Financing

National and state policies impact CHWs. In Michigan, MiCHWA continues to work on policy and financing issues that impact CHW sustainability. We also have a policy brief that you can download here.

 

How do you pay for CHW services?

Michigan’s Health Homes SPA

The State of Michigan was approved to participate in the Affordable Care Act’s Section 2703 program, also known as Health Homes, by CMS in December 2014. Michigan’s program is called MI Care Team and is running at eligible Federally Qualified Health Centers (FQHCs) and Tribal Health Centers (THCs). The program began July 1, 2016.

Michigan Medicaid, in partnership with the Michigan Primary Care Association, designed the MI Care Team program and issued the following handbook for participating providers: download the handbook here.

MI Care Teams will work persons eligible for Medicaid or Healthy Michigan who have depression and/or anxiety and one or more of the following conditions:

• Heart Disease
• COPD
• Hypertension
• Diabetes
• Asthma

MI Care Teams are interdisciplinary teams with at least six on-site team members. One of these team members is a Community Health Worker. Per the handbook for participating centers, the Community Health Worker will provide the following functions:

• Coordinate and provide access to individual and family supports, including referral to community social supports;
• Meet regularly with the care team to plan care and discuss cases, and exchange information with team members as part of the daily routine of the clinic;
• Identify community resources (i.e. social services, workshops, etc.) for patient to use to maximize wellness;
• Referral tracking;
• Coordinate and provide access to chronic disease management including self-management support;
• Implement wellness and prevention initiatives;
• Facilitate health education groups;
• Provide education on health conditions and strategies to implement care plan goals including both clinical and non-clinical needs.

Other required team members are a primary care provider, a behavioral health consultant, a nurse care manager, and a health homes coordinator who will serve in an administrative capacity. There must also be access to a doctoral-level psychologist and/or psychiatrist.

Ten FQHCs are participating in Michigan, including sites in Bay, Genesee, Houghton, Huron, Iron, Kalamazoo, Kent, Lapeer, Lenawee, Macomb, Marquette, Menominee, Monroe, Montcalm, Montmorency, Oakland, Ontonagon, Presque Isle, Saginaw, Shiawassee, and Wayne counties.

Nationally, Michigan is one of several states implementing the Health Homes initiative. Learn more on the CMS Medicaid Health Homes website. You can also watch a webinar from the Michigan Primary Care Association on the design of MI Care Team. Learn more about MI Care Team at www.michigan.gov/micareteam.

Sources: State of Michigan Department of Health & Human Services Office of Contracts & Purchasing Invitation to Bid, ITB #043116B0006411. State of Michigan Policy Notice of Proposed Policy 1569-MiCT.
MI Care Team Webpage, www.michigan.gov/micareteam
MI Care Team Handbook (for providers), http://www.michigan.gov/documents/mdhhs/MI_Care_Team_Handbook_528104_7.pdf

Michigan’s Medicaid RFP

The State of Michigan released their 2016 request for proposals for the annual Medicaid Managed Care Rebid. As part of the most recent rebid, Community Health Workers (CHWs) are specifically included in the rebid requirements. You can read these requirements in the current State of Michigan sample health plan contract.

• Contractor must provide or arrange for the provision of community health worker (CHW) or peer-support specialist services to Enrollees who have significant behavioral health issues and complex physical co-morbidities who will engage with and benefit from CHW or peer-support specialist services
• Contractor agrees to establish a reimbursement methodology for outreach, engagement, education and coordination services provided by community health workers or peer support specialists to promote behavioral health integration
• Contractor must maintain a CHW to Enrollee ratio of at least one full-time CHW per 20,000 Enrollees

• Fun Facts!

  • Health plans are given the option to contract with community-based providers and organizations for existing CHW services
  • The APHA definition of a Community Health Worker is used within the rebid document
  • Core competencies of a CHW align well with MiCHWA’s CHW training

Michigan Medicaid Managed Care Contracts began January 1, 2016. Then Medicaid Managed Care contracts were awarded with four plans covering the entire Lower Peninsula. MI Care Team launched July 1, 2016, and covers counties statewide, including in the UP.

Download our *updated* fact sheet on Michigan Medicaid payment for CHWs here

Michigan Health Plans & CHWs

In Spring 2016, MiCHWA partnered with the Michigan Association of Health Plans (MAHP) and the Michigan Association of Health Plans Foundation (MAHPF) to develop and conduct a survey of managed care plans to assess how they are addressing population health needs with their members an and how they are meeting the CHW-related requirements of the Medicaid contract. All but one Michigan Medicaid health plan is a member of MAHP.

MiCHWA, MAHP, MAHPF and members of MiCHWA’s Financing Models Ad-Hoc Group (including MAHP, MAHPF, several health plans, health systems, community-based organizations and others interested in CHW sustainability), partnered to design a survey of health plans in response to the rapid changes in Medicaid managed care policy at the State level. Survey content related to population health and use of CHWs, including payment for CHW services. A full report detailing the survey findings is now publicly available. The appendix contains the survey instrument.

1. 2016 Michigan Health Plan Survey: CHWs & Population Health
2. Appendix: 2016 Michigan Health Plan Survey: CHWs & Population Health

 
For questions about this report, please contact MiCHWA Project Director Priscilla Hohmann (priscilla@michwa.org).

Michigan’s SIM Award

Michigan received a $70 million State Innovation Model test award.

What is SIM?

From the Centers for Medicare and Medicaid Services: “The State Innovation Models (SIM) Initiative is providing financial and technical support to states for the development and testing of state-led, multi-payer health care payment and service delivery models that will improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries—and for all residents of participating states.”

SIM is about transforming the existing system of health care delivery. The 5 fundamental components of the Michigan Blueprint for Health Innovation, Michigan’s SIM design award submission, are as follows:

1. Patient-centered medical homes providing access to high quality primary care;
2. Accountable systems of care responsible for improving systems of care to ensure delivery of the right care, by the right provider , at the right time, and the right place;
3. Community health innovation regions building capacity within a community to improve overall population health;
4. Payers committed to paying for value rather than paying for volume; and
5. Infrastructure support that facilitates system improvements to reduce administrative and delivery system complexity.

What about CHWs?

CHWs are cited several times in Michigan’s Blueprint to Health Innovation. You can read about all the references on our fact sheet here.

• Fun Facts!

  • CHWs are listed as potential members of health care teams in patient-centered medical homes and as members of interdisciplinary teams providing patient-centered care
  • The APHA definition of a Community Health Worker is used within Michigan’s SIM document
  • MiCHWA is cited as the “lead in convening community stakeholders to determine the best approach to regulation, licensure, and certification” (pg 160)

Learn more about Michigan’s SIM Award on the State of Michigan SIM website.

SIM Update: the following updated timeline was released in July 2015, download it here.