 2015.

The report includes feedback about a variety of items, including the decision process for making potential changes to CCS, design framework for alternative options, and key issues and considerations for redesigning care for CCS-eligible children with chronic conditions and special health care needs.

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The Critical Role of Public Health Departments in Health Care Delivery System Reform

April 2, 2014

Dawn Hamilton, JD, MHA | Senior Consultant | Contributor
Margaret Kirkegaard, MD, MPH | Principal | Contributor
Jack Meyer, PhD | Managing Principal | Contributor
Mona Shah, JD, MPH | Senior Consultant | Contributor
Pat Terrell | Managing Principal | Contributor
Lori Weiselberg, MPH | Principal | Contributor

The purpose of this paper is to build a bridge that connects local and state public health officials with the leadership of hospitals, physicians and other providers, and public and private payers in an effort to improve the health of individuals and lower avoidable health care spending. This paper focuses on local reforms, including health care delivery system and community-based initiatives that factor in poor housing, long-term unemployment, inadequate nutrition, and other problems that clearly contribute to poor health but fall outside of the health care system.

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Express Lane Eligibility Evaluation Findings

March 24, 2014

Mathematica

The U.S. Department of Health and Human Services recently submitted a final independent evaluation of the Express Lane Eligibility (ELE) policy to Congress. Health Management Associates and The Urban Institute worked with Mathematica Policy Research to conduct this multi-year review.

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) gave states the ability to utilize ELE. With ELE, Medicaid and CHIP programs can use data gathered by another agency to determine if a child is eligible for enrollment. As ELE was a new option to address the number of children eligible yet not enrolled in publicly funded health care programs, the legislation required a comprehensive review of its impact.

The final report to Congress examines how different states implemented ELE, estimates the impact of ELE adoption on total enrollment, takes a look at enrollment and renewal trends along with administrative costs and/or savings, and reviews service utilization.

The Final Findings

  • ELE adoption can increase enrollment.
  • States have adopted ELE differently, and those differences can affect its potential benefits.
  • Automatic ELE processes serve the most individuals, yield the greatest administrative savings, and eliminate procedural barriers to coverage.
  • Simplified procedure and simplified application ELE processes, which rely on families initiating or returning an application for coverage, produce little to no administrative savings and show more modest descriptive evidence of increasing enrollment.
  • Given the size of renewal caseloads compared to new enrollment caseloads and the recurring nature of renewal, using ELE for renewals holds great promise for administrative savings and keeping kids covered.
  • ELE enrollees use health care services, though fewer than those who enroll through standard routes.
  • Like ELE, all three of the other simplifications studied can help simplify the enrollment or renewal process for families, but they differ in their reach and impact.

As part of the evaluation process, HMA Managing Principal Jennifer Edwards and Senior Consultant Diana Rodin also produced a Case Study of Massachusetts’ Express Lane Eligibility Processes. Managing Principal Sharon Silow-Carroll and Diana Rodin produced a Case Study of New York’s Telephone Renewal in Medicaid. Jennifer Edwards and Rebecca Kellenberg produced a Case Study of South Caroliina's Express Lane Eligibility Processes.


 

 
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