STRATEGIES FOR CHANGING STATE MEDICAID POLICY
TO IMPROVE SERVICES TO CHILDREN WITH MEDICAL COMPLEXITY
STEPHEN FITTON AND MEG COMEAU, MHA
Children with medical complexity (CMC) are a growing population disproportionately covered by Medicaid for their healthcare needs.1 It follows that Medicaid policy has a major impact on healthcare access and quality for CMC. As an exceptionally large public program serving more Americans than Medicare, Medicaid also has influence on broader state health policy and can influence the design of state commercial health insurance coverages for CMC. This paper will introduce a number of existing Medicaid policy instruments and then explain how they can be used more effectively for programs and providers dedicated to serving CMC. Because Medicaid programs are so variable across the nation, this paper also will provide a diagnostic approach to understanding each state’s Medicaid policy and service delivery system environment. The different environments shape decisions about which Medicaid policy instruments will be most effective in improving services for CMC. Finally, strategies of different scale are offered to demonstrate how policy can be changed in increments from targeted to transformative. The ultimate purpose is to improve the service delivery system for CMC and their families, which can be accomplished in many ways.
A unique and key challenge around CMC is the lack of a universal definition of the population and especially the ability to operationalize a common definition. This could merit its own discussion but for our purposes it is sufficient to point out that the literature cites, often without qualification, CMC prevalence levels ranging from 0.5% to 6%.2–5 Rather than try to impose a definition, this paper leaves that as a choice for the reader in their particular circumstance.6 The bottom line is that this process is offered for your purposes in your environment.
Full PDF article can be found here: FITTON – STRATEGIES FOR CHANGING STATE MEDICAID POLICY