Proposal Presented for the Master Plan for Aging (#13)
Disclaimer
Throughout the MPA process, more than 100 proposals were developed thanks in particular to thousands of hours of work by external stakeholders and members of the public. These proposals and the MPA Council commentary are being submitted to the Governor and shared with policymakers and the public to inform policymaking. These proposals represent a starting point for discussion. Further discussion is necessary between relevant state agencies and stakeholders to both refine these proposals and assess which may be appropriate to adopt and implement.
Summary
Look for flexibilities in the 1115 Medicaid Waiver to incorporate a focus on care transition and navigation needs of the aging population in the procurement process, including Health Equity Regional Organization (HERO) and Social Care Networks (SCNs). Consider reimbursement strategies for community-based organizations, support the growth of Community Benefit Organizations (CBOs), and support full integration of social and medical care throughout the State.
Justification
There is limited access to effective and evidence-based care transition models that successfully incorporate cross-service system care coordination that provide meaningful, holistic navigation for older adults, individuals with disabilities, and their caregivers. Utilizing the 1115 Medicaid Waiver to reimburse CBOs for health promotion through education and class offerings will mitigate adverse health outcomes and decrease the demand for services in the long-term.
Full Proposal
There is limited access to effective and evidence-based care transition models that successfully incorporate cross service system care coordination and provide meaningful, holistic navigation for older adults, individuals with disabilities, and their caregivers. To address this barrier, the State would:
- Within the context of the 1115 Medicaid Waiver, formally incorporate a focus on the care transition and navigation needs of the aging population in the procurement process for new entities, including the HERO and SCNs. The State would also integrate solutions to meet these needs, including with community-based organizations, under the value-based purchasing (VBP) roadmap and seek other funding sources to maintain this focus outside of the Medicaid context.
- Through the 1115 Medicaid Waiver, reimburse CBOs to engage in health promotion through education and class offerings.
- Use the 1115 Medicaid Waiver to encourage full integration of social and medical care throughout the State. SCNs would serve as umbrella organizations to help CBOs build capacity, enhance data collection and sharing, and fully integrate with healthcare organizations.
- Support the growth of CBOs to support care for older adults, including through data sharing, partnerships between medical and social services providers, and study of the particular benefits generated by CBOs.
MPA Council Commentary
This proposal is categorized as long-term. The current iteration of the 1115 Medicaid Waiver that has been approved by CMS includes a focus on the integration of social and medical care throughout the state and is currently being implemented. The State is continuously evaluating potential additional changes to the waiver that could be negotiated with the federal government as part of future waiver renewals.