Lawrence Kingsley DrPH
POTENTIAL IMPLICATIONS OF MEDICAID HEALTH HOMES ON HIV/AIDS COMMUNITY-BASED ORGANIZATIONS: A REVIEW OF NEW YORK, ALABAMA, AND WISCONSIN STATE PLANS Kristin Slovenkay, MPH
University of Pittsburgh, 2014
Abstract: Human Immunodeficiency Virus (HIV) infection /Acquired Immune Deficiency Syndrome (AIDS) has transitioned into a complex chronic condition in the United States. HIV/AIDS often occurs in socially disadvantaged persons with coexisting mental or behavioral health problems. Individuals among these populations commonly seek care and support from a variety of health care and social service providers. Community-based organizations (CBO’s) are one example of social service providers often located in separate physical locations from medical treatment centers. The Affordable Care Act (ACA) contains several components to improve the coordination of healthcare providers and ultimately reduce costs. Medicaid Health Homes are a specific provision of the Affordable Care Act providing coordinated, comprehensive care among providers for persons with a combination of mental health, substance use, and chronic conditions such as HIV/AIDS. States must receive approval for Medicaid Health Homes and develop operational definitions, and regulations. This paper explored the state plan amendments of New York, Alabama, and Wisconsin in order to anticipate the potential downstream impact of Health Homes on HIV/AIDS CBO’s. The role of CBO’s in the state plans range from paid integrated Health Home network members, to recipients of community support referrals. CBO’s will need to advocate their services to larger designated providers in order to remain a viable entity in HIV/AIDS care. The importance of health information technology and quality reporting pushed by the Affordable Care Act may be a limitation for some HIV/AIDS CBO’s in the transition to Health Homes. The provision of support services by CBO’s, and coordination among HIV/AIDS providers is of public health importance in order to retain individuals in care and reduce the viral load in the community. These strategies will help prevent further transmission of the virus.
TABLE OF CONTENTS
TABLE OF CONTENTS vi
1.0 Introduction 1
background of hiv/aids 2
Chronic Disease Era 2
Subpopulations with Social Service Needs 4
role of social service providers 6
Relationship between Social Support Services and Medical Care 6
Geographic Variations in Social Support Service Needs 8
2.0 AffoRdable care act: medicaid chronic health homes 11
2.1New york state plan amendment 15
Review of Operational Definitions 15
Implications for CBO’s in New York 18
ALABAMA STATE PLAN AMENDMENT 19
Review of Operational Definitions 19
Implications for CBO’s in Alabama 23
3.0 CONCLUSION AND PUBLIC HEALTH RECOMMENDATIONS 29
I would like to thank my essay committee, Dr. Joel Weissfeld, and my advisor Dr. Lawrence Kingsley. Their reviews and suggestions were of great help and importance to the creation of this essay.
This paper will critique the Medicaid Health Home Plans for chronic conditions of New York, Alabama, and Wisconsin in order to assess their potential impact on HIV/AIDS community-based organizations (CBO’s). These three states along with Washington and Oregon applied and received approval for HIV/AIDS Medicaid Health Homes, however only New York, Alabama, and Wisconsin were included in this assessment (Center for Medicare and Medicaid Services 2014). Background on the nature of HIV/AIDS as a chronic condition, and the need for social support services among the population will be provided along with evidence of the relationship between support services and medical treatment. This will develop the foundation for discussion of HIV/AIDS Medicaid Health Homes in the Affordable Care Act. The operational definitions developed by the states of New York, Alabama, and Wisconsin will be critiqued along with their implications on HIV/AIDS CBO’s that provide social support services.
HIV/AIDS is a complex chronic condition in the United States that requires a variety of healthcare and social service providers. Individuals with HIV/AIDS on antiretroviral therapy (ART) are experiencing more chronic conditions and comorbidities in contrast to the AIDS-related illnesses and mortalities that occurred in the early years of the virus (Deeks, Lewin et al. 2013). Innovative care models such as the Medicaid Health Home provision in the Affordable Care Act present an opportunity to improve HIV/AIDS care in the chronic disease era of the virus. The focus of the Medicaid Health Homes is to provide a comprehensive, coordinated approach to care for individuals with chronic conditions (Office of the Legislative Counsel 2010). HIV/AIDS is an eligible chronic condition under this initiative (Sebelius 29 Nov 2012).
HIV/AIDS affects particular populations of the United States at disproportionate rates including individuals with comorbid mental illnesses, and individuals of low socioeconomic status (Pence, Reif et al. 2007). This has created a need for a variety of social service providers including community-based organizations (CBO’s) to serve these populations. CBO’s are typically separate from medical providers, and address basic needs such as transportation, case management, and housing. Social support services are important for retention in medical care, and medication adherence (Ashman, Conviser et al. 2002, Chan, Absher et al. 2002, Conover and Whetten-Goldstein 2002, Cunningham, Sanchez et al. 2008, Stewart, Phillips et al. 2011). The incorporation of CBO’s into the Medicaid Health Homes could be an important asset to fulfilling the goals of comprehensive, coordinated care. However, elements of the Health Home State plans may also decrease the importance and viability of CBO’s if services get wrapped into medical care providers. This research will analyze the Health Home State Plan amendments of New York, Alabama, and Wisconsin, and discuss their potential implications for HIV/AIDS CBO’s.