Title V Transformation Tools
Recommendations to Support NPM 15 – Adequate Insurance
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Significance. The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this NPM as follows:
Almost one-quarter of American children with continuous insurance coverage are not adequately insured. Inadequately insured children are more likely to have delayed or forgone care, lack a medical home, be less likely to receive needed referrals and care coordination, and receive family-centered care. The American Academy of Pediatrics highlighted the importance of this issue with a policy statement. The major problems cited were cost-sharing requirements that are too high, benefit limitations, and inadequate coverage of needed services.
Background. The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health Services Block Grants to States Program has established 15 National Performance Measures (NPMs) for the 2015-2017 grant cycle. In order to effectively address the NPMs, MCH professionals need to think about not only the evidence and strategies to make change, but also the capacity of the workforce to carry out these activities. These lists identify online learning materials, resources, and evidence-based strategies and programs to support the knowledge sets and skills needed to advance each NPM.
Introduction. Six skill sets have been identified by the National MCH Workforce Development Center to support implementation of this NPM: (1) population health; (2) strategic planning and program design; (3) strategic alliances and effective partnerships; (4) consumer engagement and cultural and linguistic brokering; (5) policy and program implementation; and (6) communication.
In addition, two knowledge areas specific to the NPM topic area have been highlighted that are keyed to the evidence base and promising practices: (1) insurance background, recommendations, and guidelines and (2) insurance policies and strategies.
The MCH Navigator, in collaboration with the Center, has developed this crosswalk to guide MCH professionals to online learning opportunities and implementation resources to support these skill sets.
Please click on the Read More buttons below for additional information, learning materials, and implementation resources. You can also email us with suggestions for additions.
Six skill sets have been identified to support implementation of this NPM:
1. Population Health
A renewed focus on MCH population health is key to achieving the NPMs in the era of health transformation. These skills enable Title V professionals to analyze how program interventions and their related health outcomes are distributed among a state’s MCH population. Population health skills complement all of Title V’s work, including program design and implementation, strategic partnerships and communication.
- Skills to monitor trends of insurance adequacy for children
2. Strategic Planning & Program Design
Effective strategic planning and program design require the ability to base programs on defined goals and desired outcomes. Strategic planning should include a monitoring and evaluation system to track and monitor progress and inform program alterations as needed. Program design skills must ultimately be coupled with implementation, where program design is carried out.
- Skills to train local partners about insurance coverage options
- Skills to map networks of adequate and inadequate coverage
3. Strategic Alliances & Effective Partnerships
The wide array of stakeholders and partners in the field of MCH, from providers and insurers to women and children, require a set of skills in strategically aligning Title V goals with those of their partners. In the Title V world, there is an increasing interest in engaging unlikely or nontraditional partners to achieve the NPMs. The skills in this category take that into account and include unique partner groups linked to this measure.
- Ability to collaborate with partners to promote insurance coverage, including:
- Accountable care organizations (ACOs) and managed care organizations (MCOs)
- Medicaid and Children’s Health Program (CHIP)
- Ability to align efforts to enroll children in health insurance with other initiatives related to insurance coverage for the population as a whole
4. Consumer Engagement/Cultural & Linguistic Brokering
Consumers are arguably the most important stakeholders in MCH work, thus skills in consumer engagement and cultural and linguistic brokering are essential to moving the needle for each NPM. In some cases, consumer engagement includes negotiating with other stakeholders on behalf of MCH populations. Closely linked with this skills category are skills in communication and strategic alliances.
- Skills to engage consumers, especially families of children and youth with special health care needs, to:
- Serve as peer educators
- Provide input into Title V outreach effort plans
5. Policy & Program Implementation
These skills ensure that MCH priorities are integrated into all aspects of policy and program implementation, as well as ensuring that policies and programs selected are well-aligned with NPMs and other MCH program goals. Implementing policies and programs with fidelity also requires skills in the implementation science drivers: technical and adaptive leadership; selection; training; coaching; systems intervention; facilitative administration; and decision support data systems.
- Skills to identify, assess, and select appropriate outreach and enrollment activities for state and local jurisdictions
- Skills to train local health agencies and health care providers to effectively inform families about insurance coverage options
- Skills to support robust and effective referral systems for insurance enrollment
- Skills to assist with enrollment in insurance for children
Communication skills support the creation and delivery of effective messages between MCH professionals, professional and community partners, and populations served by Title V. Effective communication ensures the delivery of appropriate messages to audiences in the way that they were intended and is key to all aspects of MCH work. These skills are linked closely with skills in strategic partnerships and cultural and linguistic brokering.
- Skills to effectively communicate with families about insurance coverage options
- Ability to effectively use traditional and social media to conduct outreach for insurance enrollment
- Ability to communicate effectively with decision makers/local legislators regarding:
- The health impacts of insurance coverage
- The economic benefits of insurance coverage
- Ability to effectively communicate with decision makers/legislators regarding the importance of adequate coverage for children (CHIP reauthorization, Medicaid expansion, etc.)
In addition to skills, each NPM requires a knowledge base that will help Title V progress effectively in the measure. Knowledge should be considered at the foundation of achieving all measures.
1. Insurance Background, Recommendations & Guidelines
- Knowledge of definition(s) of adequate insurance and how adequacy is measured
- Knowledge of specific definitions related to insurance coverage for children and youth with special health care needs
- Knowledge of state insurance landscape for children, including application process and coverage rates for:
- Children’s Health Insurance Program
- Marketplace process
- Private Insurance
- Knowledge of insurance navigators within state/territory, including who, where, roles, how to access
- Knowledge of existing efforts to increase insurance coverage broadly for children
- Ability to identify insurance coverage for children and youth with special health care needs
2. Insurance Policies & Strategies
- Knowledge of best practices for enrolling in insurance within a given state/territory, including automated enrollment strategies
- Knowledge of safety net programs for children who are not adequately insured
- Knowledge of other states/territories’ best practice interventions in which Title V has successfully helped increase rates of insurance through policy and outreach measures
- Essential components of the Affordable Care Act (ACA) and other state and federal policies that facilitate expanded enrollment in adequate insurance for children
See other online learning resources related to health transformation, collected in the Health Transformation Learning Laboratory.
1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms for the Title V Application/Annual Report, Appendix F, p. 90.