Medicaid Opportunities for Evidence-Based Program Sustainability
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NCOA has utilized responses from its 2022-23 Business Acumen and Sustainability Assessment to create a new series of themed webinars for Evidence-Based Program grantees. Assessment results indicated that Chronic Disease Self-Management Education (CDSME) and Falls Prevention grantees are seeking to increase their market intelligence regarding state Medicaid transformation initiatives that may generate new earned revenue streams. Community-based organizations (CBOs) can benefit from a broader understanding of the healthcare transformation drivers that are opening doors for expanded coverage of optional Medicaid benefits to support population health and quality improvement.
Grantees around the country are finding success with contracting for evidence-based programs (EBP) with state agencies and/or Medicaid managed care organizations (MCOs). Though each state’s coverage of optional benefits is unique, this webinar series will explore common denominators to approaching state agencies and MCOs. In addition to addressing fundamental information about Medicaid benefit structure and policies, this four-part webinar series will offer both fundamental education about Medicaid programming and real time experience from CBOs on their journeys to Medicaid reimbursement.
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Join this session for a discussion on preparing your organization or Community Care Hub for engagement with your state Medicaid agency.
Organizations across the country implement valuable evidence-based programs in community settings. With proven outcomes for both clinical and behavioral measures, these programs could be a valuable asset for Medicaid beneficiaries. Join this session for a discussion on preparing your organization or Community Care Hub for engagement with your state Medicaid agency. Presenters will highlight why state and community-based organizations should be “at the table” for Medicaid transformation at the state level, federal policies and trends that drive state Medicaid decision-making, and the first steps for making connections. At the end of this webinar, we expect all attendees to be ready to identify the leads in your state Medicaid policy office and managed care division and take the first steps to reach out and connect.
In this webinar, participants will be able to:
1. Identify ways to prepare your organization for engagement with your state Medicaid agency.
2. Highlight why state and community-based organizations should be “at the table” for Medicaid transformation at the state and federal levels.
3. Describe trends that drive state Medicaid decision-making and steps for making connections.
Sharon Williams
Founder and CEO
Williams Jaxon, Consulting, LLC
Sharon R. Williams is the founder and CEO of Williams Jaxon, Consulting, LLC, a business development and training firm focused on support for community organizations, government agencies and health organizations serving Medicare/Medicare consumers. Sharon’s experience includes executive leadership in both the traditional health care and the Home and Community Based Services industries. She is a seasoned and results oriented executive with a passion for the delivery of high quality, culturally competent, comprehensive and cost effective health care services for publicly funded consumers. Sharon was CEO at CareSource Michigan, a top 100 ranked health plan with Medicaid and Medicare product lines. Additional leadership experiences include Vice President roles at Coventry, Amerigroup and OmniCare. She has also served as COO for one of the nation’s leading Area Agencies on Aging. Sharon is a consultant with the National Council on Aging (NCOA). She conducted the research and construct for the soon-to-be-released CDSME marketing video. Additionally, she administers NCOA’s Community Integrated Health Council and the 2017 Network Development Learning Collaborative.
Sharon has been affiliated with leading industry organizations such as America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA), National Association of Area Agencies on Aging (n4a), National Association of Health Services Executives, Meals on Wheels America (MOWA), and the Association for Community Affiliated Plans (ACAP).
Erika Saleski
Project Director
MARC
Erika is a consultant focusing on design, implementation, and management of programs to improve health care delivery to marginalized and underserved communities. Erika supported the Mid-America Regional Council to establish a Community Care Hub operating in both a regional and statewide market, including network infrastructure development, contracting, quality assurance, and referral management.
Tane Lewis
Managed Services Network Supervisor
Mid-America Regional Council
Tane Lewis, BA, Evidence-Based Program (EBP) Coordinator for Mid-America Regional Center (MARC), Local Project Coordinator for the Missouri Association of Area Agencies on Aging (MA4), Master Trainer and Leader of Chronic Disease Self-Management Education (CDSME) Programs, and Community Health Worker (CHW). Tane is also a member of the Missouri Senior Falls Prevention Coalition of Clay and Platte Counties. As the EBP Coordinator for MARC Tane is building a regional network of Community Based Organizations (CBOs), in partnership with MARC, that are committed to facilitating EBPs to empower our communities through health promotion, disease prevention education and support services. MARC is dedicated to investing in local CBOs to increase the capacity and sustainability of their health and wellness programs to better serve our communities.
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State Medicaid Agencies are looking for ways to improve the quality of care, achieve better health outcomes for the people they serve, and control costs. Toward this end, a variety of innovative approaches are being implemented, including removing barriers to care and adding evidence-based programs to approved covered services. AgeSpan in Massachusetts will share their experience working with Medicaid through different payment mechanisms, including contracting directly with the Managed Care Organization and through multiple waivers. At the end of this webinar, we will challenge all attendees to learn more about the initiatives in your state to integrate clinical and social care service delivery.
State Medicaid Agencies are looking for ways to improve the quality of care, achieve better health outcomes for the people they serve, and control costs. Toward this end, a variety of innovative approaches are being implemented, including removing barriers to care and adding evidence-based programs to approved covered services. AgeSpan in Massachusetts will share their experience working with Medicaid through different payment mechanisms, including contracting directly with the Managed Care Organization and through multiple waivers. At the end of this webinar, we will challenge all attendees to learn more about the initiatives in your state to integrate clinical and social care service delivery.
In this webinar, participants will be able to:
1. Identify ways to remove barriers to care and add evidence-based programs to approved covered services
2. Share experiences working with Medicaid through different payment mechanisms, including contracting directly with the Managed Care Organization.
3. Describe initiatives states use to integrate clinical and social care service delivery.Sharon Williams
Founder and CEO
Williams Jaxon, Consulting, LLC
Sharon R. Williams is the founder and CEO of Williams Jaxon, Consulting, LLC, a business development and training firm focused on support for community organizations, government agencies and health organizations serving Medicare/Medicare consumers. Sharon’s experience includes executive leadership in both the traditional health care and the Home and Community Based Services industries. She is a seasoned and results oriented executive with a passion for the delivery of high quality, culturally competent, comprehensive and cost effective health care services for publicly funded consumers. Sharon was CEO at CareSource Michigan, a top 100 ranked health plan with Medicaid and Medicare product lines. Additional leadership experiences include Vice President roles at Coventry, Amerigroup and OmniCare. She has also served as COO for one of the nation’s leading Area Agencies on Aging. Sharon is a consultant with the National Council on Aging (NCOA). She conducted the research and construct for the soon-to-be-released CDSME marketing video. Additionally, she administers NCOA’s Community Integrated Health Council and the 2017 Network Development Learning Collaborative.
Sharon has been affiliated with leading industry organizations such as America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA), National Association of Area Agencies on Aging (n4a), National Association of Health Services Executives, Meals on Wheels America (MOWA), and the Association for Community Affiliated Plans (ACAP).
Jennifer Raymond
AgeSpan
Jennifer Raymond, JD, MBA is the Chief Strategy Officer for AgeSpan and Director of the Healthy Living Center of Excellence (HLCE). HLCE is the statewide hub for dissemination of and contracting for evidence-based self-management programs in Massachusetts. As Director of HLCE, Jennifer is responsible for strategic planning and sustainability, overseeing an 80+ member provider network of community based organizations, as well as all efforts to integrate these programs with a variety of health care payors. Jennifer speaks across the stateand nationally on the impact of community-clinical linkages to successfullyaddress the social determinants of health and improve overall care and healthoutcomes for older adults.
Jennifer has been involved with evidence-based programs since in 2005 and as director of the Healthy Living Center of Excellence (www.healthyliving4me.org) since 2012. She earned a jurisdoctorate from the University of Maine School of Law and a Master’s in Business Administration with a focus on Leadership Development from Saint Joseph’s College of Maine. She serves on the Executive Committee of the Massachusetts Healthy Aging Collaborative, as a consultant for the Aging and Disability Business Institute, and is a member of the national Evidence Based Leadership Collaborative.
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Establishing Medicaid pathways for evidence-based programs involves collaboration across agencies and increasing awareness of the impact of the programs. This webinar will provide an overview of mechanisms available to State Medicaid Agencies to make changes to operations and covered services, including submitting a State Plan Amendment (SPA) to CMS or completing a waiver process. Speakers will highlight the process of submitting a request to add the Chronic Disease Self-Management Program as a covered benefit in Oregon. At the end of this webinar, we will encourage all attendees to reach out to their state association or other stakeholders to discuss taking initial steps in their state.
Establishing Medicaid pathways for evidence-based programs involves collaboration across agencies and increasing awareness of the impact of the programs. This webinar will provide an overview of mechanisms available to State Medicaid Agencies to make changes to operations and covered services, including submitting a State Plan Amendment (SPA) to CMS or completing a waiver process. Speakers will highlight the process of submitting a request to add the Chronic Disease Self-Management Program as a covered benefit in Oregon. At the end of this webinar, we will encourage all attendees to reach out to their state association or other stakeholders to discuss taking initial steps in their state.
Sharon Williams
Founder and CEO
Williams Jaxon, Consulting, LLC
Sharon R. Williams is the founder and CEO of Williams Jaxon, Consulting, LLC, a business development and training firm focused on support for community organizations, government agencies and health organizations serving Medicare/Medicare consumers. Sharon’s experience includes executive leadership in both the traditional health care and the Home and Community Based Services industries. She is a seasoned and results oriented executive with a passion for the delivery of high quality, culturally competent, comprehensive and cost effective health care services for publicly funded consumers. Sharon was CEO at CareSource Michigan, a top 100 ranked health plan with Medicaid and Medicare product lines. Additional leadership experiences include Vice President roles at Coventry, Amerigroup and OmniCare. She has also served as COO for one of the nation’s leading Area Agencies on Aging. Sharon is a consultant with the National Council on Aging (NCOA). She conducted the research and construct for the soon-to-be-released CDSME marketing video. Additionally, she administers NCOA’s Community Integrated Health Council and the 2017 Network Development Learning Collaborative.
Sharon has been affiliated with leading industry organizations such as America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA), National Association of Area Agencies on Aging (n4a), National Association of Health Services Executives, Meals on Wheels America (MOWA), and the Association for Community Affiliated Plans (ACAP).
Katrina Seipp-Lewington
Manager of Community Health
Comagine Health
Katrina Seipp-Lewington is the Manager, Community Health at Comagine Health supporting cooperative agreements with the Centers for Disease Control and Prevention to scale the National DPP, the Administration for Community Living to Grow the Community Integrated Network of Oregon (CINO) to Deliver and Sustain Evidence Based Chronic Disease Self-Management and Support Programs, and multiple state public health interventions. Her work focuses on community engagement, quality improvement, and multi-stakeholder partnerships to support the system design and implementation of state and local sustainable infrastructure for evidence-based health education. Katrina holds a Master of Public Health degree in Health Promotion from Portland State University.
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Community health workers (CHWs) serve in numerous roles to improve the health and well-being of communities, including delivering evidence-based programs. This webinar will provide an overview of what Medicaid reimbursement avenues are available to support CHW services as well as other aspects of CHW sustainability. Speakers from Rhode Island will share the process they used to successfully create a pathway for billing CHW time for Chronic Disease Self-Management workshops. At the end of this webinar, we will encourage all attendees to learn more about the role of CHWs in their state and how that could fit into a reimbursement opportunity.
Community health workers (CHWs) serve in numerous roles to improve the health and well-being of communities, including delivering evidence-based programs. This webinar will provide an overview of what Medicaid reimbursement avenues are available to support CHW services as well as other aspects of CHW sustainability. Speakers from Rhode Island will share the process they used to successfully create a pathway for billing CHW time for Chronic Disease Self-Management workshops. At the end of this webinar, we will encourage all attendees to learn more about the role of CHWs in their state and how that could fit into a reimbursement opportunity.
Carl Rush
Senior Technical Advisor
National Association of Community Health Workers
Carl H. Rush, MRP (he, his) has specialized in policy and workforce development for community health workers (CHWs) since 1996. He has advised CHW policy initiatives in more than 25 individual states; he is currently advising on Medicaid SPA discussions for CHW services in seven states. He was a lead author on HRSA’s 2007 CHW National Workforce Study, and co-lead on the CHW Core Consensus (C3) Project (2013-16). Carl completed two national policy studies with the CDC, on CHW certification and workforce development (WD) strategy (2014-17), and is advising CDC’s new follow-on study of WD policy. He is a consultant to National Academy for State Heath Policy (NASHP) on their current CHW policy learning community TA project, and the Envision (CDC 2110) TA effort for “2109” grantees. He was on a steering committee (2015-19) that became the inaugural Board of Directors for the National Association of CHWs (NACHW), and is currently serving as a policy consultant to NACHW under contract.
Nancy Silva
Senior Director, Health Initiatives
RIPIN
Nancy Silva, MBA, CCHW, is the Senior Director of Health Initiatives at RIPIN. For over 15 years, Nancy has paved the way for Community Health Workers (CHWs) in RI.
Nancy is an elected member of the RI Certification Board of Directors. Nancy is a member of the Community Health Worker Association of RI (CHWARI), the National Association of Community Health Workers (NACHW), and the Armenian International Women’s Association. Nancy has spoken locally and nationally on the integration and utilization of Community Health Workers to improve health outcomes.
She is co-chair of the Payment and Sustainability workgroup as part of the RI Department of Health's CHW Network Strategy and Roadmap for Community Health Workers in RI.
During her tenure at RIPIN, Nancy developed programs designed to improve the health of Rhode Islanders utilizing CHWs. Most recently, Nancy is a 2022 Administration for Community Living awardee for a novel approach to sustaining evidence-based interventions using CHWs.
Sharon Williams
Founder and CEO
Williams Jaxon, Consulting, LLC
Sharon R. Williams is the founder and CEO of Williams Jaxon, Consulting, LLC, a business development and training firm focused on support for community organizations, government agencies and health organizations serving Medicare/Medicare consumers. Sharon’s experience includes executive leadership in both the traditional health care and the Home and Community Based Services industries. She is a seasoned and results oriented executive with a passion for the delivery of high quality, culturally competent, comprehensive and cost effective health care services for publicly funded consumers. Sharon was CEO at CareSource Michigan, a top 100 ranked health plan with Medicaid and Medicare product lines. Additional leadership experiences include Vice President roles at Coventry, Amerigroup and OmniCare. She has also served as COO for one of the nation’s leading Area Agencies on Aging. Sharon is a consultant with the National Council on Aging (NCOA). She conducted the research and construct for the soon-to-be-released CDSME marketing video. Additionally, she administers NCOA’s Community Integrated Health Council and the 2017 Network Development Learning Collaborative.
Sharon has been affiliated with leading industry organizations such as America’s Health Insurance Plans (AHIP), Medicaid Health Plans of America (MHPA), National Association of Area Agencies on Aging (n4a), National Association of Health Services Executives, Meals on Wheels America (MOWA), and the Association for Community Affiliated Plans (ACAP).