Alaska’s Title V-Medicaid MOU was updated in 2022 to extend to 6/30/22, the final day of the former Department of Health and Social Services. Following the split of DHSS into two Departments, the MOU will be updated and re-signed. It is anticipated the MOU will need to go through a legal review. Title V and Medicaid leadership are meeting in August 2022 to review, update, and expand the MOU. Operations and collaborations between Medicaid and Title V will remain the same with both programs falling under the new Department of Health (DOH), including while the new MOU is in development.

In January 2018, the State of Alaska applied to CMS for approval of an 1115 behavioral health waiver at the direction of the Alaska Legislature through Senate Bill (SB) 74. This effort was led by the Division of Behavioral Health (DBH), with Title V as a partner. The goal was to create a data-driven, integrated system for behavioral health for people experiencing serious mental illness, severe emotional disturbance, substance use disorder (SUD), co-occurring SUD and mental illness, and at-risk families and children. The SUD component was approved in November 2018, and the behavioral health component in September 2019. This waiver allows for expansion of services for children and adults. The MCH Epi Unit has provided data and staff expertise to assist with efforts to evaluate the waiver program.

Current and Ongoing Collaborations with Medicaid:

Outreach/Promotion of Well-Child Visits – As of June 2022, there were 102,350 Alaska children ages 18 or under relying on Medicaid and Denali KidCare (CHIP) for healthcare, with children representing 39.5% of Medicaid/CHIP enrollment. Title V involvement in promoting well child visits and outreach is critical to work by the Division of Public Assistance (DPA) and the Division of Healthcare Services to reduce eligibility backlog.

During the COVID-19 pandemic, Alaska experienced a decrease in the rate of well-child visits and childhood immunizations. WCFH, Medicaid, the state Immunization Program, and the Public Information Team partnered on outreach strategies to promote preventive health visits for children. Title V staff created rack cards which were distributed to schools, with Title I schools prioritized. The rack cards included information on how to enroll in Medicaid.

It is anticipated the new Office of School Health & Safety will increase collaborative opportunities with Medicaid related to preventative health visits. While schools can bill for some services such as OT, PT, and speech therapy, they cannot currently bill for school nursing or behavioral health services. Possible solutions to this barrier are being considered, including a State Plan Amendment to provide for reimbursement changes, demonstration projects, and potentially a new long-term, non-permanent Program Coordinator to partner with Medicaid on school-based services.

Long Acting Reversible Contraception (LARC) - Alaska Title V staff previously partnered with Medicaid on a LARC workgroup and creation of a clarification paper on LARC reimbursement. While Medicaid was headed in the direction of de-bundling LARC from the global maternity fee, COVID-19 halted this work. At the same time, the Department began to work with a contractor to explore the use of DRG methodology for hospital payments. The Title V Director and other WCFH experts joined this workgroup to promote LARC reimbursement inclusion in this process. Title V staff wrote a white paper which was submitted to the Office of Rate Review, the DRG contractor, and Medicaid on the health and financial reasons to do a carveout and incentivize this process. The project resulted in a carveout for LARC. This is expected to be implemented on 1/1/2023. There is work remaining to expand the carveout to hospitals not using DRG Methodology for billing, which includes all Tribal health hospitals.

Extending Postpartum Coverage to 12 Months – WCFH has a goal to actualize the extension of postpartum Medicaid coverage from 60 days to 12 months. The Title V MCH Director met with the CHIP Director, Chief Medical Officer, and representatives from the Commissioner’s Office on this topic, and submitted a white paper to the Commissioner’s Office for consideration. A policy decision on the extension of coverage has not yet been made, but it appears action from the state legislature is needed to move forward. The paper was updated in July 2022 at the request of the Chief Medical Officer.

Genetic testing - A key reason Providence Children’s Hospital ended their pediatric genetics clinic was lack of Medicaid reimbursement for genetic testing. To help mitigate this issue and work towards re-establishing these services, the Title V Director participates in a workgroup that includes the MCH Medical Director at the Alaska Native Medical Center, a genetic counselor, healthcare providers, and Medicaid staff. This workgroup is an offset of Alaska’s Medical Care Advisory Committee (MCAC), a public advisory group charged with advising the State’s Medicaid agency on policy and program changes. The group finalized guidance to improve, streamline, and clarify reimbursement for genetic testing. The next step is to obtain input from additional private sector providers.

CHIP Work Plan – Multiple Title V staff have collaborated with the CHIP Director and Medicaid team on revising the Alaska CHIP Work Plan, which has been submitted to CMS for approval. Members of the MCH Epi Unit are also working with Medicaid staff to establish a more comprehensive picture of the number and demographic characteristics of uninsured children in Alaska. This information will assist with a State Plan Amendment goal to reduce the number of uninsured children.

Telehealth – Title V partnered with Medicaid on the transition of pediatric clinics to telehealth services, which became necessary due to COVID-19. Alaska Medicaid relaxed some rules related to telehealth and billing. Telehealth will continue as an option after the pandemic.

Pediatric Sub-Specialty Care – The Title V Director and CYSHCN staff have partnered with Medicaid and others to create and work on a strategic plan to address the ongoing shortage of pediatric specialists. This will include increased access to telehealth, workforce development, creating additional partnerships with universities, and provider recruitment.

Oral Health – The WCFH Oral Health Program continues to partner with Medicaid on oral health data, including a project with a UAA researcher to review Medicaid oral health claims data. WCFH also partners on the Oral Health Affinity Group’s CMCS quality improvement project.

Developmental Screening – The WCFH Early Childhood Program Manager continues to lead the Universal Developmental Screening Advisory Committee for Alaska. This includes a separate workgroup with Medicaid focused on billing for screenings. Medicaid was an active partner in the development of the statewide developmental screening environmental scan and gap analysis. They added questions which will facilitate policy changes related to developmental screening reporting and reimbursement.

Aligning Early Childhood and Medicaid Learning Collaborative– Title V staff lead a learning opportunity with Medicaid and child welfare on aligning early childhood and Medicaid. The focus area will expand maternal SUD supports and home visiting programs to better support families and prevent infant out of home placement.

Participation in peer learning network funded by ASTHO – This project aims to link PRAMS data with clinical outcomes data. In collaboration with Medicaid and vital records, WCFH linked 10 years of PRAMS data to Medicaid claims focusing on household factors that predict early injury-related health care utilization. Support from Medicaid ensures the data used are accurate, understandable, and communicated effectively.

Breast and Cervical Medicaid – The Alaska Breast and Cervical Cancer Screening program (AK Breast + Cervical) enrolls eligible Alaskans to receive breast and cervical screening and diagnostics paid for by the program. These services are limited to screening and diagnostics, so a long-standing collaboration with Medicaid supports treatment services if enrollees receive a diagnosis.

Substance-Exposed Newborns Initiative (SENI) Perinatal Screening, Brief Intervention, Referral to Treatment (SBIRT) – Alaska Medicaid encourages providers to incorporate Perinatal SBIRT services into normal practice and allows billing for two SENI SBIRT screens during pregnancy.