Medicaid pays a large share of treatment costs for children with behavioral health conditions. In 2011, more than 4 million children enrolled in Medicaid had a diagnosed behavioral health condition. The National Academy for State Health Policy (NASHP) has developed an informational fact sheet summarizing Medicaid provisions that cover behavioral health treatment for children. The fact sheet also highlights two state approaches for providing behavioral health services through Medicaid delivery systems.
Read or download: Providing Behavioral Health Treatment for Children Through Medicaid Delivery Systems
Wednesday, August 15th
8:00am – 4:00 pm
Breakfast and lunch are served during preconference sessions.
Download the Ebook for this preconference.
This unique preconference gives state policymakers a forum to identify and share innovative policy solutions to improve outcomes for women and children affected by substance use disorder (SUD). Learn about policy approaches to meet the unique needs of families affected by SUD or opioid use disorder, identify financing and service delivery options to ensure access to continuous care for women and children, and examine opportunities for cross-agency collaboration to efficiently support children and pregnant or parenting women affected by SUD. Participants include:
Kate Neuhausen, Chief Medical Officer, Department of Medical Assistance Services
Abby is a Senior Policy Analyst, Substance Use Services at the NH Department of Health and Human Services. Her work focuses on several of the Department’s substance use disorder (SUD) initiatives, including substance use disorder policy analysis and Medicaid coverage for SUD. Abby coordinates activities across the Department and with other State and Federal agencies, and develops and strengthens relationships with external stakeholders in support of the Department’s goals and policies in the area of substance use issues. She currently serves as the Project Director for SUD related programs funded by the Cures Act, including a targeted prevention program for child welfare involved families. Prior to joining DHHS, Abby worked with Bi-State Primary Care Association and the NH Alcohol and other Drug Service Providers Association. Before coming to NH, Abby worked on maternal and child health initiatives in Florida with Healthy Start and the Florida Perinatal Quality Collaborative.
Debra Bercuvitz is the Substance Use Coordinator for the Massachusetts’ Department of Public Health’s Bureau of Family Health and Nutrition. She is currently leading projects to improve Early Intervention referrals and enrollment for babies with neonatal abstinence syndrome.
Ms. Bercuvitz has been instrumental in the development of many state initiatives including the perinatal recovery coach workforce, perinatal substance use community collaboratives, IDEA Part C services for substance exposed newborns, and the Plan of Safe Care. She was formerly the director of a home visiting program staffed by peer mentors, working with perinatal women affected by substance use disorders, and their children.
Ashley Harrell, Senior Program Advisor, Virginia Department of Medical Assistance Services
Ashley is licensed in Clinical Social Work in Virginia as of 2002. Ashley graduated from Virginia Commonwealth University with degrees both in Master’s in Social Work as well as a Magna Cum Laude, Bachelor’s in Social Work.
Karen Palombo, Team Lead - Substance Use Disorder Intervention and Treatment, Texas Health and Human Services
Karen Palombo works for the Health and Human Services Commission in the Medical and Social Services Division in the Substance Use Disorder Unit as the Substance Use Disorder Treatment and Intervention Team Lead in Texas. Prior to this experience she has worked in hospital settings, mental health and substance use disorder treatment settings and for 9 years. She graduated from Louisiana State University with her Masters in Social Work. She has three children and currently lives in Austin, Texas.
Friday, August 17th
10:15am – 11:45am
When individuals with serious mental illness (SMI) transition out of psychiatric institutions, they often struggle with a lack of housing and social, health, and other supports, which can lead to repeated inpatient stays, incarcerations, and homelessness. This session highlights innovative state programs that successfully reintegrate individuals with SMI into the community by providing peer support and arranging housing, transportation, and other assistance. Panelists also discuss how changes to federal funding restrictions regulating inpatient transitions could help advance state efforts in this area.
ModeratorDena Stoner, Senior Policy Advisor, Texas Health and Human Services
Dena Stoner, a Senior Policy Advisor for Texas Health and Human Services, has over 35 years of design and implementation experience, including long term services, acute care, managed care and behavioral health. She currently concentrates on behavioral health integration, including research and demonstration projects, Medicaid state plan and waiver initiatives. Her work has been featured in peer-reviewed publications. She also chairs the National Association of State Mental Health Program Directors’ Finance Policy Division, serves on the National Research Institute’s board of directors and is a member of the executive council of the National Academy for State Health Policy.
SpeakersMoira Tashjian, Associate Commissioner, Division of Adult Services
Wendy Tiegreen, Director of Medicaid Coordination & Health System Innovation, Georgia Department of Behavioral Health and Developmental Disabilities
Wendy White Tiegreen, M.S.W. is the Director of Medicaid & Health System Innovation for the Georgia Department of Behavioral Health & Developmental Disabilities. She has 25 years of experience working in public behavioral health services delivery and administration. Her career has been spent in leadership and Medicaid financing, notably negotiating with the Centers for Medicare & Medicaid Services in the establishment of peer supports. She is a regular presenter at national Medicaid and behavioral health management conferences and has also been a consultant for SAMHSA, NASMHPD, and more than half of all states related to behavioral health, Medicaid, and peer support.
Rob Cotterman, Assistant Commissioner of Mental Health Services, Tennessee Department of Mental Health and Substance Abuse Services
Rob is a veteran of the Tennessee Department of Mental Health and Substance Abuse Services, having dedicated 32 years of services at the Moccasin Bend Mental Health Institute
in Chattanooga. Rob has served as a psychiatric technician, rehabilitation therapist and supervisor, program director, Assistant Superintendent for Program Services, CEO, Director of Hospital Services and most recently Assistant Commissioner of Mental Health Services. In addition to his responsibilities at Moccasin Bend, Rob has served as an ancillary professor in the Graduate
School of Psychology for the University of Tennessee at Chattanooga and as a day treatment counselor for Chattanooga Psychiatric Clinic, now Fortwood Center. Rob is a graduate of Tennessee
Government Executive Institute and holds a Master of Science degree in Industrial/Organizational Psychology from the University of Tennessee at Chattanooga. He earned his Bachelor of Arts in Counseling Psychology from William Jennings Bryan College. Rob served on the Board of Directors for several community organizations that include: the AIM Center for Mental Health, Hamilton County Homeless Healthcare Center, and Hamilton County Mental Health Court Advisory Board. In his free time, Rob enjoys spoiling his toy poodles, bowling, and working to preserve and maintain his historic 120-year-old home.
Thursday, August 16th
1:30pm – 3:00pm
A robust, health care workforce enables states to ensure accessible, affordable, and high-quality health care. However, workforce and population demographics are changing and posing new challenges. As innovation in health care and an aging population increase the need for services, states face critical shortages of nurses, doctors, and other professionals, especially in rural areas. This session highlights how states are working across public and private sectors to leverage resources and use data and technology to address critical health care workforce shortages.
ModeratorDr. Norman Thurston, Representative, Utah State Legislature
Director, Office of Health Care Statistics, Utah Department of Health
Dr. Thurston has a Masters and Ph.D. in economics from Princeton University. Dr. Thurston has been a policy analyst and health economist for the Utah Department of Health in various roles for 15 years, including work on health systems reform. Currently, he is the Director of the Office of Health Care Statistics
Before joining the state, Dr. Thurston worked for eight years as an assistant professor of economics at Brigham Young University.
In 2014, Dr. Thurston was elected to the Utah House of Representatives.
SpeakersFrederick Payne, Commissioner, Indiana Department of Workforce Development
Fred Payne was appointed Commissioner of the Indiana Department of Workforce Development in November 2017 and assumed his new role a month later. He leads DWD’s Executive Team in developing, communicating, executing and sustaining the agency’s strategic initiatives, including establishment of key performance indicators.
Mr. Payne came to DWD from Honda Manufacturing of Indiana, LLC (HMIN), where he served as Chief Administrator, Secretary and Compliance Officer, after being General Counsel and Manager of Corporate Affairs.
Prior to Honda Mr. Payne was in private practice.
Dawn Hunter, Deputy Cabinet Secretary, New Mexico Department of Health
Dawn Hunter is a Deputy Cabinet Secretary for the New Mexico Department of Health. In this role, she has oversight of four program areas, including Public Health, Epidemiology and Response, the State Laboratory, and Health Facilities Licensing and Oversight. Dawn is the former Policy Director and continues to oversee the policy office. Dawn first joined the New Mexico Department of Health as a Visiting Attorney in Public Health Law through the Robert Wood Johnson Foundation Visiting Attorney Program. Prior to this, Dawn was a microbiologist in the Advanced Biosensors Laboratory in the Center for Biological Defense at the University of South Florida, specializing in the rapid detection of food- and waterborne pathogens. Dawn also has experience in residential foster care, child protective services, and foster care adoptions. Dawn has an AB in English Literature from Princeton University, a BS in Microbiology and an MPH in Global Communicable Disease from the University of South Florida, and a JD from Stetson University College of Law. She is a member of the Florida Bar, and is Certified in Public Health by the National Board of Public Health Examiners.
Thursday, August 16th
10:00am – 11:30am
Transitioning from youth to adulthood requires increased responsibility for many areas of life, including managing one’s health. This can be particularly challenging for children with a range of social and health care needs, particularly children with special health care needs. Policymakers from several states, including Georgia and Wisconsin, discuss innovative approaches to support young adults’ transitions to adult health care services and programs through managed care, quality improvement, family engagement, care coordination, and interagency collaboration and cooperation.
This session is supported by the Lucile Packard Foundation for Children’s Health
ModeratorsLori Abramson, Director-Georgia Families 360, Georgia Department of Community Health
Lori Abramson, LCSW is Director of the Georgia Families 360° program at the Georgia Department of Community Health. She ensures that children in foster care, adoption assistance, and youth in the juvenile justice system receive medical, dental, and behadvioral health care without barriers. Lori has 38 years’ experience in clinical practice, advocacy, collaboration building, and the managed care environment. Lori’s professional focus is about leveraging that experience on behalf of Georgia’s children and families.
Donna Bradbury, Associate Commissioner, NYS Office of Mental Health
Donna Bradbury directs the Division of Integrated Community Services for Children and Families at the Office of Mental Health. She oversees all community-based children’s mental health programs in New York State. She is currently leading the effort to transition children’s behavioral health services into Medicaid managed care as part of the larger Medicaid Redesign project.
Prior to state service, Donna worked for twelve years for the Rensselaer County Department of Mental Health. She delivered clinical services to children and their families, served as a consultant to Family Court as well as county-operated human service departments and schools, ran a specialized treatment program which successfully prevented institutional placement for many youth, and assisted in the creation and implementation of several interagency initiatives that resulted in children and their families having easier access to better quality services.
SpeakersBecky Burns, Statewide Coordinator, Wisconsin Children and Youth with Special Health Care Needs Program
Becky’s career centers on supporting children and families whose lives have been affected by unanticipated journeys through the world of disability services. She treasures the opportunities to work with these families whose resilience and growth continues to astound her. With a Master’s of Science in Social Work, she has used her education along with her personal experience of being raised in a family with a child who has a disability to influence her work with families. She has worked in one capacity or another for the state of WI for over 18 years.
Gordon Lee, Health Program Administrator, KY Office for Children with Special Health Care Needs
Peggy McManus, President, The National Alliance to Advance Adolescent Health
Peggy McManus is President of The National Alliance to Advance Adolescent Health and Co-Director of Got Transition. With Dr. White, she led the revision of the Six Core Elements of Health Care Transition, developed new transition quality improvement and consumer feedback measurement tools, published systematic reviews on transition outcomes and measures, and published extensively on transition quality improvement, payment options, state Title V transition efforts, and the status of transition preparation in the US.
Thursday, August 16th
10:00am – 11:30am
Integrating health services in school settings can promote student health and readiness to learn. This session focuses on cross-agency collaboration between Medicaid and schools to improve coordination and delivery of school-based health services. The session includes a national overview of school health services delivery models, and Ohio and South Carolina officials share best practices of effective health-education state partnerships, including successes, challenges, and lessons learned.
ModeratorColleen Sonosky, Associate Director, DC Department of Health Care Finance
Colleen Sonosky, JD is the Associate Director of the Division of Children’s Health Services in the Health Care Delivery Management Administration in the District of Columbia’s Department of Health Care Finance (DHCF). DHCF is the agency responsible for the administration of the Medicaid program and the Division of Children’s Health Services oversees policies and procedures for Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit—the pediatric component of the Medicaid program for children under 21. Ms. Sonosky serves as the District’s EPSDT Coordinator as well as the CHIP Director for the Medicaid-expansion program. In addition, Ms. Sonosky represents DHCF on the District-wide Child Fatality Review Committee, Interagency Coordinating Committee for Early Intervention, and the State Early Child Development Coordinating Committee (SECDCC) where she co-chairs the Health/Wellbeing Subcommittee. She has also served on many national work groups concerning maternal and child health.
SpeakersAnne De Biasi, Director of Policy Development, Trust for America's Health
Anne Ekedahl De Biasi is Director of Policy Development at the Trust for America’s Health (TFAH), a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. She is responsible for defining the agenda and general strategy associated with the organization’s goal to create a modernized, accountable public health system and to integrate prevention into a reforming health care delivery and financing system. Previously Anne served as the first Director of Child Health Policy and Advocacy at Nemours, Director of Public Policy at the National Breast Cancer Coalition and Director of the Children’s Dental Health Project. She was President/CEO of the Oak Orchard Community Health Center and came to Washington, D.C. as a Robert Wood Johnson Health Policy Fellow, working as health care staff for U.S. Senate Majority Leader Tom Daschle.
Lesley Scott-Charlton, Ohio Department of Medicaid, Medicaid Health Systems Administrator
Lesley Scott-Charlton currently serves as a Policy Administrator with the Ohio Department of Medicaid. She has over 20 years of experience in public service, policy development, and systems administration. Mrs. Scott-Charlton spends a great portion of her time presenting on initiatives that serve Ohio’s children and families. Her Collaborative efforts include partnerships with the Centers for Medicare and Medicaid Services; the US Department of Health and Human Services; the US Department of Education; State and Local Government agencies; Managed Care Plans; Hospital Associations; and Community organizations. Ms. Scott-Charlton’s Associate Degree training was in the field of Mental Health/Chemical Dependency/and Developmental Disabilities. Her confirmed bachelor degree training is in the field of Social Work, and subsequently dual Graduate degree training in School Counseling and Clinical Counseling from Capital University in Columbus, Ohio.
Pete Liggett, Deputy Director, SC Dept of Health and Human Services
Pete Liggett, Ph.D., licensed psychologist, serves as the Deputy Director of Long Term Care and Behavioral Health for the South Carolina Department of Health and Human Services. His focus is guiding long term care and behavioral health policies as SCDHHS transforms these critical services and explores ways to better integrate long term care and behavioral health with primary care services. He joined SCDHHS in August 2012 as Director of Behavioral Health.
Mark Smith, Agency Lead, Medicaid School Program, Ohio Department of Education
Mark H. Smith MPA, BA, QIDP, CPM, Agency Lead, Medicaid in Schools Program, Ohio Department of Education, is currently an administrator with the Ohio Department of Education (ODE), serving as the agency’s Medicaid lead as well as its lead health services administrator. Mark also currently serves on the National Alliance for Medicaid in Education’s Board of Directors and has served as NAME’s Past President.
In his work, Mark has presented nationally on topics related to school-based health, data sharing between education and health arenas, parental consent, HCBS waivers, intellectual disabilities program design, electronic signatures protocol, and telepractice service delivery.
States around the country are actively working to improve service delivery under the Medicaid benefit for children and adolescents (also known as the Early and Periodic Screening, Diagnostic, and Treatment benefit or EPSDT), Medicaid’s comprehensive and preventive child health program for individuals under the age of 21. The benefit provides tens of millions of children with access to a range of preventive, screening, and treatment services, as well as vision, dental, and hearing services. The benefit is critical to early identification of health conditions, as well as to maintaining and improving the health of low-income children, making it a key priority for states as they strive to improve population health.
This webinar will draw together Medicaid officials from three states for a conversation about how they have worked to improve the Medicaid benefit for children in their states. Speakers from Iowa, the District of Columbia, and Minnesota will discuss strategies for improving access and service delivery for Medicaid-enrolled children. The conversation will have a particular emphasis on efforts in these states to better coordinate care, use public health resources to deliver benefits, collect data on and improve quality, and enhance access and delivery of behavioral health services for children. This webinar is the first in a series on the Medicaid benefit for children and adolescents: future webinars will delve more deeply into oral health, adolescent health, and care coordination.
- Eliot Fishman, Director of the Children and Adults Health Programs Group, Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services
- Glenace Edwall, Director of the Children’s Mental Health Division, Minnesota Department of Human Services
- Colleen Sonosky, Associate Director of the D.C. Department of Health Care Finance
- Jennifer Vermeer, Medicaid Director, Iowa Department of Human Services
|Download Webinar Agenda||29.6 KB|
|Download Webinar Slides||1.4 MB|
- There were a total of 201,777 beneficiaries enrolled in District Medicaid as of July 2011. Of these, 136,003 were enrolled into managed care organizations (MCOs). Children and adults who qualify for Medicaid because they belong to an income-eligible family, as well as poverty level pregnant women and CHIP enrollees, are required to enroll into an MCO. Children enrolled in these MCOs receive physical, behavioral, and oral health services from their MCO.
- The District has developed a managed care product specifically for children with special health care needs who meet SSI eligibility requirements. Enrollees in the voluntary Health Services for Children with Special Needs (HSCSN) plan receive all EPSDT services from their well-child visit screenings to treatment services for chronic conditions and special needs. As of July 2011 there were 4,626 children enrolled in the plan.
- All managed care organizations offer transportation services and the District also operates a capitated non-emergency transportation broker program that serves children who are on fee-for-service. As of July 2011, 51,617 beneficiaries received non-emergency transportation services from that contractor.
|Medical Necessity||The District’s EPSDT manual currently defines medical necessity for EPSDT services as “medical, surgical or other services required for the prevention, diagnosis, cure, or treatment of a health related illness, condition or disability including services necessary to prevent a detrimental change in either medical, behavioral, mental or dental health status.”|
|Initiatives to Improve Access
District MCO contracts include child/EPSDT network adequacy requirements such as:
|Reporting & Data Collection||
The District requires its managed care organizations (MCOs) to compile and submit quarterly reports for HealthCheck utilization and outreach efforts. These reports are generated by MCOs using encounter data, and supplemented by other data sources.
The Department of Health Care Finance (DHCF) contracts with managed care organizations (MCOs) to provide most behavioral health care. Children with significant behavioral health needs may voluntarily enroll into a specialized MCO that serves only children with special health care needs and provides an integrated behavioral and physical health care benefit. The Health Services for Children with Special Needs (HSCSN) Plan is a managed care organization that focuses on the SSI/SSDI child population. Enrollment in the plan is voluntary; children who do not choose to enroll in the plan remain in fee-for-service Medicaid.
Integrating primary care with developmental, behavioral and oral health care Physicians are expected to screen for developmental and behavioral health issues within the standard well-child visit; the HealthCheck Manual and a collection of screening guidelines, tools, and recommendations provided for District physicians offer guidance on performing these and other screens as part of the well-child visit. In 2013, the DHCF partnered with Georgetown University and The National Alliance to Advance Adolescent Health to develop new training modules on transition issues for pediatricians on its HealthCheck website, including modules on mental health, autism spectrum disorders, and substance use and abuse.
|Supporting to Providers and Families||
Support to Providers:
The HealthCheck website portal provides education, resources, and online training on EPSDT to the provider community. The District has also adopted a version of the Bright Futures curriculum as the foundation for its EPSDT benefit. This guidance has been incorporated into HealthCheck information and provider materials. The website is not only intended for providers, but also for government agencies serving children and families as well.
Support to Families:
Since its creation, the HealthCheck portal has been expanded to include educational and training resources for families and District government agencies.
All MCOs (including the Health Services for Children with Special Needs MCO) also provide outreach and information to families on the EPSDT benefit.
The Health Services for Children with Special Needs (HSCSN) managed care plan provides comprehensive services to children, most of whom have an SSI-level of disability. In addition to a broad set of benefits available, the plan is required to coordinate with other services and systems, including Individuals with Disabilities Act (IDEA) services, mental health and substance abuse services, child protective services, and other systems that can involve transitions for children with special health care needs, such as Title V.
Contract and plan provisions for HSCSN managed care plan require that the MCO provides all enrollees with a Care Coordinator, whose responsibilities include:
In 2004, the District developed a dental periodicity schedule and a plan to improve provider participation, training, coordination of dental services and outreach. The schedule follows the American Academy of Pediatric Dentistry’s Periodicity Schedule oral health recommendations in consultation with the local dental community.
The Department of Health Care Finance works closely with the District’s Pediatric Oral Health Coalition to improve pediatric dental services for children in Medicaid. As of FY 2014, the District implemented payment for fluoride varnish services by primary care providers in an effort to increase the number of young children receiving oral health services. The District’s HealthCheck provider training portal began offering a training on fluoride varnish as well.
- All Medicaid behavioral health, mental health, and dental service services are delivered entirely on a fee-for-service basis through EqualityCare, the state Medicaid program. There were a total of 69,947 beneficiaries enrolled in Wyoming Medicaid as of July 2011.
- Wyoming also delivers home and community based services including care coordination, youth and family training and support, and respite care, through a 1915(i) Home and Community Based Services State Plan Amendment.
Wyoming Rules and Regulations define Medical Necessity for the Health Check program as follows:
|Initiatives to Improve Access
|Reporting & Data Collection|
The target population for the Care Management Entities created under the Wyoming CHIPRA Quality Demonstration Grant includes Medicaid-enrolled children and south with serious emotional disturbance, as well as children in Psychiatric Residential Treatment Facilities (or at risk of such a placement). Medicaid-enrolled children whose use of prescription drugs does not conform to state prescribing guidelines are also targeted under the grant.
The children that meet these criteria, and live in the southeastern part of the state (the focus area for the pilots), are eligible to be treated by a Care Management Entity (CME). The CME is an organizational entity that serves as a centralized accountable hub to coordinate all care for youth with complex behavioral health needs and who are receiving care in multiple systems. The authority Wyoming uses to run the CMEs is its 1915(i) State plan Home and Community-Based Services benefit, which was approved in July 2013.
Wyoming also offers ongoing case management for Medicaid beneficiaries under age 21 with a behavioral health disorder. This includes linking beneficiaries to needed services; monitoring and follow-up; referrals; other advocacy on behalf of the beneficiary; and crisis intervention.
|Support to Providers and Families||The Wyoming Health Check website has information for families about the EPSDT benefit, a provider list, and newsletters about EPSDT.|
Wyoming, in partnership with Maryland and Georgia, received a CHIPRA Quality Demonstration Grant in 2010 to implement and/or expand a Care Management Entity (CME) provider model using high fidelity wraparound and intensive care coordination. Through this grant Wyoming seeks to improve clinical, functional, and cost outcomes, access to home and community-based services, and youth and family resiliency of Medicaid children and youth with serious behavioral health challenges.
The coordination services the CMEs offer include:
Wyoming believes that this program will demonstrate improved access, reduced use of restrictive services, improved clinical and financial outcomes for children in the target population, reductions in disproportional use of restricted services by racial and ethnic minorities, and improved quality of care.
Wyoming’s 1915(i) State Plan Amendment also establishes that Family Care Coordinators will work to coordinate care and secure wraparound services for children. Care Management Entities and primary care physicians are expected to work together to track EPSDT requirements and coordinate care.
All children in Wyoming Health Check receive dental services on a fee-for-service basis. The Health Check brochure details which services are covered by age group. Other dental services are provided as deemed medically necessary.