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Blog

Kansas releases KanCare, CHIP Medicaid managed care RFP

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This week, our In Focus section reviews the KanCare Medicaid capitated managed care request for proposals (RFP), released October 2, 2023, by the Kansas Department of Health and Environment and Department for Aging and Disability Services. The program covers approximately 520,000 beneficiaries and is worth $4.1 billion. New contracts would begin January 2025.

KanCare Background

KanCare is the state’s Medicaid managed care program, covering both traditional Medicaid and Children’s Health Insurance Program (CHIP) members. In all, KanCare covers approximately 320,000 children, 79,000 parents and pregnant women, 59,000 individuals with disabilities, and 54,000 individuals ages 65 and older.

Managed care organizations (MCOs) provide statewide integrated physical health, behavioral health, and long-term services and supports. Covered services include nursing facility care and home and community-based services, as well as Medicaid-funded inpatient and outpatient mental health and substance use disorder services and seven Section 1915(c) HCBS waiver programs.

Kansas is not currently an expansion state. While the governor’s 2024 budget plan called for Medicaid expansion, lawmakers rejected the proposal during the last legislative session.

In 2022, the state legislature delayed the procurement until 2023 to ensure that it occurred after the gubernatorial election and extended current MCO contracts through 2024.

RFP

Kansas expects to select three MCOs. The RFP includes a renewed focus on integrated, whole-person care, workforce retention, and accountability measures for the MCOs. The state lists the main goals for the KanCare procurement as:

  • Improve member experience and satisfaction
  • Improve health outcomes by providing integrated, holistic care with a focus on the impacts of social determinants of health
  • Reduce healthcare disparities
  • Expand provider network and direct care workforce capacity and skill sets
  • Improve provider experience and encourage provider participation in Medicaid
  • Increase the use of cost-effective strategies to improve health outcomes and the service delivery system
  • Leverage data to promote continuous quality improvement

Timeline

A mandatory pre-bid conference will take place on October 16, 2023. Proposals are due January 4, 2024, with awards expected April 12, 2024. Contracts will be effective January 1, 2025, through December 31, 2027, with up to two one-year renewal options. Following is the timeline leading up to implementation.

Current Market

Incumbents are Centene, CVS/Aetna, and UnitedHealthcare. A breakdown of market share by enrollment as of June 2023 can be seen in the table below. Other insurers have already cited their interest in bidding for the new contracts.

Link to RFP

Blog

Impact of a federal government shutdown on healthcare programs and services

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HMA is releasing an agency-by-agency analysis of the impacts on several key healthcare programs and services in the event of the potential federal government shutdown in the coming days. As of September 27, 2023, the U.S. Congress has not approved any of the twelve appropriations bills for FY 2024 or a continuing resolution (CR) that would maintain federal funding at the FY 2023 level for a specified period of time into FY 2024 while Congress continues negotiating. If the shutdown is not averted before the deadline, look for a LinkedIn live at 10am Monday, October 2 to discuss the ramifications on the U.S. healthcare system. Go to the HMA LinkedIn page to watch.

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Blog

Child and family wellbeing

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Child welfare services face challenges every day to prevent, treat, and reduce risk of maltreatment, neglect, trauma, housing instability, and violence in communities. These issues need to be seen as a priority for public health and community wellbeing and not just the jurisdiction and responsibility of child welfare agencies.

There are many opportunities for improvement in this area, including:

Integrating prevention services within the human services system to help support families and youth experiencing child welfare interventions

Providing technical assistance and supports to systems serving child welfare and justice-involved youth, including: policy and practice reviews, workforce and workload analyses, process re-engineering

Increasing Medicaid providers who offer more community based Evidenced Based and Informed Practices (EBP) among Community Based Organizations (CBO), Providers, and Local Government entities

Developing the workforce to enable prevention programs and building competencies to engage in meaningful interactions with children, youth, and families

Addressing disparities in both experiences and outcomes for children, youth and families, rather than focusing on responding through merely a transactional and compliance driven approach

If your organization works to help meet the needs of children, youth and families impacted by issues like mental health and substance abuse, domestic violence, child abuse and neglect, food insecurity, housing instability, incarceration, and other traumas, Health Management Associates (HMA) can help make your efforts more effective.

Together we can help you move programs upstream with strong prevention and family strengthening approaches and integrate payment models with the human services delivery system to streamline and improve resources. 

HMA can help in the following ways:

Developing system integration models

Strategies to improve school-based mental health support implementation

Provide technical assistance and consulting support regarding service access and expansion of Medicaid utilization for implementation of evidence-informed programs

Workforce planning and strategy

Assist states, counties, hospitals, providers, and MCO’s address the challenges of hospital overstays and behavioral health placements

Provide technical assistance to state and local governments regarding limiting exposure to class action lawsuits or providing expert witness services

Strategic planning

Program evaluation, research and analysis including cost/benefit analysis of programs

Leadership development

Stakeholder engagement

A longtime leader in health and human services, HMA experts have front line and executive level experience providing direction to child welfare programs.

We consult with public and private sector entities who serve children and families to improve, streamline and integrate essential services. We ground our work in human-centered design, lived expertise, and change management and leadership principles in state and county program development.

Contact our experts:

Uma Ahluwalia

Uma Ahluwalia

Managing Principal

Uma S. Ahluwalia is a respected healthcare and human services professional with extensive experience leading key growth initiatives in demanding … Read more
John Eller

John Eller

Managing Principal

John Eller is a seasoned executive with more than 23 years of service in public administration and health and human … Read more
Jon Rubin

Jon Rubin

Principal

Jon Rubin is a human services leader with over 20 years of experience in strategic planning, identifying and analyzing problems, … Read more
Doris Tolliver

Doris Tolliver

Principal

Doris Tolliver is a strategic thinker specializing in racial and ethnic equity, organizational effectiveness, change management, and business strategy development. She … Read more
Blog

Child and family wellbeing: family resilience

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This is part of an ongoing series highlighting efforts in human services and family wellbeing. 

For decades, practitioners have recognized that child neglect was often interconnected in some families with stressors associated with familial poverty. Poverty is often a stressor in cases of child neglect, poor health, and even youth incarceration. Food insecurity, housing instability, and family stressors often related to unemployment, incarceration, and domestic violence can in some circumstances, result in parental burnout and lead to poor parenting decisions. There is also a perverse disincentive for families to experience career and wage progression which often results in steep fiscal cliffs with benefits that are needed to stabilize families and guide them towards economic self-sufficiency[1]. There is advocacy and increasing recognition through efforts such as Universal Basic Income Pilot programs and experiments with expanding Earned Income Tax Credits and Child Tax Credits attempting to mitigate catastrophic benefits cliffs that impact child and family wellbeing and economic self-sufficiency.

Public Safety Net programs such as Temporary Assistance to Needy Families, Supplemental Nutrition Assistance Program, WIC, Free and Reduced School Meals, Child Care Subsidies, Earned Income Tax Credit, Eviction Prevention Grants, and a host of other federal, state, and local programs are intended to support and strengthen families and increase protective factors for children[2].   

Recent investments in the safety net including the childcare tax credit and the Pandemic Electronic Benefit Card (P-EBT) have shown that when concrete supports are provided to families, child maltreatment rates significantly decrease.[3]  

During the height of the COVID-19 pandemic, the federal government implemented a One-Year Expansion of the Child Tax Credit which extended the eligibility to families with little to no income. It helped increase the credit amount families received from $3,600 per qualifying child younger than six years old and $3,000 for qualifying child between the ages of 6 and 17. It also provided monthly payments of $250 to $300 per qualifying child as opposed to an annual payment which aligned with monthly living expenses. According to the US Census Bureau, 2021 saw a historic decline in child poverty which lifted one million children under the age of six out of poverty, and 1.9 million for children between the ages of six and 17.  

More recently States are experimenting with Universal Basic Income projects aimed at reducing child poverty, improving protective factors in families and reducing child maltreatment.[4] These experiments are currently being evaluated, but early research is showing promising signs of reduced child poverty in jurisdictions where these projects have gone live. 

There is considerable literature that shows that changes in income alone, holding all other factors constant, have a major impact on the numbers of children being maltreated. Conversely, reduction in income or other economic shocks to the family increase incidents of child maltreatment. 

A study performed by the Nuffield Foundation noted that internationally, evidence has shown a much stronger relationship between poverty and child abuse and neglect. Research has shown that without government and service providers responding to increased pressures on family life will lead to the risk of more children suffering harm, abuse and neglect.[5]

 Another study by Casey Family Programs on predicting chronic neglect, found that the strongest predictors of chronic neglect were parent cognitive impairment, history of substitute care, parent mental health problems, and a higher number of substantiated allegations in the first CPS report[6]. This suggests that families at risk for chronic neglect face multiple challenges and significant financial insecurity that require significant support.

  • Other significant predictors include:
    • Younger parents
    • Families with a higher number of children
    • Families with a child under age 1

Recognizing these challenges to strengthening the protective factors for young moms, there have been several successful efforts around the country to focus on pregnant and parenting teen and young adult moms. From Health Families America, Nurse Home Visiting Programs, there has been a body of evidence created that shows the strengths of providing wrap around services and home-based interventions for moms and babies. These supports strengthen the mom-baby nurturing relationship and reduce risk of maltreatment and increase protective factors. 

One such organization that has demonstrated significant success in disrupting the cycle of generational poverty is The Jeremiah Program. This is a national organization that aids single mothers and their children to provide coaching and assistance in navigating barriers to education, college access and career support, safe and affordable housing, early childhood education and childcare, and empowerment, leadership, and career training. This supportive program helps build up single mothers to achieve their educational and career goals and gain long-term economic prosperity. 

As child welfare and poverty policies intersect, the current thought leadership is focused on recognizing that economic and concrete supports reduce involvement in child welfare.[7] As the science and voices of children and families with lived experience intersect and rise up, the federal and state policy landscape around alleviating poverty to improve child wellbeing will continue to gain momentum. Family and Child Well-Being indicators significantly reflect racial and ethnic inequalities both in child welfare and across the poverty landscape. Economic stability is also a key strategy to address racial and ethnic inequalities and closing the opportunity gap for all. Over the next 3-5 years we believe there will be a fundamental shift in policy, financing, and outcomes tracking that reflect our commitment to our society’s most vulnerable children and families. That is why it is crucial for States and Local governments to enact policies that would support programming to alleviate poverty and improve child and family resilience and protective factors.

HMA consultants have decades of experience working hand-in-hand with public health, social services, behavioral health, Medicaid, and human services agencies. We help strengthen relationships surrounding policy, practice and revenue maximization in the human services space. Our experts work to help support programs in areas of Nutrition: Women, Infants & Children (WIC), Supplemental Nutrition Assistance Program (SNAP); Financial Support: Child Support, Temporary Assistance for Needy Families (TANF); Child and Adult Welfare Services; Medicaid; Housing and Weatherization; Early Education: Childcare Subsidy, Child Care and Development Block Grant (CCBDG) programs; and Workforce Development and Workforce Innovation and Opportunity Act (WIOA) programs.

If you have questions on how HMA can support your efforts in Child and Family Wellbeing, please contact Uma Ahluwalia, MSW, MHA, Managing Principal or Kathryn Ngo, MPH, BSN, Project Manager.


[1] What Are Benefits Cliffs? – Federal Reserve Bank of Atlanta (atlantafed.org)

[2] Economic Supports Chapin Anderson Nov 2020b (chapinhall.org)

[3] Research Reinforces: Providing Cash to Families in Poverty Reduces Risk of Family Involvement in Child Welfare | Center on Budget and Policy Priorities (cbpp.org)

[4] Understanding The Difference Between Guaranteed Basic Income Vs Universal Basic Income – Orange and Blue Press

[5] https://www.nuffieldfoundation.org/news/relationship-between-poverty-and-child-abuse-and-neglect

[6] Predicting Chronic Neglect – Casey Family Programs

[7] Economic Supports Chapin Anderson Nov 2020b (chapinhall.org)


Webinar

Webinar replay: youth mental health access: school-based intervention strategies

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This webinar was held on June 14, 2023.

The youth behavioral health crisis has resulted in a cascade of federal funding, advisories, and overall opportunities to improve resources to help kids. This webinar presented the Dialectical Behavioral Therapy (DBT) STEPS for Adolescents model, which is a low cost, high impact approach that empowers schools to intervene and support well-being and resiliency before students are in crisis, self-harming, or suicidal. Attendees learned how to fund and implement this approach to promoting mental wellness as a strategy to reduce the burden on clinical resources designed to treat mental illness.

Whether you are a plan looking to develop value added services, a provider looking to better integrate with schools, or a school team looking for new approaches, this discussion offered information about available funding, highlight research demonstrating evidence for the model, and offer Q&A with one of the developers of the DBT model.

Learning Objectives

  • Credentialing Not Required – Why DBT is a preferred model to address the youth BH crisis.
  • Ease of Implementation – How DBT has been adapted for current school personnel to deliver.
  • Financing Options –How to finance enhancements to school-based mental health services including, but not limited to DBT-STEPS-A.

Featured Speakers

Blog

Resources for Medicaid 1115 Waivers: creating new programs for justice-involved individuals

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HMA created a comprehensive series of webinars discussing the potential for using 1115 demonstrations to expand and improve healthcare services for the justice-involved population. Replays of the webinars and other justice-involved healthcare resources are now available.

What’s next for 1115 Waivers in your organization?

If your organization or state agency is ready to create new initiatives to improve carceral healthcare delivery and facilitate smoother transitions back into communities, HMA can help. Our consultants bring unparalleled expertise in Medicaid policy and correctional health as well as a deep understanding of the unique needs of this population. We have the operational knowledge and experience with technology and digital health solutions – and the ability to collect and analyze the right data to drive meaningful improvements in equity and access to care.

If you have questions or want to discuss options, please contact any of the speakers from the series:

Register today for HMA’s 6th annual conference on Trends in Publicly Sponsored Healthcare, Oct. 30-31 in Chicago. The event will feature the session, Medicaid and Individuals in Carceral Settings: Improving Coordination, Managing Transitions. Register now: https://conference.healthmanagement.com/

Blog

CMS AHEAD model offers a flexible framework for state-led total cost of care initiatives

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This week, our In Focus section reviews the new States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model, which the Centers for Medicare & Medicaid Services (CMS) Center for Medicaid and Medicare Innovation (the Innovation Center) announced on September 5, 2023. AHEAD is the third major model that the Innovation Center has introduced to its payment portfolio since July, clearly signaling that CMS has transitioned from conducting its internal review to laying the groundwork for action on approaches that will be tested over the next decade.

CMS views this model as the next iteration of earlier total cost of care (TCOC) models that were designed and tested in three states—Maryland, Vermont, and Pennsylvania. The AHEAD model includes several important updates based on its experience with these earlier models. For example, the AHEAD model is designed to be scalable in multiple states. Although it most certainly will be adapted to state-specific markets, landscapes, and provider needs, CMS intends to apply a consistent framework across participating states.

Additionally, though Medicare has been involved in formulating some state-level total cost of care initiatives, the AHEAD model promises specific investments in primary care and enhanced member engagement to support all-payer movement toward patient-centered care.

AHEAD Model Parameters

The goal of the AHEAD Model is to improve population health and health equity in states that apply and that CMS selects for participation. CMS plans to select up to eight pilot states, each eligible to receive up to $12 million to support statewide implementation over a six-year period. States will be accountable for constraining overall growth in healthcare expenditures. Requirements centered on health equity mirror other CMS policies and are integrated throughout the model.

The model focuses heavily on strengthening primary care. The primary care AHEAD component includes Medicare reimbursement for care management, a commitment to align with ongoing Medicaid transformation efforts, and expectations for primary care practices to achieve certain goals on quality measures.

The investments in primary care are paired with global budgets for hospitals. Participating hospitals will receive a fixed payment that will include both Medicare fee-for-service and Medicaid. States will need to ensure participation among other payers, including at least the state employee health plan, Marketplace Qualified Health Plans, or other commercial payers in the state or sub-state region. Other payers will have the option to pay participating hospitals based on a global budget.

All-Payer Health Equity Approaches and Developments (AHEAD)

Source: https://www.cms.gov/files/document/ahead-infographic.pdf

The model will be in operation 2024−2034, and three cohorts will be to accommodate variation in readiness among participating states and providers. The first cohort pre-implementation period is scheduled to begin in summer 2024, and the performance period is scheduled to begin as soon as January 2026. CMS expects to release additional details in fall 2023.

AHEAD Opportunities and Considerations

The AHEAD Model will need significant gubernatorial leadership and possibly from state legislators, depending upon the particular state’s related healthcare laws, and the model does provide flexibility for interested states and relevant stakeholders to develop programs that are adaptable to their needs.

Health Management Associates (HMA) experts have identified the following list of policies and considerations that states; hospitals, health systems, and provider organizations; other payers, including employers; and other stakeholders will need to bear in mind when determining whether to participate in the program.

  • States will need to describe their partners and provide an assessment of their readiness to implement the AHEAD model. CMS will expect states to address whether they have legislation in place related to primary care investment and/or cost growth. Potential participating states should be able to describe their vision for population health improvement and primary care transformation, a proposed strategy for hospital and primary care provider recruitment, a plan for Medicaid and multi-payer alignment, and their current population health and health equity activities. Interested states will need early input from hospitals and health systems, providers, and other payers to define, develop, and implement a model that accommodates their healthcare landscape.
  • States will develop a Medicaid hospital global budget methodology that must have CMS approval. Medicaid hospital global budgets must be implemented in the first performance year. CMS will develop a standardized Medicare fee-for-service (FFS) hospital global budget methodology, that also accommodates critical access hospitals (CAHs).
  • CMS will set the parameters for quality measurement, but states will have significant flexibility to establish the metrics that will be applied for accountability and bonus purposes. CMS will use the current CMS hospital quality programs as the basis for determining eligibility for a health equity improvement bonus. CAHs will have a similar opportunity. States will work with CMS to set quality measures for participating primary care practices.
  • The model requires a statewide health equity plan. Additionally, participating hospitals will need to create their own health equity plans in alignment with statewide priorities and activities.
  • Participating states will need to generate savings. CMS will identify state-specific factors to determine the level of expected savings. All-payer cost growth targets include Medicare FFS, Medicare Advantage, Medicaid, commercial, state employee health plans, and marketplace-qualified health plans. States will also be responsible for performance on all-payer and Medicare FFS primary care investment targets.

The HMA team will continue to evaluate the AHEAD model as more information becomes available. We also can answer questions about the Innovation Center’s other recently announced models and the linkages with new Medicare and Medicaid regulations. For more information, contact Amy Bassano ([email protected]), Caprice Knapp ([email protected]), and Andrea Maresca ([email protected]).