Care Coordination
Most Title V programs fund care coordination for Children and Youth with Special Health Care Needs (CYSHCN), but these services are often limited by the availability of block grant funds or state funding for this specific service. Several states have expanded the availability of care coordination services for CYSHCN by blending state Title V and Medicaid funding, or by blending Title V and Medicaid funding. Other states use Medicaid funding alone for care coordination.
In Michigan and Utah, state funds for CYSHCN are used to provide the state match to draw down federal Medicaid funds for care coordination for Medicaid-eligible CYSHCN. This means that states are able to expand the availability of care coordination services by preserving their block grant funds to pay for care coordination for children who are uninsured or privately insured. Michigan also uses these funds to provide case management services, including coverage for nurse home visits for children with more complex conditions.
In New Mexico, Title V employs 45 social workers throughout the state to provide care coordination for CYSHCN enrolled in either Title V or Medicaid. Care coordination is financed with a mix of Title V and Medicaid dollars.
Maine Medicaid uses Early Periodic Screening, Diagnosis, and Treatment (EPSDT) funding to operate its own three-tiered care coordination program:
• Tier 1: The state’s Medicaid member services office provides standard referrals to services for all children.
• Tier 2: Nurses focus on hard-to-find services such as dental care for CYSHCN, private duty nursing, and mental health care.
• Tier 3: Public health nurses work with families using the Bright Futures guidelines, a detailed standard of care to promote the health and well-being of children with a particular focus on child development and screening.
Oklahoma Medicaid also operates its own care management unit, using nurses and social workers to coordinate care for members. Other state Medicaid programs, such as Oregon’s, purchase care coordination services from outside vendors.
The California and Vermont Medicaid programs fund the delivery of care coordination services in conjunction with primary care practices. In California, this is accomplished by paying enhanced rates for pediatric primary care, which includes funding for care coordination for CYSHCN. Vermont Medicaid, on the other hand, hires its own care coordinators who work with primary care practices to provide care coordination for adults or children with disabilities who are not connected with other care coordination services.
Texas Medicaid reimburses clinicians for face-to-face and non–face-to-face care coordination for CYSHCN served by the Medicaid program or the CSHCN Services Program. This new service is called Clinician Directed Care Coordination.
Highmark Caring Foundation’s program, “Care Coordination for Children with Special Health Care Needs and Their Families,” has provided care coordination services to over 5,000 children with special needs enrolled in CHIP in the 49 counties of Pennsylvania served by Highmark over the past two years. In addition, over 320 children and families have received in-home evaluations and on-going services from their Nurse Care Coordinators in the Caring Program. This special needs program and effort is solely funded by Highmark’s Caring Foundation.
Also in Pennsylvania, Title V dollars support care coordination through the Pennsylvania Medical Home Program. When pediatric practices are trained, they can receive a small, short term stipend to support the cost of a care coordinator. Practices need to meet minimum practice criteria to be eligible for this funding. The Medical Home Program has trained 107 practices since inception in 2002 and is active in 37 counties. Pennsylvania has also developed some pay-for-performance (P4P) measures surrounding CYSHCN. Any pediatrician who serves children with complex care needs can receive extra funding for maintaining and updating a care plan twice a year. This is available to any pediatrician or family practice physician in Pennsylvania, not only those who are part of the medical home initiative.
Rhode Island ‘s Comprehensive Evaluation Diagnosis Assessment Referral, Re-evaluation Program (CEDARR) Family Centers is a Medicaid-sponsored program that provides care coordination/care management, along with a range of services such as nursing care, home-based therapeutic care, or respite care. In addition, the RIte Care plans serve children who are low income (and their families) and provide in-plan care coordination by health plan staff. Also, the Pediatric Practice Enhancement Project (PPEP) employs parents in key primary and specialty sites to provide services including care coordination. There are 25 practices that are funded as PPEP sites through the Health Department‘s New Freedom Initiative (D-70) grant and through the Department of Human Services.
