If the promise of new and emerging approaches to integrated and cost-effective care for people experiencing chronic homelessness and PSH tenants is to be realized, many aspects of Medicaid state plans will have to be brought into alignment. Service definitions will need to be updated, examining them to assure that they can accommodate the evidence
This research has sought to identify the many ways that our case study states and communities are moving forward, using and modifying their Medicaid programs and health care delivery systems to better serve people with histories of chronic homelessness. Our findings indicate that Medicaid's configurations up through 2013 offered opportunities for
The past few years have been a time of great ferment in the health care world, with the next few years promising to see even more evolution and change. Medicaid is an important part of these changes, as states design and implement the coverage expansion aspects of the Affordable Care Act while also looking for ways to get better results from the h
In Minnesota, a 2010 state law authorized the Department of Human Services to develop a Medicaid demonstration project to test alternative and innovative health care delivery systems, including Accountable Care Organizations. That year a state law also authorized Hennepin County to establish a pilot program to provide a health delivery network for
This chapter looks at three innovative models for care coordination for individuals experiencing chronic homelessness. Two of the examples are initiatives to create Accountable Care Organizations (ACOs) or ACO-like models--Hennepin County, Minnesota's Hennepin Health and Chicago's Together4Health (T4H). These initiatives are led by providers from
"Full-risk" managed care plans receive funding on the basis of capitation, meaning that the plans are paid a set amount per-member per-month and expected to cover all care needed by their members. Capitation payments may be adjusted based on a variety of factors, including geography (reflecting regional cost variations within a state), characteris
Nationwide, over 1,100 federally funded Health Centers served over 21 million patients in 2012. 35 The majority of Health Center patients have incomes below the federal poverty level. Before 2014, more than one-third of Health Center patients were uninsured, and 40 percent of health center patients were Medicaid beneficiaries. Many patients wh
Cook County, Illinois, is another community that used a Medicaid waiver as a "bridge to reform." At the end of October 2012, Illinois received federal approval for an 1115 waiver to use Medicaid financing to expand coverage through CountyCare, a program operated by the State of Illinois and the Cook County Health and Hospital System (CCHHS). CCHHS
California's "Bridge to Reform" 1115 waiver authorized counties to create Low Income Health Programs (LIHPs) to prepare for the expansion of health coverage in 2014 under the Affordable Care Act. The waiver allowed each California county to decide whether to establish an LIHP, and most counties chose to do so. 26 California's counties were resp
In addition to providing coverage for health benefits for many uninsured low-income people who would not otherwise qualify for Medicaid until 2014, the waivers expanded the base of financing for providers who are part of the health care safety net. This financing took the form of federal Medicaid funds that match state and county spending on healt
The approaches described in this report are being developed and implemented in a period of dramatic change and challenging circumstances. During the transitional period before the Affordable Care Act was fully implemented, stakeholders at all levels were attempting to sustain programs in a lean fiscal climate while designing new strategies that ma
This report presents the results from six community case studies we conducted from early 2011 through early 2013. We observed as these communities designed and implemented service funding strategies such as Medicaid waivers, state plan amendments, health care delivery system reforms, and new programs and partnerships.
Increasingly, states are working to develop more efficient and effective systems of care. The Affordable Care Act included many provisions to give these efforts a substantial push forward. This section examines several approaches that state Medicaid officials could consider as ways to meet the needs of people who are now experiencing chronic homel
Until recently, most people with disabilities who were enrolled in Medicaid, including people experiencing homelessness and those who became tenants of PSH, have received health care and behavioral health services reimbursed through fee-for-service arrangements.
This chapter begins with a review of the basic fee-for-service payment mechanisms and payments for FQHCs that have been used most frequently to provide Medicaid reimbursement for services to people living in PSH. Next, the chapter focuses on Medicaid managed care. While new payment mechanisms are being developed, these three mechanisms will likely
PSH is intended to provide affordable housing combined with supportive services for people with disabilities or other significant barriers to housing stability. PSH is decent, safe, affordable, community-based housing, providing tenants with the rights of tenancy through leases and similar arrangements. PSH staff help tenants link to voluntary and
There is considerable uncertainty regarding the relative contribution of various factors to the slowdown in national healthcare spending. Factors likely to have affected spending growth in recent years include:
Based on our synthesis of the strengths and limitations of measurement approaches and feedback from our expert panel, we propose prioritizing the measurement of outcomes. This would involve developing the infrastructure for outcomes monitoring and building capacity for delivering evidence-based psychotherapies.
Health systems must overcome several obstacles to widely implement psychotherapy outcome measures, including: (1) selecting outcome measures that are meaningful for consumers, providers, and other stakeholders; (2) deciding on the appropriate level of reporting and strategies for making fair comparisons across providers, plans, or systems; (3) ove