The Affordable Care Act (ACA) has affected nearly every Program within the Office of Maternal, Child and Family Health. Managers projected steep declines in safety net programs over time, but when WV far exceeded the projected goals in Medicaid enrollment, Programs experienced immediate sharp declines in service Programs. For example, the Breast and Cervical Cancer Screening Program may not even screen 25% of the women that were screened prior to Medicaid expansion, and at this time, there are no uninsured children enrolled in the Children with Special Health Care Needs Program.
In many ways the implementation of ACA has shifted the mission of the Office. Prior to January 2014, the Office focused much of its energy and funds on providing safety net services. While the Office is still providing those same services on a much smaller scale, the focus of the Office is evolving to support the Triple Aim of the ACA. The WV Department of Health and Human Resources, under the direction of Cabinet Bill Crouch, has brings together leaders from all health sectors across WV to form a Health Improvement Collaborative to support the implementation of ACA. Under this Collaborative, the Department facilitates three workgroups including Better Health, Better Care and Lower Cost. The Office continues to make numerous presentations to all three workgroups, and the Office Director is an active member of the Better Health Committee. At the time of this application, this group is working to complete the State Health Plan.
The Office is supporting the efforts of the Triple Aim in many ways. Historically, the Office has always established disseminated and monitored evidence-based practices for health care providers, specific to clinical service programs. However, the Office has taken a more active role in promoting evidence-based health services by working with Managed Care Organizations (MCO) to have services not covered in the Medicaid State Plan included as value added services. For example, one MCO began covering limited preventive dental care for pregnant women.
Like many states, WV cannot afford fee for service Medicaid in the expansion environment. As a result, enrollment in Medicaid managed care has risen dramatically. While the Office has always set standards for the State’s EPSDT Program, this role has remained and in some areas expanded with the State’s utilization of MCOs. Currently, the Office is working closely with the Medicaid and the MCOs to help with the transition of children with special health care needs to managed care.
The Office is also working to support linkages for coordinated care at the community level. This became a central focus of the Children with Special Health Care Needs Program during the Program’s recent redesign. The redesign was hastened by the implementation of ACA in order to meet the goal of assuring that children receive services within their community and that those services are coordinated among all the child’s providers. This is a theme throughout OMCFH programs including the Home Visitation and Birth To Three Programs.
The Office also continues to advance quality maternal child health programs. One example of this effort is the implementation of the State’s Home Visitation Program. The Program has become one of the Office’s foundational programs over the last year, because it exemplifies the goals of ACA in a way that residents of WV understand from the policy level to the family level. Implementation of this Program has provided the Office an opportunity to communicate in a meaningful way with new stakeholders and partners. While the relationship with the Department’s Bureau for Children and Families is not a new one, both groups have struggled to find a common language. Language created barriers in identifying ways to improve the health outcomes of children, a common goal. The Home Visitation Program provides a common language that allows both groups to address the issue of child welfare at a broader level.
In addition, the Office continues to monitor the quality of clinical practice at the community level. For example, the HealthCheck Program audited provider charts to assess the level of developmental screening for children zero to three years, and completed an audit of provider records to assess vision screening. When these audits were combined with provider training, rates for developmental screening with an approved tool more than doubled for some age groups. Improvements are further supported by the fact that the Birth To Three Program experienced corresponding increases in the number of referrals for this same time period. The Office intends to expand the practice of clinical audits to other critical issues.
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