A large body of evidence suggests that home visiting programs that address indoor environmental triggers (e.g., cockroaches, mice, tobacco smoke, mold) can improve asthma control, reduce asthma-related hospitalizations and emergency department visits, and provide a positive return on investment. These types of services are recommended as a component of comprehensive asthma care for people with poorly controlled asthma but are not widely available and often limited in scale. However, recent changes resulting from healthcare reform have increased opportunities for states to consider more sustainable and widespread implementation. Some states have already invested heavily in developing programs, policies, and funding to increase access to these critical public health services. Yet many states may be unsure about how to translate these evidence-based practices into policy.
These case studies summarize the current healthcare financing landscape
for home-based asthma services with an emphasis on public financing. Based on survey findings and interviews with state Medicaid agencies, state health departments, and other stakeholders, they describe the current state of healthcare, other important funding mechanisms, key barriers, next steps, and lessons learned. This information may be useful to stakeholders in other states that are seeking healthcare financing for home-based asthma or other preventive services, or for stakeholders interested in a summary of current and future opportunities within the state.Case studies in states where Medicaid coverage of home-based asthma services is or has been in place at one time:California:
The project team conducted interviews with representatives from the Alameda County Health Department, the California Department of Health Care Services, the California Department of Public Health, and Regional Asthma Management and Prevention.Delaware:
The project team conducted interviews with representatives from the Delaware Division of Medicaid and Medical Assistance, the Delaware Division of Public Health, and Nemours/Alfred I. duPont Hospital for Children.Missouri:
The project team conducted interviews with representatives from Children’s Mercy Hospital, the Missouri Department of Health and Senior Services, the Missouri Department of Social Services’ MO HealthNet Division, and the Asthma and Allergy Foundation, St. Louis Chapter. New York:
The project team conducted interviews with representatives from the American Lung Association in New York, Little Sisters of the Assumption Family Health Service, the Monroe Plan for Medical Care, and the New York State Department of Health. Case studies in states (and Washington, DC) where Medicaid coverage of home-based asthma services is not yet in place but there is interest or efforts are ongoing:District of Columbia:
The project team conducted interviews with representatives from the Asthma Control Program, District of Columbia Department of Health; the DC Asthma Coalition; the Health Care Delivery Management Administration, DC Department of Health Care Finance (DHCF); and IMPACT DC (Improving Pediatric Asthma Care in the District of Columbia). South Carolina:
The project team conducted interviews with representatives from the South Carolina Department of Health and Environmental Control, the South Carolina Department of Health and Human Services, and the Medical University of South Carolina. Vermont:
The project team conducted interviews with representatives from the Department of Vermont Health Access, the Vermont Department of Health, and Health Resources in Action.Washington:
The project team conducted interviews with Dr. Greg Ledgerwood, AAFP, ACAAI, AE-C, and with representatives from the Tribal Healthy Homes Network and the U.S. Department of Health and Human Services, HRSA.