NASHP Issue Hub: Resources to Help States Improve Integrated Care for Children

Integrating children’s care improves early identification and treatment of health issues that can improve children’s well-being and avoid costly medical, special education, foster care, and criminal justice expenses. This Issue Hub provides valuable resources for states interested in the Integrated Care for Kids (InCK) Model and others working to implement payment, coverage, and cross-agency strategies to improve for integrated care coordination of behavioral, physical and health-related social needs for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Most of these resources focus on children, with the inclusion of adult resources that can serve as alternative payment and care coordination models for children.

Child Health Access

State Strategies for Defining Medical Necessity for Children and Youth with Special Health Care Needs
The brief examines the current issues affecting the state EPSDT and CHIP officials who implement medical necessity policy, and looks ahead to new and emerging issues that may affect future state EPSDT policy.

Improving Behavioral Health Access & Integration Using Telehealth and Teleconsultation: A Health Care System for the 21st Century
This brief explores how telehealth and teleconsultantion models (e.g., Project ECHO) can be used to help improve access to behavioral health services.

State Approaches to Promoting Young Children’s Healthy Mental Development: A Survey of Medicaid, Maternal and Child Health, and Mental Health Agencies
This report examines how states are addressing the healthy mental development of children ages birth to age 3 and is based on a survey of Medicaid, maternal and child health, and children’s mental health agencies in all 50 states and the District of Columbia.

Linking Children to Services: Building on Community Assets to Pilot Test Improvement Strategies
The five states participating in the third Assuring Better Child Health and Development (ABCD) learning consortium have gone through an extensive planning process to set the stage for implementation of interventions to improve coordination among providers serving children in pilot communities. This document describes how Arkansas, Illinois, Minnesota, Oklahoma, and Oregon are building on existing local partnerships and assets to organize community pilots, and preliminary lessons that have emerged from these states, including new federal opportunities to bolster community partnerships that will improve service linkages for children.

CHIP and Medicaid are Essential Partners for Cross Agency Collaboration to Better Serve Children
This blog examines how Massachusetts and Washington, DC are using their CHIP and Medicaid programs to create improved coordination across multiple state agencies and programs serving youth.

All 50 States and D.C. CHIP Fact Sheets
These CHIP fact sheets provide information about CHIP for each state, including data on enrollment, participation rates, eligibility levels, benefits, cost sharing requirements, and other key program characteristics.

Improving the Delivery Health Care that Supports Young Children’s Healthy Mental Development: Update on Accomplishments and Lessons from a Five-State Consortium
The five states that participated in the second Assuring Better Child Health and Development (ABCD II) Consortium were successful in improving child development services, increasing the rate of identification of children in need of developmental services, and improving the likelihood that those identified with a potential need received appropriate follow-up services. The results of the three-year project are detailed in a new report from the National Academy for State Health Policy (NASHP), Improving the Delivery of Health Care that Supports Young Children’s Healthy Mental Development: Update on the Accomplishments and Lessons from a Five-State Consortium.

Behavioral Health/SUD

State Strategies to Meet the Needs of Young Children and Families Affected by the Opioid Crisis
This report identifies promising state strategies developed by Kentucky, New Hampshire, and Virginia to support children and families affected by the opioid epidemic.

State Strategies for Meeting the Needs of Young Children and Families Affected by the Opioid Crisis
This webinar features two New Hampshire officials detailing their state’s strategies to support families affected by the opioid epidemic.

Behavioral Health Homes for Children: An Opportunity for States to Improve Care for Children with Serious Emotional Disturbance
Developed by NASHP and the National Center for Medical Home Implementation, this fact sheet provides an overview of federal health home requirements, state considerations for implementing behavioral health homes for children, and three examples of successful state pediatric behavioral health home programs.

West Virginia Medicaid Covers an Innovative and Less Costly Treatment Model for Opioid-Affected Infants

Intervention, Treatment, and Prevention Strategies to Address Opioid Use Disorders in Rural Areas
This primer is for Medicaid officials and healthcare providers working to reduce opioid addiction in their state’s rural areas. It details the role HRSA-supported safety net providers play in improving emergency medical intervention and treatment to Medicaid enrollees, many of whom live in rural regions, and low-income and vulnerable populations facing opioid use disorders.

Turning the Tide: State Strategies to Meet the Needs of Families Affected by Substance Use Disorder
This ebook from a NASHP preconference contains presentations that explore policy approaches to meet the unique needs of families affected by substance use or opioid use disorder.

Comprehensive Early Childhood Mental Health Systems to Improve Outcomes and Reduce Costs
This blog describes examples of comprehensive state and community strategies that recognize the importance of early childhood mental health as part of overall health and school readiness and success.

Screening for Behavioral Developmental Problems: Issues, Obstacles, and Opportunities for Change
This paper examines issues related to screening children for developmental disabilities and problems. It examines the ways in which screening tools differ from one another and the challenges that are often faced by those working to integrate screening tools in medical practices. The paper is designed to provide states with a framework for evaluating developmental screening tools for young children so that state officials are equipped to make informed decisions and to work with pediatricians, parents, and other stakeholders in strengthening services to young children. The paper also includes summary information on 17 different tools.

Integrated Care Coordination

Why Shared Plans of Care Are Critical to Coordinated Care and How States Are Implementing Them
This blog and the issue brief describe how states are using Shared Plans of Crae to improve care coordination for children, particularly those with special health care needs.

Structuring Care Coordination Services for Children and Youth with Special Health Care Needs in Medicaid Managed Care: Lessons from Six States
State Medicaid agencies are strengthening care coordination programs as part of their health care deliv-ery transformation efforts to improve health care quality and outcomes and reduce costs. States are in- creasingly enrolling CYSHCN into their Medicaid managed care delivery systems. As this shift occurs, it is critical to identify how managed care systems provide effective care coordination to CYSHCN.

Physical and Behavioral Health Integration: State Policy Approaches to Support Key Infrastructure
NASHP reviewed emerging areas of consensus in what makes for a successful integrated care model and highlights how leading states have supported infrastructure development using diverse policy strategies

Integrating Maternal and Child Health Data Systems
This blog and report describes information from state officials in Illinois, New Jersey, Rhode Island, and Utah–and a state contractor in Connecticut— in their experiences integrating maternal and child health data systems.

Improving Care Coordination, Case Management, and Linkages to Service for Young Children: Opportunities for States
States can use primary care practice-based strategies, service provider linkage strategies, and systems change and cross-system strategies to improve linkages to services for young children. This paper uses a framework that illustrates the various roles that states can play to facilitate and support improved linkages: 1) maximizing the use of personnel; 2) undertaking quality improvement initiatives; 3) supporting data, information and technology; and 4) supporting individualized care plans and cross systems planning.

Improving Care Coordination and Service Linkages to Support Healthy Child Development: Early Lessons and Recommendations from a Five-State Consortium
This report summarizes early findings from the current Assuring Better Child Health and Development (ABCD III) learning collaborative of five states. Arkansas, Illinois, Minnesota, Oklahoma, and Oregon are testing models to strengthen linkages and care coordination between pediatric primary care providers and community-based providers of early intervention, mental health, public health, and early care and education services. The states’ early experiences piloting communication tools, facilitating data sharing, implementing quality improvement processes, and involving families are relevant for efforts to engage multi-sector stakeholders to improve state policy, primary care practice, and population health.

Policies for Care Coordination Across Systems: Lessons from ABCD III
How can states help primary care providers (PCPs) and community service providers coordinate care? In NASHP’s third Assuring Better Child Health and Development learning collaborative (ABCD III), five state teams (AR, IL, OK, OR, and MN) have piloted projects to systematize care coordination between PCPs of young children with potential developmental delay and community providers, particularly early intervention services. Drawing on eleven years of ABCD experience, these state teams offer model policies and protocols to implement cross-system care coordination.

Improving the Lives of Young Children: Opportunities for Care Coordination and Case Management for Children Receiving Services for Developmental Delay
This brief examines states’ Medicaid and CHIP policy choices and new opportunities under health reform and other federal legislation to develop a well-coordinated system of care for children receiving Early Intervention and other ongoing services. State examples in the paper draw significantly from ABCD III.

Care Coordination and Linkages to Services
Building on previous ABCD efforts, these projects will seek to identify existing assessment and treatment resources, remove policy barriers to accessing those services, and facilitate referrals to these resources. States play an important role in removing barriers and providing support as communities move toward more integrated services. This section focuses on resources designed to assist states working to address the health and developmental needs of children and families.

50-State Chart of Medicaid Policies on Maternal Depression Screening during Well-Child Visits
Thirty-six states recommend, require, or allow maternal depression screening during well-child visits and 11 states capture positive and negative screens using modifiers or codes. These policies recognize the interdependent relationship between the health of mothers and children by providing families with necessary resources that support the health of mothers and their children’s’ healthy development.

State Strategies for Shared Plans of Care to Improve Care Coordination for Children and Youth with Special Health Care Needs
The issue brief identifies approaches and strategies states can use to promote the use of shared plans of care (SPoC) as part of care coordination. It also features case studies showcasing how Iowa, Oregon, Utah, and West Virginia are implementing SPoC for CYSHCN.

Measuring and Improving Care Coordination: Lessons from ABCD III
As states and providers move away from siloed health care systems and toward integrated systems of care, care coordination has become a key area of focus. Through the Assuring Better Child Health and Development (ABCD) III initiative, Arkansas, Illinois, Minnesota, Oklahoma and Oregon piloted and evaluated strategies to improve care coordination among primary care providers and community service providers serving Medicaid-eligible children, aged birth to three with or at risk of developmental delays. This report describes states’ evaluation methods, summarizes the results, and highlights lessons learned about evaluating care coordination.

Supporting Healthy Child Development through Medical Homes: Strategies from ABCD III States
Through Assuring Better Child Health and Development (ABCD) III, Arkansas, Illinois, Minnesota, Oklahoma, and Oregon have developed and tested models to improve care coordination for children with or at risk of developmental delay. The medical home has been a key mechanism in their improvement efforts. This brief draws from these states’ experiences to outline opportunities and lessons for state policy makers to consider in order to strengthen medical home initiatives by explicitly addressing the needs of children.

Policies for Care Coordination Across Systems: Lessons from ABCD III
How can states help primary care providers (PCPs) and community service providers coordinate care? In NASHP’s third Assuring Better Child Health and Development learning collaborative (ABCD III), five state teams (AR, IL, OK, OR, and MN) have piloted projects to systematize care coordination between PCPs of young children with potential developmental delay and community providers, particularly early intervention services. Drawing on eleven years of ABCD experience, these state teams offer model policies and protocols to implement cross-system care coordination.

Engaging Parents as Partners to Support Early Child Health and Development
Ensuring and coordinating services that support young children’s healthy development requires strong and effective partnerships between families and health care providers. This brief puts forth a three-part framework for engaging parents in supporting healthy child development: parents engaging with: 1) their child, 2) the services and programs they receive, and 3) the larger systems and policies that govern those services. It describes each level of engagement, explains why each is critical to improving care coordination and services for young children, and gives examples of how states can incorporate parent partnerships into their work. The framework represents a dynamic structure in which the three types of partnership support and inform each other.

State Strategies for Care Coordination, Case Management, and Linkages for Young Children: A Scan of State Medicaid. Title V, And Part C Agencies
NASHP conducted this scan of states in order to better identify and understand what states are doing through variously funded early child health and development agencies to promote better care coordination, case management, and linkages to services for young children. The scan was designed to elicit strategies used by the three state agencies to improve healthcare and community linkages in three areas: within primary care practices; between primary care practices and other child and family service providers; and through systems or statewide strategies. This paper describes state models that may help policy makers become more aware of the potential resources and tools available to promote healthy development for young children and can provide states with strategies to more effectively coordinate resources and achieve better outcomes for their children.

National Standards for Systems of Care for Children and Youth with Special Health Care Needs Version 2.0
The National Standards for Systems of Care for Children and Youth with Special Health Care Needs (CYSHCN) define the core components of a comprehensive, coordinated, and family-centered system of care for CYSHCN. Since its release in 2014, many Medicaid and Children’s Health Insurance Program (CHIP) agencies, other government programs, health care systems, consumers, and others have used these standards as guideposts to improve systems of care for CYSHCN in an ever-changing health care landscape.

Medicaid VBP & Delivery Reform

Using DSRIP to Improve Population Health
This blog describes Delivery System Reform Incentive Payment (DSRIP) programs to improve care, improve health, and lower costs by incentivizing and supporting care delivery redesign that transitions away from episodic treatment toward prevention and management of health and wellness for low-income populations.

The Roadmap Ahead: New York’s Value-Based Payments Reward Communities and Providers for Addressing the Social Determinants of Health
This blog outlines New York’s Value-Based Payment (VBP) Roadmap, which rewards Medicaid providers and community-based organizations for addressing the social and economic impacts on health.

The Evolving Promise of Delivery System Reform Incentive Programs
This blog describes the findings from a NASHP report on DSRIP programs and similar state incentive programs, developed under contract with the Medicaid and CHIP Payment and Access Commission (MACPAC).

Exploration of the Evolving Federal and State Promise of Delivery System Reform Incentive Payment (DSRIP) and Similar Programs
This report details a 12-month project NASHP, under contract to MACPAC, conducted to explore the evolution of DSRIP, examining DSRIP’s alignment with other initiatives, its financing and sustainability, and Medicaid’s role in delivery system transformation.

States Develop New Approaches to Improve Population Health Through Accountable Health Models
This blog outlines various models states are working on across Medicaid, public health, and other agencies to develop accountable health structures.

Financing Prevention: How States are Balancing Delivery System & Public Health Roles
This report highlights leading states’ approaches to support community-based prevention initiatives by bridging the health care delivery and public health systems.

How States Address Social Determinants of Health in Their Medicaid Contracts and Contract Guidance Documents
This chart compares the social determinants each state targeted to enhance population health, and how states monitored outcomes and funded these efforts.

The Integration of Behavioral Health into Pediatric Primary Care Settings
This issue brief reviews findings from the Project LAUNCH grantees’ efforts to integrate behavioral health services into pediatric primary care settings, highlighting the promising approaches to behavioral health integration and the impact of these efforts, including increased screening and early referrals from primary care providers and improved social-emotional functioning among children.

State Strategies to Develop Value-Based Payment Methodologies in FQHCS
While not specific to women and children, this toolkit provides states with state examples and key considerations when designing value-based payment models for Medicaid safety net providers. Many states’ goals for VBP is to better support FQHCs in providing integrated care to patients, including women and children.

NASHP’s Delivery System and Payment Reform Map
This 50-state map provides detailed information about Health Home, PCMH, and DSRIP programs within Medicaid. Many of these programs include or are specific to children.

Measuring Physical and Behavioral Health Integration: A look at State Approaches in the Context of VBP
Brief describes state strategies to measure integrated care. This brief focuses on how three states—Alabama, Maine, and New York.

State Policy Options to Improve Delivery of Child Development Services: Strategies from the Eight ABCD States
The policies that govern the operation of any state program can be divided into three groups – policies that define what services the program will cover for which people (coverage), those that establish how much the program will pay for a qualified service (reimbursement), and those that establish how services will be delivered (performance). State Policy Options to Improve Delivery of Child Development Services presents specific policy improvements that emerged from efforts of the eight ABCD states that can serve as models and inspiration for states interested in improving developmental services for young children.

How States Structure Medicaid Managed Care to Meet the Unique Needs of Children and Youth with Special Health Care Needs
The National Academy for State Health Policy (NASHP), studied how six states (Arizona, Colorado, Minnesota, Ohio, Texas, and Virginia) designed their managed care systems to serve CYSHCN and examined some of their best practices and strategies to meet the unique needs of these children.

State Strategies for Medicaid Quality Improvement for Children and Youth with Special Health Care Needs
This issue brief and case studies from Michigan, New York, and Texas, examine strategies that states can use to advance quality measurement and improvement for CYSHCN.

The National Standards for Children and Youth with Special Health Care Needs: A Compendium of Data and Quality Measure Sets
This measures compendium is a reference tool that highlights relevant quality measures aligned with key elements for a system of care for CYSHCN as outlined in the National Standards for CYSHCN. This tool compiles existing data and quality measures from applicable and widely used measure sets. Identification of data and quality measures can help states evaluate how well their system of care is serving CYSHCN.

Multi-sector Child-Serving Systems

Cross-Systems Collaboration: Working Together to Identify and Support Children and Youth with Special Health Care Needs
This webinar features three states discussing collaborations across state programs that impact the identification and treatment of children in need of specific services.

Strengthening the Title V-Medicaid Partnership: Strategies to Support the Development of Robust Interagency Agreements between Title V and Medicaid
This technical assistance document provides several strategies for Title V programs to consider when approaching the review of their interagency agreements with their state Medicaid programs. It offers guidance on how Title V programs may strengthen the collaboration and coordination across these two state entities and create robust interagency agreements.

Braiding Funds to House Complex Medicaid Beneficiaries: Key Policy Lessons from Louisiana
This brief explores Louisiana’s permanent supportive housing program, which is administered jointly by the state’s Medicaid agency and housing authority.

Learn How Oregon Is Integrating Oral and Physical Health in Medicaid Through Its Coordinated Care Organizations
This report describes Oregon’s innovative payment and financing structures, incentive measures, and key partnerships of their oral health model.

The Nuts and Bolts of Medicaid Reimbursement for Developmental Screening: Insights from Georgia, Minnesota, and North Carolina
This report examines developmental screening reimbursement policies in three states in the top quartile for parent-reported developmental screening rates: Georgia, Minnesota, and North Carolina.

Pooling and Braiding Funds for Health-Related Social Needs: Lessons from Virginia’s Children’s Services Act
This brief examines lessons from Virginia about the promise and pitfalls of braiding and blending funding across agencies, and explores whether the state’s model could serve as a roadmap for other states seeking to coordinate funding and services for other populations.

Braiding and Blending Funding Streams to Meet the Health-Related Social Needs of Low-Income Persons: Considerations for State Health Policymakers
This brief aims to bring attention to non-Medicaid funding sources that states could potentially blend or braid to address health-related social needs, and to outline a continuum of options for states seeking to coordinate funding to better serve the needs of low-income populations.

State and Federal Officials Explore Ways to Promote Healthy Child Development in a New Era
This report includes recommendations from state and federal leaders from agencies serving young children to promote healthy child development through delivery system, data, and payment strategies.

Case Studies: Innovative State Programs That Promote Children’s Health
This link includes several case studies that highlight successful initiatives designed to improve the health of children and adolescents.

State Levers to Advance Accountable Communities for Health (ACH)
This brief and the accompanying state profiles identify state levers that advance ACHs by examining the ACH programs in California, Minnesota, Vermont, and Washington State.

Engaging Parents as Partners to Support Early Child Health and Development
This brief puts forth a three-part framework for engaging parents in supporting healthy child development: parents engaging with: 1) their child, 2) the services and programs they receive, and 3) the larger systems and policies that govern those services.

The National Research Council/Institute of Medicine’s Adolescent Health Services: Highlights and Considerations for State Health Policymakers
This report describes adolescent health services health services and suggestions for state policymakers.

The Use of Mental Health Consultation in Home Visiting and Early Care and Education (ECE) Settings
This issue brief examines the impact of early childhood mental health consultation (ECMHC) on children, families, and ECE and home visiting staff based on the Project LAUNCH grantee evaluations, and identifies lessons from this work that can inform the successful expansion of ECMHC services within ECE settings and home visiting programs in other states.

Medicaid Financing of Home Visiting Services for Women, Children, and Their Families
This issue brief highlights Medicaid and other funding sources available to support home visiting services; explores opportunities to integrate home visiting into state health reform efforts; and features examples of how states use Medicaid to finance home visiting programs.

New Law Helps States Pay for Mental Health and Substance Abuse Services with Federal Foster Care Funds
The Family First Prevention Services Act, passed in February 2018, gives states new opportunities to provide mental health and substance abuse services to prevent placement of children in foster care. This blog explores how states can use federal Title IV-E funds to pay for these services and other parenting supports for families and caregivers.

Oklahoma Uses Focus Groups to Identify Strategies to Better Serve Foster Care Youth
This blog outlines how Oklahoma used some of its CHIP funding to conduct cross-agency research to determine how to better serve the health and behavioral health needs of youth involved in foster care.

A Multi-Agency Approach to Using Medicaid to Meet the Health Needs of Juvenile Justice-Involved Youth
This issue brief highlights barriers and opportunities for working across Medicaid, mental health and juvenile justice agencies to use Medicaid appropriately and effectively to meet children’s health needs.

State Strategies to Leverage Medicaid and Title V Programs to Improve Care for Children with Special Health Care Needs in Medicaid Managed Care
This NASHP issue brief identified a number of effective, collaborative strategies used by state Medicaid and Title V CYSHCN programs to ensure that their Medicaid managed care meets the needs of CYSHCN and their families.