CMS has announced that it will launch a new innovation model funding opportunity this fall as part of a multi-prong response to the opioid crisis. The Integrated Care for Kids (InCK) Model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs.
This is a really big deal – not only because the innovation model is focused on kids, but it is also intended to address one of the existing gaps in health care for children. Details about the program note that the current health care system faces challenges in the early detection of behavioral health conditions because the earliest signs may present outside of clinical settings, in schools, or when child welfare and foster care systems become involved with chaotic family situations.
Information about the new program cites the 2015 Annual Report on Health Care Quality for Children in Medicaid and CHIP noting that one in three children in Medicaid and CHIP have behavioral health needs but only one-third of those children receive needed care. It also cites a 2017 HHS report on Opioids and Adolescents reporting that half of adolescent deaths from drug overdoses, which are on the rise, result from opioids.
Despite the fact that the funding opportunity has not been formally released, there are lots of details about the program here. I love the fact that CMS identified the first goal as improving child health outcomes, rather than reducing costs. Other goals include reducing health care utilization and advancing sustainable alternative payment models (such as value-based purchasing). It will do so through early detection and treatment and integrated care coordination and case management.
The program will involve both the state Medicaid agency and a lead organization, which will coordinate core child services, including clinical care, food, housing, early care and education, Title V agencies, child welfare, and mobile crisis response services. Lead organizations must be HIPAA-covered entities and will convene with community partners to integrate coordination and management of the InCK Model’s core child services. The lead organization may be the state Medicaid agency but, if not, the agency will still participate in the model. The grant application will be jointly developed between the Medicaid agency and the lead organization. Eight grantees will be selected, and funding levels can be up to $16 million over a seven-year period.
While the program is aimed at the opioid crisis, all children covered by Medicaid and CHIP (if applicable) from the prenatal period up to 21 years of age, who reside within an awardee-specified (and CMS-approved), sub-state geographic service area, will benefit from the program.