In the United States, Medicaid expansion is now being adopted by 41 states, which unlocks a new funding stream for social service organizations in whole person care. In this article, we’ll break down a recent study that reinforces the need for increased care coordination efforts when it comes to breaking down data siloes, 1115 waiver billing, and better case management technology.
With the spread of Housing First came one fundamental insight: people experiencing homelessness or other adverse social determinants of health (SDoH) are best served when they are served beyond the scope of normal multi-payer healthcare. However, with Medicaid expansion being adopted in many states, there is more funding available for reimbursing community based organizations (CBOs) to provide additional services such as supportive housing, rent assistance, and other social services.
In a research article titled, “Addressing housing-related social needs for Medicaid beneficiaries: a qualitative assessment of Maryland’s Medicaid §1115 waiver program,” the spotlight was put on the state of Maryland and its barriers and successes of its Assistance in Community Integration Services (ACIS) pilot program. Here, we’ll summarize the main findings and recommendations of the researchers.
The Context: Data Quality, Whole Person Care, and Medicaid 1115 Waivers
We’ve been saying it for years, but there’s now more research suggesting that when community-based organizations (CBOs) collect data inefficiently and work in siloes, they see low data quality, known to correlate with suboptimal SDoH outcomes for clients.
However, now that there is more funding available for CBOs to utilize Medicaid 1115 waivers for reimbursement of SDoH services (i.e., housing, substance abuse treatment, behavioral health) these communities need a way to streamline the reimbursement workflow for billing.
Section 1115 waivers from Medicaid provide states the “opportunity to introduce programs that are ‘budget neutral’ . . . while better serving Medicaid populations,” according to the study. For instance, some states use 1115 waivers to support housing case management and tenancy sustaining services (i.e., eviction prevention, rent assistance, legal representation). Why are we funding healthcare costs for indirectly-related services? The answer lies in whole person care.
The study continues:
Although housing stability is increasingly being recognized as an important determinant of health outcome, an estimated 380,657 individuals in the U.S. experienced unsheltered homelessness according to the 2021 point in time count. Millions more were considered unstably housed, including doubling up on their housing, living in homes with poor physical conditions, or paying more than a third of their income on rent and utilities. The health effects of homelessness and housing instability are wide-ranging, with increased morbidity and mortality, more frequent emergency department visits, longer inpatient hospitalizations, and excess medical expenses compared to the general population.
In other words, lack of shelter only serves to exacerbate and undo the majority of Medicaid healthcare services provided to unsheltered people. That’s where Maryland’s ACIS program comes in.
The Community: Maryland’s Housing Tenancy Services
In the study mentioned, the researchers conducted several interviews with program leads and managers who were in charge of reporting and coordinating service delivery across the participating Maryland counties. Some common themes were found among the interviews:
Population Risks and Lack of Affordable Housing
Like many states, Maryland is suffering a lack of affordable housing. At the same time, people experiencing homelessness also tend to have poor rental histories, credit scores, and comorbid conditions that limit their ability to successfully apply for rentals. Landlords are often hesitant to accept housing vouchers, and housing voucher recipients might not know how to assert their legal rights, even though housing vouchers hold legal sway.
Client and Collaborator Communication
ACIS program stakeholders and leaders were able to break down siloes by meeting at least once per quarter to coordinate care, but more importantly, it was found that most service providers had a few obstacles to coordinating care:
- Lack of follow-up for referrals was common among service providers, because there were no “mechanisms to appropriately track that.”
- Participant retention was also a difficulty primarily because of the lack of communication with clients. In addition, clients with untreated mental health conditions or substance abuse disorders were also difficult to communicate with.
Data Collection in Program Implementation
Documenting the services delivered, for the purpose of receiving 1115 waiver reimbursement, and demonstrating program effectiveness was also a huge challenge. Service providers are required to provide and document a minimum threshold of services provided, in order to receive the funds from the federal government.
However, as the researchers pointed out:
A considerable proportion of interviewees worried that direct service providers—who often worked in community-based organizations and were not healthcare-based—were not as familiar with the documentation requirements.
Compounding concerns, many noted that the data was collected using spreadsheets in ways that were inefficient and time consuming. Interviewees stated that some direct service providers were unable to keep up with these requirements and subsequently had to cease their participation in ACIS.
As one interviewee said, “One of the challenges that our [direct service providers] complain about is the data and how much we must collect and how it is collected. If there was a way that all jurisdictions collected data the same way, in the same system or platform, it would be a lot easier.”
But what if there were already technology solutions for improving care coordination, case management, and Medicaid billing workflows?
That’s where Eccovia and technical providers like Health Roads come into play.
The Gist: Data Collection, Medicaid Billing, and Other Needs
Medicaid expansion is necessary but not sufficient for communities to provide whole person care. Each community’s unique needs should be accounted for, and as the researchers pointed out: “communication was also noted to be a recurring theme. This aligns with prior work demonstrating the difficulties of working with a hard-to-reach population by virtue of their housing insecurity and limited financial resources.”
Organizations like Health Roads and Eccovia, which are composed of social service experts with deep technological and project knowledge, are becoming more prominent and useful for improving community care coordination.
Consider the issue of tracking data in spreadsheets, as stated in the article above. “If there was a way that all jurisdictions collected data the same way, in the same system or platform, it would be a lot easier,” said one of the interviewees.
Fortunately, platforms like ClientTrack are already making a huge difference in communities where data collection is an issue. Take the State of Georgia, for example: this community implemented a statewide case management system with over 450 agencies using ClientTrack and achieved compliance as well as increased efficiency across its service network.
But what about Medicaid billing? It’s a convoluted structure to receive federal reimbursement for participating communities. Health Roads, a partner organization, has solved for this issue and is empowering communities to amplify the impact of ClientTrack with SocialRCM, its billing workflow technical service. Together, ClientTrack and SocialRCM empower communities to unlock the full revenue potential needed to meet growing service needs.
The above researchers conclude:
Medicaid §1115 waivers allow novel approaches to use Medicaid funds to support tenancy-based services, such as ACIS, to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized.
Consider that these challenges were still prevalent in a community that is actually taking Medicaid expansion seriously—it stands to reason that technology will continue to play a huge role in the expansion of whole person care throughout the United States.
If your community needs a new solution for case management and care coordination, including the potential of Medicaid reimbursement for housing services, please schedule a demo with an Eccovia expert.
