We asked members the following question: What is the relationship of Title V and your state Medicaid department in coordinating and funding home visiting services?
Stephanie Trusty, BSN
Nurse Clinician, Iowa Department of Public Health
In Iowa we have 21 local Title V Maternal Health agencies selected through a competitive bid process and contracted by the Iowa Department of Public Health (IDPH) to provide services to pregnant and postpartum women in all 99 counties. Through the request for proposal process, local Title V agencies received state and federal Title V funds and are designated by Iowa Medicaid as a "Maternal Health Center." The Medicaid provider designation allows the Title V agency the ability to bill Medicaid for nursing home visits and other MH services provided to Medicaid eligible women enrolled in the Title V Maternal Health Program.
The nursing home visit is provided by a registered nurse and includes nursing assessment of the mom and infant and also includes health education, care coordination and oral health services. The nursing home visit is a timed code and must provide at least 31 minutes of face-to-face time in the client’s home. Local maternal health agencies can bill 10 visits in 200 days for each client in the maternal health program.
The Medicaid revenue typically doubles the amount of funding the local maternal health agency has to provide preventive health services and helps makes the Title V MH program sustainable. The Medicaid revenue the agency receives must be reinvested in the Maternal Health Program.
IDPH has an interagency agreement with Iowa Medicaid Enterprise (IME) that clarifies our responsibilities for oversight of the Maternal Health services provided to Medicaid eligible women. IDPH has a long standing collaborative relationship with our Medicaid partners. IDPH and IME staff meet on a monthly basis to discuss any barriers to care for Medicaid members and quality improvement strategies. For more information, view the Iowa Medicaid Maternal Health Center Provider Manual.
Michael D. Warren, MD, MPH, FAAP
Director, Division of Family Health and Wellness, Tennessee Department of Health
The Tennessee Department of Health (TDH) is the recipient of the MIECHV funds for Tennessee. MIECHV funds have been used to expand the availability of evidence-based home visiting programs in the most at-risk counties in Tennessee. Additionally, the MIECHV program has prompted us to explore opportunities for further developing our early childhood infrastructure, which includes a spectrum of services for children and families. Our state Medicaid program, TennCare, is a vital partner in this arena. TennCare funds a statewide targeted case-management program, Help Us Grow Successfully (HUGS), which is administered by TDH and works in concert with the MIECHV-funded programs as well as other state-funded home visiting programs. MIECHV funding also has been used to build on an existing Medicaid-funded outreach initiative (TENNderCare) to create the "Welcome Baby" program. The parents of every new baby born in Tennessee receive a "Welcome Baby" packet with a letter from the First Lady and important information about early childhood priorities; families at medium and high risk for infant death (as determined from the birth certificate) receive a phone or home visit, respectively. Our goal has been to maximize all the available funding sources to create a system of services of varying intensity that enables us to provide the right service for the right family at the right time. The funding from Medicaid allows us to have a more robust spectrum of services available for Tennessee children and families.
Lauri Kalanges, MD, MPH
Acting Director, Office of Family Health Services, Deputy Director, Office of Family Health Services, Virginia Department of Health
The Virginia Title V program at Virginia Department of Health has been collaborating with the state Medicaid office, Department of Medical Assistance Services (DMAS), to provide home visiting for at-risk pregnant women and high-risk infants in the agency’s local health departments. In Virginia, this home visiting program, called Baby Care, has served high-risk pregnant women and infants up to age two for more than 25 years. Both agencies have a designated staff member who is named in a memorandum of agreement. Collaboration occurs across several home visiting efforts by both agencies including the statewide implementation of Behavioral Health Risk Screening for pregnant and parenting women, representation on the Virginia Home Visiting Consortium, and launch of the Virginia Infant Mortality Strategic Plan. The Title V MCH Services Block Grant funds the infrastructure by supporting staff salaries in local health departments to provide Baby Care home visiting services. DMAS reimburses health departments for Baby Care services that partially support the staff salaries and program operations.
The purpose of the Baby Care Program is to improve birth outcomes, reduce infant mortality and morbidity, ensure provision of comprehensive services to pregnant women and infants up to age two, and assist pregnant women and caretakers of infants in receiving wrap-around services that affect their well-being and that of their families.
The Baby Care program includes two key components:
Case management through home visits for at-risk pregnant women and high-risk infants up to age two by a registered nurse or social worker
Expanded prenatal services for pregnant women including patient education classes (including tobacco cessation), nutritional services, homemaker services and substance abuse treatment services by an approved provider