Shannon McMahon’s Post

With increasing support and guidance from #CMS and its federal partners, states are using a variety of #Medicaid levers to address individuals’ health-related social needs (#HRSN). Yet, there is no one-size fits all approach across states. This tool, featuring our ongoing program design and implementation work at New York State Department of Health Medicaid, presents foundational decision points for states interested in defining an approach to address members’ HRSN. It explores insights and examples of how nine states participating in Center for Health Care Strategies' Medicaid Health-Related Social Needs Implementation Learning Series are navigating decisions related to HRSN services. The tool and learning series are made possible by Kaiser Permanente National Community Benefit Fund at The East Bay Community Foundation: https://bit.ly/4cdo5fo along with HealthBegins and Social Interventions Research and Evaluation Network (SIREN)

North Carolina’s Healthy Opportunities Pilots is a comprehensive state Medicaid initiative that tests the impact of providing select non-medical services related to housing, food, and other social needs of eligible enrollees. A new Milbank Memorial Fund report copublished with the Duke-Margolis Center for Health Policy offers timely findings and recommendations from the planning, capacity-building, and early implementation of the program. In the report, Katie M. Huber, William K. Bleser, and colleagues from Duke-Margolis identify six themes for planners of state cross-sectoral programs targeting health-related social needs to consider: 1. Create a structure that accommodates and balances building local capacity with scaling service delivery. 2. Leverage Medicaid demonstrations as part of a broader funding strategy to maximize flexibility and sustainability. 3. Engage diverse community stakeholders during design and implementation to maximize existing community infrastructure.  4. Build a business case for scaling and sustaining CBO capacity to overcome historic funding challenges. 5. Develop effective training and technical assistance approaches to build cross-sectoral knowledge across all program entities.  6. Ensure data and technology are flexible to support key cross-sectoral program functions and in compliance with multiple sectors’ laws and regulations.

Addressing housing-related social needs for Medicaid beneficiaries: a qualitative assessment of Maryland’s Medicaid §1115 waiver program https://lnkd.in/gQW3Yf9s

Here's another interesting article on CHW models, specifically financing and sustainability under Medicaid. Briefly, this article estimates the Medicaid payment rates needed to sustain community health worker (CHW) programs across the US, using a microsimulation model based on wage and overhead data. The study is significant because it provides a rigorous approach to support the financial viability of CHW programs. It should be noted that there are limitations to the study such as assumptions of the model, the variations in CHW program implementation and regulation, and the lack of publicly available payment data. With that said, 💎the key takeaway is that CHW programs may require higher fee-for-service or capitated rates than currently offered, and accounting for local wage and overhead costs is crucial. https://lnkd.in/gMDAkS6G #communityhealthworkers #communityhealth #sustainability

Upcoming Webinar, January 9, 10:30 am – 12:00 pm PT | California’s Medicaid transformation initiative, CalAIM, includes 14 optional managed care services that address health-related social needs, known as Community Supports. Some Community Supports, like those addressing housing insecurity, were widely implemented during CalAIM’s first year, while other services received less traction. With the aim of increasing Community Supports uptake and amplifying promising practices, this Center for Health Care Strategies webinar, made possible by the California Health Care Foundation, will highlight two less-often implemented Community Supports: sobering centers and day habilitation programs. The webinar will spotlight the experiences of a sobering center and a day habilitation provider in Orange County, and highlight their partnerships with the local Medicaid managed care plan to expand services to Medi-Cal members.  https://bit.ly/3RqupqS

Hyphen has the blueprint for supporting networks connecting social care under 1115 Medicaid waiver programs. Together with ACO Community Care Cooperative (C3), we built a platform in Massachusetts that connects payers, providers, and community-based organizations to improve population health and reduce costs—and now we’re bringing that model to New York State.   Read more from Kim Prendergast, vice president of policy at C3, and Suzanne Wogelius, MBA, vice president of product management at Hyphen, in Fierce Healthcare: https://bit.ly/3IgjITz.   If you’re interested in learning more about the Hyphen platform, contact us: hyphencare.com/contact-us.   #1115waiver #socialcare #healthequity #connectedcare

Community Health Centers in Florida face uncertain futures without state lawmakers' help. Centers are experiencing a $106 gap for every Medicaid patient visit, snowballing into unparalleled challenges, including the inability to recruit and retain providers, discontinuing services, and closing facilities. The solution is simple: Centers need an increased Medicaid reimbursement rate. FACHC is urging lawmakers including Sam Garrison, Colleen Burton, Paul Renner, Gayle Harrell, Deborah Mayfield, Tom Leek, Kathleen Passidomo, and Ben Albritton to ensure Florida’s most vulnerable patient populations continue to have access to healthcare services in the communities where they live. Read more about this critical issue in the article published by Florida Politics. #FACHC #FundCHCs #ProtectFLPatients

ICYMI, 1115 waivers - still hot right now (kudos if you get that reference). I remember when I first heard about this pilot a year ago and thinking, "wow, this is what multi-sector collaboration and breaking down silos looks like; the future." Excited to see what future iterations of the HOP program look like and can accomplish given that new CMS guidance will open the door for funding innovative and creative solutions to address HRSN. Key takeaways: 1️⃣ North Carolina's Healthy Opportunities Pilots (the Pilots) is a program addressing housing and other social needs for Medicaid enrollees. 2️⃣ Community-based organizations (CBOs) are crucial partners in providing housing and other support services, but they need capacity building and training to participate in Medicaid. 3️⃣ The Pilots were strategically launched in phases, addressing one type of social need at a time, to allow for real-time modifications and effective service delivery. Key to this were network leads that oversee a network of CBO's. 4️⃣ Medicaid can't and shouldn't handle it alone; successful implementation requires collaboration between health and housing agencies, providers, CBOs, and others. #healthrelatedsocialneeds #healthyopportunitiespilot #1115waivers