The Alaska Title V program continues to partner with the health care delivery system, including Medicaid, to reduce duplication and improve access to health care for families. In the 2017-2020 WCFH Strategic Plan, WCFH identified that strengthening essential public health infrastructure, services, and partnerships is one of the four strategies the Section uses to achieve our mission and vision. This strategy is achieved through partnering with families and consumers, collaborating broadly to grow networks and systems, and building capacity through education, securing funding, and sharing quality data.

All of the programs and services within WCFH are delivered in collaboration and partnership with others. In addition to the Title V Block Grant, other key federal programs administered by WCFH include the Maternal Infant Early Childhood Home Visiting (MIECHV) program, Early Childhood Comprehensive Systems (ECCS),  Universal Newborn Hearing Screening/Early Hearing Detection & Intervention (EHDI), Personal Responsibility Education Program, CDC Rape Prevention Education Program, HRSA Oral Health Workforce Development, Title X Family Planning, and CDC Breast and Cervical Cancer Screening. Title V funds are braided with TANF funds to support unintended teen pregnancy prevention work and improving clinics to be teen-friendly.

The past year has shown continued growth and development of partnerships both within and outside of State government. WCFH continues to increase partnership with the Department of Education and Early Development (DEED). Staff partner with DEED on a funding initiative titled, “Improving Student Health and Academic Achievement through Nutrition, Physical Activity and the Management of Chronic Conditions in Schools.” WCFH and DEED also co-coordinate Alaska’s Early Childhood Coordinating Council. WCFH has been identified as the lead for early childhood within the DHSS. WCFH also continued to partner with DEED on Year 1 of Alaska’s Preschool Development Grant. WCFH also took the lead on COVID-19 for DHSS in terms of partnering with DEED on the reopening of schools. Both the Title V Director and Title V-funded School Nurse Consultant provided health guidelines that were included in the Smart Start Framework to reopen schools. WCFH also continues to administer the Parents as Teachers grant program on behalf of DEED.

WCFH also continues to partner with the Division of Behavioral Health, Office of Substance Misuse Addiction & Prevention, and the Office of Children’s Services on increasing the use of universal screening of substance for all pregnant women and plans of safe care for all families in Alaska.

WCFH continues to partner with other state government partners including the Governor’s Council on Disabilities & Special Education and Early Intervention on improving the use of evidence-based developmental screening tools and launching Help Me Grow Alaska. Title V partners with the DPH Section of Chronic Disease Prevention and Health Promotion on initiatives related to childhood obesity, violence prevention, oral health, breastfeeding, and cancer prevention leadership activities.

We frequently partner with Tribal organizations, including co-sponsoring the biennial Alaska MCH and Immunization Conference with the Alaska Native Tribal Health Consortium. WCFH continues to partner with Tribal health and numerous initiatives such as newborn screening, genetics, epidemiology, safe sleep, the perinatal quality collaborative, among many others.

The Alaska Perinatal Quality Collaborative, coordinated and led by a Title V-funded Nurse Consultant, has been an excellent means for WCFH to collaborate and partner with private, Tribal and military health care systems across Alaska. The first quality improvement initiatives are focusing on maternal hypertension, improving the birth transfer process, and universal screening of pregnant women for substance and plans of safe care for all newborns. Since April 2020, the Section has also been leading and facilitating a Perinatal Project ECHO related to COVID-19. While this has been an effective way to disseminate evidence-based clinical information and guidelines to the perinatal community on a statewide level, it has also helped to strengthen partnerships and connect with more hospitals and healthcare providers. Sessions have included topics such as PPE, testing, breastfeeding, maternal mental health, among others. WCFH has also strengthening partnership with the Alaska State Hospital & Nursing Home Association through the PQC and through the maternal mortality review program.

Coordination with Medicaid

Medicaid expansion began in Alaska in September 2015 by executive authority. By May 2020, 56,847 Alaskans were covered by through Medicaid expansion. This “newly eligible” population includes all childless adults between 100% and 133% FPL. An updated dashboard on the redesign can be found online.

Children currently represent 44% of Medicaid/CHIP enrollment, and Title V involvement in promoting well child visits and outreach as outlined in Section 504 of the Social Security Administration Act is critical to work by the Division of Public Assistance (DPA) and the Division of Healthcare Services to reduce the eligibility backlog. As of February 2020, here were 97,066 Alaska children ages 18 or less who rely on Medicaid and Denali KidCare (CHIP) to access the care they need to be healthy. DPA connected the Health Insurance Marketplace for successful data transmission between the Marketplace and the AK DHSS, and began allowing the marketplace to make application determinations for the Alaska Medicaid expansion. Difficulties experienced with new data systems resulted in a decline and delay in child eligibility and enrollment, which the Department continued and will continue to work on and improve. However, Alaska has implemented Presumptive Eligibility options for hospitals to determine eligibility in ‘real time’ by giving uninsured people immediate temporary Medicaid if they appear to be eligible based on income, in an effort to streamline Medicaid and CHIP enrollment.

In January 2018, the State of Alaska applied to the Centers for Medicare and Medicaid Services (CMS), for approval of an 1115 behavioral health waiver at the Direction of Alaska Legislature through Senate Bill (SB) 74. SB 74 was originally passed during the 2016 legislative session and took aim to reform Medicaid. This has been led by the Division of Behavioral Health, and Title V was a partner in that effort. Data from the Maternal Child Health Epidemiology Unit was key in ensuring that children were covered under this waiver. The goal was to create a data-driven, integrated system for behavioral health for people who experience serious mental illness, severe emotional disturbance, substance use disorder (SUD), co-occurring substance use and mental illness, and at-risk families and children. The SUD component was approved in November 2018, and the behavioral health component was approved in September 2019. This waiver allows for expansion of services for children and adults.

WCFH last updated the MOU with Medicaid in 2019. We had a goal of adding additional content to the agreement one year after the last amendment, but that became challenging due to COVID-19. Alaska Medicaid has been focused on numerous activities and initiatives related to COVID-19. This includes relaxing restrictions on medication refills, emergency regulations to expand telehealth, updating travel policies, among numerous other items.

Despite the lack of a formal update to the MOU, the Section made progress in collaborating more with Medicaid during the last year. Back in 2018, Alaska Title V and Medicaid partnered to host a statewide convening on improving access to long-acting reversible contraception (LARC). In late 2018, WCFH collaborated with Medicaid staff while they worked to create a document seeking to provide clarification regarding billing for LARC devices and LARC insertion. There continued to be discussion surrounding a carve-out for immediate postpartum LARC insertion. During the early months of 2020, Title V provided more information and written justification to the Chief Medical Officer on the value of a carve-out for LARC. She advocated to the Commissioner and Director of Medicaid. It was agreed upon that the State would move forward on a carve-out for Alaska. This was right before COVID-19 and the corresponding “hunker down” orders came into place. At this time, Medicaid has gone back to stating that it would cause expensive changes in the data system, change the cost reporting methodologies, and would take a large amount of work for something that would provide small savings and is already available in the cost report for hospitals. DHSS is currently working with a contractor to implement the Diagnostic Related Group (DRG) payment methodology for Alaska hospitals. Any work on a carve-out at this time would conflict with that project.

One of the key reasons that there are no longer any pediatric genetics clinics in the state is due to hospital concerns regarding lack of reimbursement for genetic testing. To help mitigate this challenge and hopefully pave the way to get more services back in Alaska, the Title V Director has been part of a workgroup that includes the MCH Director at the Alaska Native Medical Center, a genetic counselor, healthcare providers, and Medicaid to help inform and improve this process. The group is currently working on a draft guidance for Alaska Medicaid Policy Clarification for Genetic Testing.

Title V has also been partnering with Medicaid on the transition of pediatric clinics to telehealth services. Due to the COVID-19 pandemic, Alaska Medicaid has relaxed some rules related to telehealth and billing. We anticipate that telehealth will continue to be a key part of the healthcare delivery system even after the pandemic. Title V is working with Medicaid to update billing procedures and codes to allow a smooth transition to telehealth.

As mentioned in previous years, the continued shortage of pediatric specialists remains a concern in terms of healthcare access for CYSHCN. The All Alaska Pediatric Partnership is leading a statewide effort to revise our plan for pediatric specialty care in Alaska. The Title V Director was part of planning and facilitating a convening in November 2019 that brought together hospitals, healthcare providers, and Medicaid to begin a strategic plan. This will include increased access to telehealth, workforce development, creating additional partnerships with universities, and provider recruitment. The Medicaid Medical Director, Title V MCH Director, CYSHCN Director, and CYSCHN Program Manager will be actively working on this initiative and corresponding work groups.

The Title V Director regularly communicates with the EPSDT Coordinator for Alaska, and she continues to participate in committees such as the Alaska Dental Action Coalition, CYSHCN, among others. Alaska also has a new CHIP Director after the retirement of the long-standing incumbent. WCFH, including CYSHCN and MCH Epidemiology have provided her an overview of Title V and our corresponding programs and surveillance systems.

Alaska Medicaid has started to become more involved in the PQC. Right now, the Medicaid Medical Director is participating in the neonatal QI workgroup for universal screening of substances. It is anticipated that Medicaid will become more involved as the PQC grows and based off what QI topics are selected by the steering committee.