The particular focus of this session is the ways in which local public health and pediatric service providers used Medicaid to re-shape the delivery system for impoverished children. Medicaid historically has played an “important, if not always consistent, role” in improving access to health care for impoverished children.” Our efforts provide an example of how public health and medical leadership can use Medicaid to integrate scattered prevention services, target them at a population most at risk for preventable illness and disability, and re-organize public federal, state and local funding streams to support the new model of preventive pediatric care.
The Rochester Child Health Initiative was part of the national Robert Wood Johnson Child Health Initiative. We developed locally driven financing reform to expand pediatric services for impoverished, young children. Two Medicaid mechanisms were created: a contract between the local health department and a Medicaid managed care plan, and a Medicaid EPSDT administrative funding stream to fund home visitors. We show the two ways in which Medicaid was used as part of a broader initiative to integrate categorically funded prevention programs for impoverished children. We describe how the local health department created a reimbursement contract with a Medicaid managed care plan. We explain how Monroe County used EPSDT administrative revenue to support home visiting services by public health nurses and lay paraprofessionals, and which increased the program budget by 27%. The conclusion summarizes the factors that allowed success, obstacles overcome and unsurmounted, unintended consequences, and applicable lessons for other communities.
Learning Objectives: 1. To learn how one community integrated Medicaid into an overall plan to integrate prevention services for young, poor children with primary pediatric care. 2. To learn how a contract between a health department and Medicaid managed care plan was negotiated. 3. To learn how to create a Medicaid administrative revenue stream to support outreach to impoverished children
Keywords: Medicaid, Child Health Promotion
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.