CHIP and Medicaid are Essential Partners for Cross Agency Collaboration to Better Serve Children

Increasingly states are focused on the critical role social determinants play in health, and public coverage programs play a key role in this focus. For more than 20 years, the Children’s Health Insurance Program (CHIP) has worked in coordination with state Medicaid programs to serve the health needs of low-income children. States are leveraging Medicaid and CHIP funds to build additional cross agency connections that address the comprehensive care needs of children. Therefore, potential changes in Medicaid and CHIP funding could also affect collaboration efforts with other programs that serve children and families.

State officials report that cross-agency collaborations have increased administrative efficiencies and helped programs become even more effective at serving children. Congressional action however, is needed to extend federal CHIP funding beyond September 2017 and as state officials are considering what proposed changes in Medicaid financing may mean for their programs, they are also weighing how funding changes for coverage programs could affect other state agencies and public programs that are serving children.

Although there is uncertainty about future funding, states are currently continuing to support collaborative efforts in place to serve children. Massachusetts and the District of Columbia offer examples of using their CHIP and Medicaid programs to create improved coordination across multiple state agencies and programs serving youth. In Massachusetts these collaborations work at assuring low-income kids are served by social supports and in D.C., they improve the seamlessness of care provided to kids by improving the exchange of data across agencies.

Leverage Funding Opportunities to Build Partnerships
Health Services Initiatives (HSIs), authorized under Title XXI, provide states the option to use CHIP administrative funds (up to the 10 percent cap) to invest in activities that directly improve the health of children under age 19. Massachusetts, and other states, are using HSIs to leverage their CHIP funding to foster cross agency connections and as an efficient way to support state public health programs serving children’s needs. For instance, currently Massachusetts’ HSI programs include: nutritional programs through schools, smoking prevention and cessation programs, and youth violence prevention through community-based organizations. These activities are primarily funded by state appropriations to the state’s Executive Office of Health and Human Services or the Executive Office of Education with a small portion of CHIP funds used to ensure targeted low-income children are served. In Massachusetts these activities are administered through a variety of state agencies including the Department of Early Education and Care, Department of Public Health, Department of Developmental Services, Department of Elementary and Secondary Education, and Department of Children and Families.

Through the implementation of HSIs, Massachusetts has successfully braided different funding streams to best serve the health needs of children. HSIs have enabled Massachusetts to build interagency connections to support a variety of programs that address an array of children’s health needs by effectively using available state and federal resources. If federal CHIP funding is not extended Massachusetts would lose a crucial funding source that is key to the operation of these initiatives.

Partner to Overcome Coordination Barriers
In the District, the Department of Health Care Finance (DHCF), which administers D.C.’s Medicaid expansion CHIP program, identified a lack of data sharing and collaboration across agencies as a barrier to accurately identifying children with unmet health needs. To address this issue, a cross-agency data sharing partnership with DHCF, the Department of Health (DOH), and D.C. Public Schools (DCPS) was formed. The partnership aims to address the issue of duplicative documentation efforts by the three agencies serving the same child and family population, as well as to provide a more accurate understanding of where there may be a lack of coverage of basic healthcare needs for children. Each of these agencies have different health data mandates including: maintenance of health forms (DCPS), immunization compliance data (DOH), Medicaid status and service utilization (DHCF), and managed care organization assignment (DHCF). In order to share their respective data, the three agencies developed a Memorandum of Agreement. Through this agreement the agencies worked together to effectively address often cited barriers to data sharing, such as the Family Educational Right and Privacy Act (FERPA) and Health Insurance Portability and Accountability Act (HIPAA). By convening stakeholders early, identifying each other’s institutional requirements, and gaining approval from all agencies the partners were able to work around these barriers.

As a result of their collaboration, these three D.C. agencies are able to promote health services outreach and target health resources to the appropriate schools. Sharing DCPS school enrollment data, DOH immunization data, and DHCF Medicaid enrollment data, the agencies can better identify which schools to target with needed services such as oral health care or health education efforts. By building these connections across agencies, D.C. has been able to better serve the health needs of children by increasing efficiencies in coverage and identifying gaps in service utilization.

These examples illustrate two distinct ways states are leveraging their CHIP and Medicaid programs to coordinate across agencies and highlight the important roll partnerships play in providing comprehensive care to children. Given the current uncertainty of federal CHIP funds after September 2017 and state officials’ concerns about the potential ripple effects of proposed funding changes on multiple agencies and programs serving families, it is particularly important to recognize the cross agency structures states have developed to serve vulnerable populations.

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