| MOUs
to Improve Linkages between Medicaid Managed Care
Organizations and Public Health Agencies Serving
Children |
|
Managed
care structures affect how public health agencies
carry out their community-wide public health
responsibilities. Certain states now require
that managed care organizations (MCOs) contracting
with Medicaid establish Memoranda
of Understanding (MOUs) with local public
health agencies to address some of these issues.
State
Title V MCH programs can and should help local
public health agencies learn about managed care
and the MOU process. In terms of EPSDT, MOUs
might define interaction related to case management,
data reporting, immunization billing, children
with special health care needs, and so forth.
Studies
by the GWU-Center for Health Services Research
and Policy indicate that: |
- MOUs
play a useful role in establishing working
relationships between public health agencies
and MCOs.
-
MOUs often do not address core public health
functions beyond the provision of personal
health services.
-
While MOUs often describe billing arrangements
for covered services delivered by a local
health department, such arrangements are often
not in use.
|
| MOUs
have a limited impact on resolution of certain
fundamental issues and do not typically improve:
|
- State
and local public health agencies’ access
to data needed for community-wide disease
surveillance (e.g. immunization registries).
-
MCO participation in larger community efforts
to control public health threats (e.g., communicable
disease outbreaks, lead exposure).
- MCO
understanding of quality improvement standards
advocated by public health agencies as a means
of community-wide public health protection.
|
| Linkages
to Other Public Programs Top |
|
Children
with Special Health Care Needs Programs |
| Many
children identified by Title V Agencies as CSHCN
are Medicaid recipients.Program
linkages can improve care, reduce expenditures,
and better support families. |
-
An EPSDT
Check list prepared by the National Health
Law Project, which can be used to guide planning
for CSHCN.
- Policy
brief discusses Medicaid and EPSDT, as
well as home and community based services
for CSHCN
|
| Child
Welfare Programs, including Foster Care |
| Children
entering the foster care system are entitled to
Medicaid and an initial or periodic EPSDT screen.
States have a variety of approaches to fulfilling
this obligation. |
-
FAQs
on how Arizona's EPSDT program pays for medically
necessary services for a child in foster care.
|
| IDEA
Part C Early Intervention Program |
| Under
the federal Individuals with Disabilities Education
Act (IDEA) Part C program, states provide early
intervention services for infants and toddlers
(birth to age 3) that have or have a high risk
for experiencing developmental delays. Some children
qualify for both Medicaid and IDEA financing.
Medicaid financing for certain services provided
to a child and family under a Part C is permitted
by federal law. |
| |
| Head
Start Programs |
| A
majority of children served in Head Start programs
are Medicaid eligible. The Federal
Head Start rules call for linkages and coordination.
|
