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APHA Scientific Session and Event Listing

Recorded presentation

L. Michele Issel, PhD RN¹, Robyn R. Wheatley, MPH², Sarah G. Forrestal³, and Amanda A. Schultz². (1) School of Public Health, University of Illinois-Chicago, 1603 W Taylor Street (MC 923), Community Health Sciences Division, Chicago, IL 60612, 312-355-1137, issel@uic.edu, (2) Community Health Sciences, University of Illinois at Chicago, 1603 W. Taylor St. (MC 923), SPHPI, Chicago, IL 60612-4394, (3) Community Health Sciences, University of Illinois - Chicago School of Public Health, 1603 W Taylor St, 6th floor, MC 923, Chicago, IL 60612

Over time and across reports, the list of which states have Medicaid reimbursed case management of high-risk pregnant women (PCM) has varied. Conducting national research on PCM programs first requires having an accurate sampling frame of these programs. The purpose of this presentation is to articulate issues identified that affect sampling Medicaid programs. To generate a list of Medicaid PCM providers, we conducted a national survey of: (a) state web sites for potential informants; (b) each HRSA regional office; and (c) Title V directors via listserv. Of all 50 states contacted, 35 have Medicaid reimbursed prenatal case management and three have prenatal case management but not Medicaid reimbursed. We obtained provider lists from 25 of the 35 states, with 10 states pending. From the 25 lists, the number of providers per state ranged from 1 in ID, telephonic only, to 1,323 in IN with duplicates and not applicable providers, and confusion over main versus satellite offices. Qualitative notes taken during contacts reveal both HRSA and state Medicaid offices as often reluctant or unable to answer whether the state reimbursed for case management and whether a provider list was available. Two states required written requests for the information yet returned a denial. Recommendations based on lessons learned include: do not rely on existing reports, use multiple contact methods multiple times, accept some roadblocks as insurmountable, and verify provider lists. These steps help ensure a valid denominator for generating a sample.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

(
• Name key challenges to obtaining lists of Medicaid-reimbursed non-medical services. (
• Appreciate the influence of state variability in Medicaid reimbursement on defining a program specific sampling frame. (
• Selectively apply contact methods and follow-up techniques that have been effective in obtaining states’ Medicaid program information.

Keywords: Medicaid, Case Management

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation