This is the season of Medicaid policy options—especially those competing for the attention of a new Administration and a new Congress. But the federal government is not the only audience; this week a terrific report was issued to policymakers in California. Written by Jocelyn Guyer (a former CCFer), Alice Lam, and Madeleine Toups at Manatt Health along with Donna Cohen Ross of DCR Initiatives. It has a very long title: “Strengthening the Social and Emotional Health of California’s Young Children: Medi-Cal Strategies and Options for Creating an Advanced Child Health Delivery System.”
This 57-page gem is crammed with concrete, progressive proposals—8 different strategies incorporating 15 different policy options—for using California’s Medicaid program to improve the health of the five million children it covers. Just listing the policy options would consume all the space in this blog (Appendix C manages it in 10 pages). As you might expect, all are specific to California. But some also apply to the 39 states that, like California, rely on managed care organizations (MCOs) to deliver services to children enrolled in Medicaid.
One option of wide applicability is the creation of a child health dashboard—i.e., a page on the state’s Medicaid website that provides “granular, plan-specific data” on the performance of each MCO for children. The types of data that the dashboard would present specific to each MCO include:
- The number and age distribution of children enrolled;
- Performance outcomes on the CMS Child Core Set Measures; and
- Data on access to services, such as behavioral health services.
All data would be stratified by race, ethnicity, and language to enable the identification of disparities among enrollees within MCOs as well as between MCOs.
(Friendly amendment: also include measures of compliance with EPSDT screening and treatment requirements.)
A child health dashboard, the authors explain, would “provide valuable information to policymakers, providers, children’s advocates, and families seeking to understand the state’s progress in establishing an equitable, advanced child health system and facilitate state and local action on issues and trends of concern sooner.” They point to Louisiana’s Medicaid Managed Care Quality Dashboard, which includes data on both adult and child health performance measures, as an example.
As it happens, we at CCF have started to look for this same MCO-specific data on state Medicaid agency websites. The websites vary considerably in user-friendliness and transparency. We have not found a child health dashboard among the seven states we’ve reviewed to date (GA, IA, MO, MS, NV, PA, and TN). That is unfortunate, because the benefits of transparency far outweigh the costs.
Let’s start with the costs. The only cost is that of setting up and maintaining the dashboard on the state Medicaid agency website; at least half of this administrative expense would be paid by the federal government. The state Medicaid agency has already paid the MCOs for the collection and reporting of the information, and it has already paid the EQROs for its validation. All that remains to be done is posting the information on a publicly-accessible dashboard.
Now for the benefits. Posting information about individual MCO performance for children on an easily accessible dashboard sends a number of important messages. The health of children enrolled in MCOs matters. How MCOs deliver for the children they enroll matters. Whether the use of services varies by race or ethnicity matters. Which MCOs the state Medicaid agency contracts with matters. A dashboard ramps up the capacity to monitor both the individual MCOs and the state Medicaid agency by adding more eyes, not another layer of bureaucratic oversight.
California has a lot going on this year. The state has announced a procurement, and the report suggests ways in which the new MCO contracts could be strengthened to improve the delivery of the EPSDT benefit. In addition, the state’s comprehensive section 1115 demonstration is scheduled to expire at the end of this year, which opens opportunities for negotiating with CMS for program improvements such as continuous eligibility for children up through age 5.
Advocates in other states going through procurement or 1115 waiver renegotiations will find useful suggestions in this report. But even in a managed care state that isn’t facing all of California Medicaid agency’s challenges, a child health dashboard is timely. In fact, those state agencies will likely have more bandwidth to stand up a dashboard. No time like the present to shed more light on how well MCOs are fulfilling their responsibilities to be good stewards of Medicaid dollars and serving the children enrolled in their plans.