Medicaid and Head Start: Opportunities to Collaborate and Pay for Upstream Prevention

Steinberg A, Chang DI
Publication Year: 2018
Patient Need Addressed: Care Coordination/Management, Financial insecurity, Food insecurity, Homelessness/housing, Patient satisfaction/engagement
Population Focus: Medicaid beneficiaries
Demographic Group: Child
Intervention Type: Partnership, Service redesign
Type of Literature: Grey
link: https://www.academyhealth.org/sites/default/files/medicaid_head_start_may2018.pdf
Abstract

Significant potential for alignment of care coordination and service delivery exists between Head Start and Medicaid. This issue brief draws upon initial experiences from Maryland Medicaid’s early efforts to explore connecting one Medicaid managed care organization (MCO) with one or more local Head Start programs in the interest of linking families to needed services — including at least one upstream preventive service — and addressing the social determinants of health. Maryland Medicaid is meeting with a Medicaid MCO, Head Start representatives and a representative from the Maryland Academy of Nutrition and Dietetics to pilot the delivery of Medicaid-funded group nutritional counseling in Head Start settings.

Research has found that interventions in the areas of housing, income support, nutrition support, care coordination and community outreach have had positive effects in terms of health improvement or healthcare spending reductions. Serving many of the same families, Head Start and Medicaid are natural partners to address social determinants of health and connect families to needed health services. This type of partnership could serve as a model and be developed in other states to explore braided funding approaches to support children’s optimal health and well-being.

Insights Results

Overview of article

  • Research has found that interventions in the areas of housing, income support, nutrition support, care coordination and community outreach have had positive effects in terms of health improvement or healthcare spending reductions. Serving many of the same families, Head Start and Medicaid are natural partners to address social determinants of health and connect families to needed health services. This type of partnership could serve as a model and be developed in other states to explore braided funding approaches to support children’s optimal health and well-being
  • Nemours Children’s Health System was awarded a 1-year grant to help 3 state Medicaid programs test approaches to financing upstream prevention and population health. Nemours provided technical assistance to 3 states – Maryland, Oregon and Washington – as they developed or implemented upstream prevention strategies using Medicaid funds

Results

  • Head Start helps to ensure early identification of health issues. Medicaid provides the medical home, and the broad Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit mandate entitles children to any treatment or procedure — within any category of Medicaid-covered services — to correct or ameliorate physical and mental illness or conditions
  • The risks families face and factors affecting their well-being are social determinants of health. Pursuing information-sharing mechanisms between Head Start(s) and Medicaid could be valuable for states to consider as they develop or enhance efforts to connect children to both needed healthcare and social services
  • Among the following opportunities identified, Maryland committed to pursuing the reimbursement of dietitians for group counseling in a Head Start setting: 1) Identify outreach and case management overlap opportunities between Medicaid and Head Start, and leverage knowledge and resources from both programs to optimize coordination and effectively meet families’ needs; 2) Gain information on the broader array of social determinants of health families face; 3) Engage vulnerable children and families to help them access preventive care and promote medical homes; 4) Engage vulnerable children and families to help them access needed treatment

Key takeaways/implications

  • Maryland’s initial efforts highlighted the following four strategies for leveraging existing financing streams to better address upstream needs and social determinants of health: 1) Aim for a financing approach to support children’s optimal health and well-being; 2) Ensure that Medicaid-covered services are paid for by Medicaid; 3) Reduce duplication of administrative functions as well as clinical services; 4) Identify the remaining needs for which a payment mechanism does not exist
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