Case Studies in Healthcare Financing of Healthy Homes Services

This multiyear project is working to document and demystify the landscape and opportunities surrounding healthcare financing for healthy homes services. In Year One of the project, the National Center for Healthy Housing (NCHH) conducted a nationwide survey to identify states where healthcare financing for lead poisoning follow-up or home-based asthma services was already in place or pending.

In Year Two and Year Three of the project, NCHH and a project team led by the Milken Institute School of Public Health conducted a series of interviews in key states identified by the survey. An interview guide was developed to ask key informants in each state questions about the extent and nature of Medicaid-supported services within the state, details of services covered, barriers to implementation, next steps for expanding services and increasing access, and lessons learned. In each state, the project team conducted interviews with at least one representative from the state Medicaid agency, a program contact in the state health department and one to two additional stakeholders (e.g., advocates, local programs, payers, or providers). The interviews were used to develop detailed case studies to distill lessons learned in states with Medicaid reimbursement for healthy homes services and ultimately to better equip other states in seeking reimbursement for these services.

To accompany this suite of case studies, Year Three will also see the publication of a summary paper designed to cultivate common themes and lessons learned across the full set of 10 case studies. This paper will help state and local agencies, nongovernmental organizations, and other stakeholders pursue healthcare financing of home-based lead poisoning and asthma services.

Summary

This summary paper examines the findings of 34 interviews conducted with Medicaid agencies, public health departments, and other stakeholders in 11 states to distill lessons learned about pursuing healthcare financing for healthy homes services at the state level.

Printable Packages:

Summary Paper [pdf]

Summary Paper with All 11 Case Studies
[pdf]

Summary Paper with 8 Asthma Case Studies [pdf]

Summary Paper with 2 Lead Case Studies [pdf]

Asthma

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.

Lead

Childhood exposure to lead can have lifelong consequences including decreased cognitive function, developmental delays, and behavior problems; and, at very high levels it can cause seizures, coma, and even death. The Centers for Disease Control and Prevention (CDC) recommend follow-up services for children with blood lead levels at or above the current reference value of 5 μg/dL. This includes continued monitoring of the blood lead level, nutritional intervention, environmental investigation of the home, and lead hazard control based on the results of the environmental investigation. The regulatory and workforce infrastructure to provide these services exists in many states, but many children in at-risk communities still lack consistent access to lead follow-up services. 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 provide lead follow-up services, but many may be unsure about how to translate these evidence-based practices into sustainable systems and policy.

These case studies summarizes the current healthcare financing landscape in Ohio and Rhode Island for lead follow-up services. Based on survey findings and interviews with each state's Medicaid agency, its state health department, 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 lead follow-up or other preventive services, or for stakeholders within the respective state interested in a summary of current and future opportunities within the state.

Ohio: The project team conducted interviews with representatives from the Ohio Department of Health, the Ohio Department of Medicaid, and the Ohio Healthy Homes Network.

Rhode Island: The project team conducted interviews with representatives from the Childhood Lead Action Project, the Rhode Island Department of Health, the Rhode Island Healthy Homes Lead Poisoning Prevention Program, and the Rhode Island Executive Office of Health and Human Services.


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