Improving Care for Kids: Engage Now to Influence State Proposals
Advocates have just two months left to influence their state’s proposal for a major initiative to overhaul care for kids. Integrated Care for Kids (InCK) is a funding opportunity from the Center for Medicare and Medicaid Innovation (CMMI) that allows states to integrate youth services across systems, including health, child welfare, housing and education. Consumer advocates working to address health inequity and expand access to youth mental health and substance use services should get involved now to ensure their state’s project includes those elements.
To do that, advocates can start by leveraging existing relationships with state Medicaid offices and other health stakeholders to identify whether a proposal is in development, who is leading it, and how consumers have been or can become involved. Although the model requires service integration across systems, the lead organization is restricted to either the state Medicaid agency or a HIPPA-Covered Entity. Advocates may need to make the case about the importance of consumer engagement. Because the proposal deadline is approaching quickly (June 10, 2019), advocates can engage established consumer groups, coalitions and community-based organizations that are ready to step in and offer consumer perspectives to those planning the project.
CMMI’s requirements for the proposal include creating a partnership council to support project implementation and evaluation, but the role of consumers on this council is not spelled out. Ideally, the council would include broad representation of consumer groups and perspectives of those most harmed by social and economic inequity. To maximize consumer representation, advocates can push for consumers to make up a majority of the council (51 percent or more). Consumer engagement should expand beyond the health system to those in other sectors of the InCK model, including family welfare, the justice system, housing and poverty-reduction.
Because this initiative aims to improve the health and well-being of young people, it’s important to include youth voices in each stage of this work. Youth engagement can take multiple forms, and consumer advocates can leverage existing relationships with community organizations to identify youth already engaged in substance use prevention and health equity work who are interested in helping to shape the program.
Once advocates have the attention of the initiative planners, they can focus on the service delivery and payment reforms at the heart of the initiative that could bring up to $16 million to each of the states selected. Advocates can promote integration and expansion of prevention and early intervention services that address the impacts of trauma and childhood adversity. This includes expanding trauma-informed care in pediatric settings and schools. It also means expanding evidence-based practices to prevent adolescent substance use like screening, brief intervention and referral to treatment.
Addressing racial health disparities requires action within and outside of the health care system, and the InCK initiative offers an opportunity to advance this work, as well. Pilot models can address discrimination in service delivery, move away from zero-tolerance policies in schools, invest in trauma-informed practices, and expand substance use treatment, mental health and prevention services in schools and communities of color. Any anti-racism initiative should be led by people of color to pinpoint where system failures are occurring and to develop effective strategies to address them. Consumer advocates can push for a broad representation of communities of color to be meaningfully involved in the development, implementation and evaluation of project outcomes.
The InCK initiative is an important chance to transform systems and ensure young people have the services and support they need to live healthy lives. If you haven’t already, reach out to your Medicaid agency and do what you can to shape this work and maximize consumer voices.