MCH programs and the Medical Services Administration (MSA), which administers the Michigan Medicaid Program (Medicaid), have a longstanding collaborative relationship of assuring the provision of quality care and services for the MCH population. This partnership allows Michigan to effectively utilize federal and state resources and create efficiencies to help ensure that women and children are provided with preventive and chronic health services, treatment, and follow-up care. MCH collaborations with Medicaid, Medicaid Health Plans (MHPs), local health departments (LHDs), and community providers include maternal and infant care and services; child and adolescent health; perinatal and postpartum care; Children’s Special Health Care Services (CSHCS); dental care; and home visiting programs. Key partnerships are discussed in this section.
The Title V/Medicaid agreement is contained within the Medicaid State Plan (Sections E and F). Discussions between Title V leadership and MDHHS legal counsel determined that the existing document broadly outlines the relationship between the two entities which are both housed in MDHHS within the administration of the Chief Deputy for Health.
One of the largest partnerships is between Medicaid and CSHCS. Since FY 2013, most individuals with both CSHCS and Medicaid coverage are enrolled in an MHP. In March 2021, CSHCS program numbers indicate that 26,949 (64.8%) of CSHCS beneficiaries are enrolled in an MHP. In relation to Section E, CSHCS determines programmatic eligibility for CSHCS; provides case management in coordination with LHDs and Children’s Multidisciplinary Specialty (CMDS) clinics; authorizes providers; and utilizes the same payment mechanism as Medicaid (CHAMPS). MSA determines eligibility for Medicaid; pays CSHCS providers; and provides IT support. MHPs are responsible for the medical care and treatment of CSHCS members. Assistance with community-based services beyond medical care and treatment is provided by the LHD CSHCS office. MHPs are responsible for coordinating and collaborating with LHDs and CMDS clinics to provide a range of essential health care and support services to enrollees. MHPs are also responsible for the coordination and continuity of care for enrollees, who require integration of medical, behavioral health and/or substance abuse services. CSHCS has been integrated as a component of the MHP onsite compliance review process. In 2019, CSHCS’s contract with MHPs included new language encouraging MHPs to discuss medical transition with clients transferring from pediatric to adult health care. In 2020, CSHCS completed virtual site reviews focusing on transition, family engagement, durable medical equipment, and grievance and appeal.
In relation to Section F, several programs and initiatives support maternal and infant care, dental health, and the health of children and youth through cooperative program planning and monitoring; referrals; program standards and guidelines; and certification processes between MCH and Medicaid. The Managed Care Plan Division (MCPD) in MSA requires all MHPs to ensure home visiting for pregnant and new moms in managed care. The Maternal Infant Health Program (MIHP), Michigan’s largest evidence-based home visiting program, is available to all Medicaid-eligible pregnant women and infants up to age one. In FY 2020, MIHP provided services to 12,187 women and 17,076 infants. The goal of MIHP is to promote healthy pregnancies, positive birth outcomes and healthy infant growth and development with the long-term goal of reducing infant mortality and morbidity. MIHP is jointly managed by the Division of Maternal and Infant Health (DMIH), the MCPD, and the Medicaid Policy and Program Division (MPPD). DMIH develops MIHP procedures, certifies and monitors providers, and provides technical assistance to providers. MPPD promulgates Medicaid policies. MCPD helps providers implement Medicaid policies, monitors MHP contracts and makes payments to Medicaid providers. MIHP has shown favorable effects on prenatal care, birth outcomes (e.g., prematurity, low birth weight), postpartum care, and well-child visits.
The Healthy Kids Dental (HKD) program is available for children enrolled in Medicaid and CHIP. HKD provides dental coverage to approximately 1 million qualifying individuals including infants, children, and pregnant women under the age of 21. Eligible beneficiaries are offered two HKD dental health plans. In July 2018, MDHHS expanded managed care dental coverage for non-Healthy Michigan Plan Medicaid eligible pregnant women through a Comprehensive Health Care Program 1915(b) waiver amendment. This benefit provides greater access to dental services and comprehensive prenatal care. MCH and MSA coordinate oral health outreach and engagement via multiple avenues including MIHP and other home visiting networks. Infants and children receive preventive services through the Varnish Michigan and SEAL! Michigan programs targeted to the Medicaid population. Healthy Michigan Plan beneficiaries receive dental benefits through MHP dental provider networks.
MCH programs and Medicaid also collaborate on quality improvement initiatives for women, pregnant women, infants, children, and CSHCN such as:
- Adult Medicaid Quality: Improving Maternal and Infant Health Outcomes in Medicaid and CHIP. This grant collects and reports data on the “Use of Contraceptive Methods in Women” measure. The goal is to increase the use of effective methods of contraception among all women in Medicaid and CHIP to improve pregnancy planning and birth spacing.
- Maternal Infant Health Program (MIHP) Evaluation: Researchers from the University of Michigan Youth Policy Lab are evaluating alternate payment methodologies for MIHP to determine if additional resources, support and focused effort to address the social determinatns of health will lead to improved outcomes for enrolled families.
- Medicaid Eligibility: MDHHS is committed to extending Medicaid eligibility for postpartum women to 12 months and covering doula services to address maternal and infant health disparities.
- Perinatal Opioid Use Disorder: Beginning in January 2020, Regional Perinatal Quality Collaborative (RPQCs) efforts related to perinatal substance use disorder (PSUD) were funded by Blue Cross Blue Shield (BCBS) Foundation. The 18-month projects focus on innovative approaches to the prevention of and response to PSUD, including rooming-in programs for babies born with Neonatal Abstinence Syndrome; creating a resource webpage for pregnant and parenting people with SUD; incorporating SUD resources into CenteringPregnancy models of care; and expanding universal prenatal screening for mental and behavioral health. While the projects are funded by BCBS, the resulting services and resources can be utilized by and will benefit individuals regardless of insurance type (including Medicaid beneficiaries, privately insured families, and uninsured families).
- CSHCS and Behavioral Health and Intellectual and Developmental Disabilities Collaborative: In 2019, CSHCS convened an interagency group to identify challenges that populations served by the CSHCS system and the mental/behavioral health system face in accessing services. The collaboration created a work plan to develop tools for families, provide education, and create system navigation resources for LHDs and community mental health staff. Current work includes developing a webinar to explain both systems, publishing a glossary for families to assist in health care literacy, and exploring policy priorities.
- EPSDT or Well Child Services: Medicaid Managed Care is an important payor for preventive health care services for children and youth. The Division of Child and Adolescent Health works to improve well care rates for adolescents with Medicaid through school-based Child & Adolescent Health Centers. The work will be especially important as states focus on preventive care and immunizations that declined during the COVID-19 pandemic.
- Lead Poisoning Prevention Projects: Medicaid and CLPPP partner on three data quality/control projects to decrease inconsistencies between data sets; improve reporting, testing, and interventions; and improve data availability for LHDs, Medicaid Health Plans, and foster care health liaison officers. They also partner on education to health care providers and MHPs about elevated blood lead outreach, testing recommendations and requirements, and implementation of point-of-care testing.
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