Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Slides:

Advertisements

Similar presentations

The Burden of Obesity in North Carolina Obesity-Related Chronic Disease.

Advertisements

Mental Health is Integral to Overall Health. Health Issues Related to People with Serious Mental Illness People with SMI who receive services in the public.

Figure 1. Medicaid and CHIP Leaders’ Views of Their State’s Top Children’s Health Priorities Source: Health Management Associates/Commonwealth Fund Child.

Medicaid Health Homes Presented by: Jayde Bumanglag, Quinne Custino & Sean Mackintosh.

State Models of Medicaid/Behavioral Health Collaboration New Jersey Stakeholder Group Meeting January 20, 2012 Allison Hamblin, CHCS.

Using AHRQ Prevention Quality Indicators to Assess Program Performance in Medicaid Managed Care Sandra K. Mahkorn MD, MPH, MS Chief Medical Officer Wisconsin.

Child Health Disparities Denice Cora-Bramble, MD, MBA Professor of Pediatrics, George Washington University Executive Director Goldberg Center for Community.

Mercy Care Advantage HMO SNP

Macon County Community Health Needs Assessment Report of Findings 2012.

Medicaid, BHP, and CHIP: Current Issues in ACA Implementation Eliot Fishman, PhD Director, Children and Adults Health Program Group Center for Medicaid.

8/17/2015 Provider Educational Seminar Care Management: Part III 8/17/2015.

Special Needs Plans Susan Nedza, M.D., M.B.A. Chief Medical Officer, CMS Chicago Regional Office March 23, 2006.

Michael Fiore, Director Division of Plan Policy Centers for Medicare and Medicaid Services June 6, 2006 Innovations in Medicare Managed Care for Dual Eligible.

Course 17: Neglected Tropical Diseases & NCDs 9 th GA of IAPB Hyderabad; 19 th September 2012 NCDs & Eye Health Converging interests and opportunities.

Medicaid Managed Care: KanCare Request for Proposals House Social Services Budget Committee Topeka, Kansas January 11, 2012 Scott Brunner Senior Analyst.

Health and Wellness: Introduction to Health Promotion/Disease Prevention Copyright © 2003, Mosby, Inc. All rights reserved.

Missouri’s Primary Care and CMHC Health Home Initiative

NHP/Brightwood Evaluation If special programs work - clinically and financially - for small groups of members with complex but homogeneous disability and.

MaineCare Behavioral Health Homes January,

2 AMERIGROUP Community Care Entered Maryland market in 1999 Largest MCO in Maryland Serving over 143,000 members in Baltimore City and 20 counties in.

Robert Margolis, M.D. Chairman & CEO HealthCare Partners ACO’s – Getting from Here to There Benefits / Risks / Opportunities.

Medicaid Managed Care for Older Persons and Persons with Disabilities: National Overview PRESENTATION BY PAUL SAUCIER at the NATIONAL ACADEMY FOR STATE.

Medicare’s Disease Management Activities Stuart Guterman Director, Office of Research, Development, and Information Centers for Medicare & Medicaid Services.

Primary Care and Behavioral Health 2/4/2011 CIBHA.

Section 2703: State Option to Provide Health Homes for Enrollees with Chronic Conditions Mike Hall, Director Division of Integrated Health Systems Disabled.

Bringing Integration Initiatives to Reality: State Implementation Mohini Venkatesh National Council for Community Behavioral Healthcare February 9, 2012.

The Indiana Family and Social Services Administration Section 2703 Health Homes July 13,2012.

 Health: is a state of complete physical, mental, and social well-being and not the absence of disease.  Social Epidemiology: is the study of the distribution.

Behavioral Health Screening in Pediatric Preventive Care The HUSKY Health Approach Robert W. Zavoski, MD, MPH Medical Director, CT Department of Social.

Alliance Hill Briefing May 4, 2012 Healthcare Integration: The Behavioral Health Perspective.

HEALTH HOMES ARKANSAS DEPARTMENT OF HUMAN SERVICES LONG-TERM CARE POLICY SUMMIT SEPTEMBER 5, 2012.

Josette Dorius, Service Director Autism Council of Utah April 6, 2011.

Health Care Reform Primary Care and Behavioral Health Integration John O’Brien Senior Advisor on Health Financing SAMHSA.

National Commission for Quality Long Term Care Testimony of George Taler, MD Director, Long Term Care Washington Hospital Center Washington, DC Past President,

1 A Risk Adjustment System for the Medicare Capitated ESRD Program.

P4P as a Support Tool for Medicaid Disease Management Programs Jim Hardy President, Sellers-Feinberg.

Iowa’s Section 2703 Health Home Development October 04, 2011 Presentation to: 24 th Annual State Health Policy Conference Show Me…New Directions in State.

Jason Bearden, CEO Highland Rivers Health Laurie Wilburn-Bailey, Clinical Director Advantage Behavioral Health Systems David Wallace, Director, Residential.

Integrating Behavioral Health and Primary Care

Maryland Medicaid’s Partnership in Improving Behavioral Health Services Susan Tucker Executive Director, Office of Health Services May 14, 2014.

DataBrief: Did you know… DataBrief Series ● October 2011 ● No. 21 Dual Eligibles, Chronic Conditions, and Functional Impairment In 2006, 37% of seniors.

Oregon's Coordinated Care Organizations: First Year Expenditure and Utilization Authors: Neal Wallace, PhD, Peter Geissert, MPH 1, and K. John McConnell,

Transition to Reform in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services D. McDowell1.

EPSDT and SUD Treatment in California Presentation to CBHDA Governing Board December 9, 2015 Lucy Pagel, Molly Brassil, and Don Kingdon, Harbage Consulting.

Transitions to Adulthood for Youth with Disabilities Robert Wm. Blum, MD, MPH, PhD William H. Gates, Sr. Professor and Chair Department of Population.

San Diego Long Term Care Integration Project LTCIP Planning Committee October 11, 2006.

Special Needs Plans Sandra Bastinelli, MS, RN Acting Director, Division of Special Programs Medicare Advantage Group Center for Beneficiary Choices.

Approaches to Slowing Cost Growth in Public Programs State Coverage Initiatives National Meeting August 5, 2010 Nikki Highsmith Center for Health Care.

Idaho Medicaid Overview Disability Rights Idaho. Idaho Medicaid Overview ▪Medicaid is a federal/state partnership program designed to provide the benefits.

Diabetes: 0–44 years Ranked comorbidity combinations Source: ABS Australian Health Survey 2011–12 (National Health Survey component) For people aged 0–44,

Medicaid Managed Care for Persons with Severe Mental Illness in New York: Challenges and Implications Michael Birnbaum Director of Policy, Medicaid Institute.

KanCare Renewal Stakeholder Feedback Forums May 24, 25 and 26, 2016; 1:00-3:00 and 5:30-7:30 pm Topeka, Kansas City, Wichita, Hays & Pittsburg, Kansas.

Can Managed Care Turn the Tide for Complex Populations?

Ratio of percentile groups

Health Homes – Providing Care to Our Recipients

Medicaid Managed Long Term Services and Supports – Moving Forward

Health Care for the Homeless and Hepatitis National Hepatitis Coordinators' Conference January 27, 2003 Presented by: Amy M. Taylor, MD, MHS Deputy Chief,

Chart 1.17: Medicare Enrollees,(1) 1995 – 2015

Health Homes – Providing Care to Our Recipients

HCBS Claims Analysis Chartbook: A Final Report

Health Home Program Services for Patient 1st Medicaid Recipients

Health Home Program Services

Addictions Developmental Disabilities Mental Health

An Overview of State Medicaid Policy the Executive Branch Prospective

Characteristics of Dual Eligibles

Nassau-Queens PPS Health Home 101

Changing Pattern of Childhood Illness & Disability

Medicare and Disease Management

Chronic Disease Transitional Care Northridge Hospital Medical Center

Presentation transcript:

Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid Working Group Medicaid Working Group Boston University School of Public Health Funded by the Center for Health Care Strategies

Medicaid Working Group - Boston University School of Public Health2 Health Plan Responses 127 plans (+-) enroll the SSI population 127 plans (+-) enroll the SSI population 61 health plans responded - 48% response rate 61 health plans responded - 48% response rate 61% predominantly (>75%) Medicaid plans 61% predominantly (>75%) Medicaid plans 39% commercial + Medicaid plans 39% commercial + Medicaid plans 59% also enroll Medicare beneficiaries 59% also enroll Medicare beneficiaries

Medicaid Working Group - Boston University School of Public Health3 States

4 Total Medicaid Enrollment

Medicaid Working Group - Boston University School of Public Health5 Medicaid SSI Enrollment SSI Enrollment

Medicaid Working Group - Boston University School of Public Health6 Clinical Programs - Overview  98% of plans have special clinical programs for Medicaid enrollees  Most (87%) have programs for MCH population or asthma/ diabetes disease management.  More than half (61%) have programs for some portion of SSI population

Medicaid Working Group - Boston University School of Public Health7 General Categories of Programs  Disease Management  Intensive Case Management  General Case Management  Behavioral Health Programs

Medicaid Working Group - Boston University School of Public Health8 Disease Management Programs n n Asthma59% Diabetes49% n n CHF/Cardiovascular20% n n Pregnancy20% n n Hypertension11% n n Sickle cell10% n n HIV/AIDS 8% n n COPD 7%

Medicaid Working Group - Boston University School of Public Health9 Case Management Programs n n Pregnancy/high risk44% n n Children with special health care needs25% n n HIV/AIDS23% n n Serious mental illness17% n n Physical disability/rehab/DME users16% n n Transplants16% n n Developmental disability 8%

Medicaid Working Group - Boston University School of Public Health10 Special Behavioral Health Programs  Only half of the plans receive the Medicaid capitation for behavioral health  Of these, 59% carve-out behavioral health services to a BHO  Half of the plans report special mechanisms to coordinate behavioral and physical health services

Medicaid Working Group - Boston University School of Public Health11 Special Behavioral Health Programs 10 plans described a special behavioral health program for one or more of the following populations: n n People with serious and persistent mental illness n n Children with serious emotional disturbances n n People with developmental disabilities n n People with physical disabilities

Medicaid Working Group - Boston University School of Public Health12 Detailed Program Descriptions  51 plans  18 states  71 programs –46 programs for MCH population, asthma or diabetes case management, hypertension –20 programs for SSI population or some portion, special needs –5 programs for COPD or cardiac disease mgmt.

Medicaid Working Group - Boston University School of Public Health13 20 Plans With Programs for SSI  SSI population 5 plans  Chronically ill, special needs populations 5 plans  Children with special health care needs 4 plans  Frail elders 3 plans  HIV 3 plans  Sickle cell, physical disability, CHF 2 plans  Morbidly obese, rehabilitation, transplants, wound care, foster children, COPD ( 1 plan each)

Medicaid Working Group - Boston University School of Public Health14 Referral Sources

Medicaid Working Group - Boston University School of Public Health15 Case Management Functions

Medicaid Working Group - Boston University School of Public Health16 Other Program Functions

Medicaid Working Group - Boston University School of Public Health17 Special Provider Relationships

Medicaid Working Group - Boston University School of Public Health18 Program Obstacles