Developing Health Equity-focused Interagency Agreements for Title V Maternal and Child Health Services Block Grant to States Program

RESOURCE COLLECTION COMING SOON!

This forthcoming accessible web-based collection of resources was designed to provide suggestions as to how Title V Directors, Coordinators, and other Title V professionals might create and/or revise Title V-Medicaid Inter-Agency Agreements (IAAs) or Memoranda of Understanding (MOU) [hereafter referred to as IAAs] to reflect their evident commitment to advancing health equity across programs and ensuring that eligible populations can access equitable health care. The collection of resources covers the following topics:

• An exploration of equity-focused health care and the importance of Title V and Medicaid programs in advancing health equity and providing services that meet these standards.
• The merits of telehealth services as a strategy for advancing health equity, the importance of collaboration between Title V and Medicaid programs, and the steps to be taken in developing IAAs which provide telehealth services.
• A step-by-step guide in a format aligned with the framework of the Federal regulations 42CFR 431.615, which provides health equity-oriented language that users may modify and apply in developing their own IAAs. This will also provide detailed sample language that may be used to incorporate telehealth services into the IAA.

OVERVIEW AND BACKGROUND 

The growing emphasis on health equity among state and local health policy makers and implementers shows promise for improving the health of populations receiving Title V and Medicaid services. Many states have taken steps to reflect their commitment to health equity in various policy and program documents, mission, and vision statements. The focus on health equity is also guiding the work of state Title V programs and while this is evident in the states’ most recent Title V block grants, many programs have yet to include this focus in their Title V-Medicaid IAAs.

The partnership between Title V and Medicaid remains an area of potential leverage that has not been fully utilized to advance health equity for all served. Title V programs may achieve this goal by including language in their IAAs which promote health equity-focused services that appropriately target health disparities. To move this initiative forward, however, Title V and Medicaid directors must have a good understanding of health equity-focused care and how to design IAAs to include services such as telehealth or others that promote equitable care for people receiving Title V and Medicaid services.

Title V and Medicaid programs are required by legislation to establish documentation for promoting coordination and mutual support between the two programs and other programs within the administering state agency. IAAs are one mode to accomplish this requirement. However, because of the variation in approaches across state agencies, IAAs lack commonality. The agreements are signed for an extended period such as five years and often include broad provisions that do not require an update with every policy or service adjustment. For example, specific guidance did not exist to coordinate the delivery of telehealth services under existing IAAs when the COVID-19 public health emergency caused a pause in in-person service delivery. However, Title V and Medicaid programs were able to meet the general philosophy of the IAA in assuring that resources could nimbly shift to ensure that services could be accessible via telehealth.

Telehealth services are not new. In fact, these services have been used in limited ways in many states for decades despite barriers such as appropriate infrastructure to support the technology and reimbursement for services.[1] [2] [3]    Federal flexibility of the regulations regarding telehealth and the commitment to support state policymakers resulted in expanding the use of telehealth by Medicaid programs during the recent COVID-19 public health emergency. This strategy helped to address many of the barriers to care and made service accessibility easier for Title V populations. This policy shift also provided an opportunity for Title V Directors, Coordinators and Medicaid professionals to think creatively about service expansion using telehealth. The focus on telehealth comes at an opportune time when policymakers are also stressing the importance of health equity, especially for populations that receive healthcare via Title V and Medicaid. 

Citations 

[1] During the COVID-19 public health emergency, physicians identified the following factors most frequently as barriers to use of telehealth: technology challenges (72%), uncertainty about reimbursement (64%) and questions about clinical appropriateness (58%) [Amwell 2020 Physician and Consumer Survey] https://business.amwell.com/press-release/new-amwell-research-finds-telehealth-use-will-accelerate-post-pandemic/

[2] https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html

[3] https://www.beckershospitalreview.com/telehealth/physician-telehealth-usage-increased-58-since-2019-survey-finds.html

Funding Acknowledgement

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UJ0MC31068-05-00 – Partnership for the State Public Health Coordinating Center for Autism ($1,650,000). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.