The Centers for Medicare and Medicaid Services (CMS) is testing a new approach to services for Medicaid-eligible youth aimed at catching behavioral and physical health problems earlier.
CMS, which oversees the two massive health care entitlements at the Department of Health and Human Services, plans to use up to eight sites around the country to test the Integrated Care for Kids (InCK) model. Each of the selected sites will be awarded $16 million over seven years to implement the model.
The plan seems to have a particular focus on mental health and substance abuse, with a goal of moving beyond the typical reliance on clinical settings to identify these challenges.
“Behavioral health conditions in children and youth … drive significant morbidity, health care utilization and premature death,” CMS said, in an announcement of the program. “The current child health care system has challenges in identifying and addressing risk factors for behavioral health conditions, because the earliest signs of a problem may present outside of clinical care — such as behavioral problems in schools, or chaotic family situations known to child welfare and foster care programs.”
Those comments echo the arguments made by a new initiative in California aimed at moving the state’s child mental health system upstream to screen and treat youth earlier.
Health care utilization “drops off a cliff” at age 10, but “75 percent of mental illness manifests between 12 and 24,” said Alex Briscoe, one of the chief organizers of the California initiative. “Right when we need there to be one, there’s no touch point. That’s where schools and child-serving systems can come in.”
Medicaid already includes a benefit that is meant to ensure eligible kids are screened and treated: the Early and Periodic Screening, Diagnostic and Treatment (EPSDT). But despite the fact that EPSDT is a guaranteed benefit, its use varies greatly from system to system.
While EPSDT “is comprehensive, variation remains among states in how and when children receive behavioral health screening, diagnostic and treatment services,” CMS said. “In addition, despite the variety of federal, state and local services that do exist to support children’s health, limited information sharing and differing eligibility and enrollment processes have created barriers to putting children and families at the center of their care and coordinating across services.”
Early identification is the first tenet of the InCK model, according to CMS. The other two are using increased information sharing to develop better coordination of physical and behavioral health for youth, and the development of “alternative payment models” that incentivize cost savings, positive outcomes or both.
The new model is part of what CMS describes as a “multi-pronged strategy to combat the nation’s opioid crisis.”
Click here for more details on the Integrated Care for Kids model. CMS plans to issue a notice of funding availability sometime this fall.