16^th Annual Medicaid Innovations Forum

Pre-Conference Maternal Health Spotlight

Ensuring that Pregnancy-Related Coverage is Focused on the Whole Person: Providing Person-Centered Care Addressing the Physical, Behavioral and Social Needs of Mom and Baby

Leveraging Culturally Competent, Personalized Maternal and Infant Care Models: Linking Women to Equitable Clinical Interventions and Evidence-Based Community Supports

Engaging Medicaid Members with a Maternity Benefit that Meets Their Needs from Conception to Postpartum: Identifying Risks, Addressing SDoH, and Enhancing the Member Experience

Panel Discussion: Transforming Medicaid to Combat the Maternal Health Crisis: Reducing Disparities and Advancing Improved Access to Critical Services that Impact Maternal Morbidity and Support Healthy Outcomes

Panelists:

Welcome Reception

Chairperson’s Welcome

MEDICAID 2025 LANDSCAPE

Taking a Look at the Political Landscape: What Election Results Mean for the Future of Medicaid

Value-Based Contracting:  Stop Swimming Against the Tide and Build a Boat

• Current state of value-based contracting
• Where it works and doesn’t and why
• What are we really trying to do, and maybe better ways to do it
• How do we go forward?

Panel Discussion: Addressing Social Needs through Medicaid: Screening for SDoH and Mitigating the Negative Health Impacts of Unmet HRSN

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Panelists:

CASE STUDY: Bending the Cost Curve: North Carolina’s Successful Strategy Investing in Whole Person Health

Morning Refreshment Break

Panel Discussion: Managing the Evolving Pharmacy Benefit in Medicaid

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Panelists:

Risk Adjustment and Revenue Integrity…then what? Discover the Main Reason Your Plan is Underperforming

CARE DELIVERY

CASE STUDY: Integrating Community Health Workers into Healthcare Teams: Leveraging These Key Resources for Health System Navigation and Resource Coordination, Health Promotion and Education, and Screening and Assessment

Luncheon

Panel Discussion: Leveraging a Care Integration Strategy to Optimize the Patient Experience and Advance Whole Health: Addressing Coverage Barriers and Care Gaps for High-Cost, High-Risk Populations

Panelists:

Hospital to Home Continuity of Care for NICU Graduates

Developing a D-SNP Model of Care: Addressing the Barriers that the Dual Eligible Population Faces through Tailored Solutions within a Unified Framework

Leveraging Chronic Care Models that Advance Health Equity and Drive Improved Outcomes

Afternoon Refreshment Break

Panel Discussion: Facilitating Transitions from Incarceration into the Community: Ensuring Continuity of Coverage, Reducing Disparities in Care, and Decreasing Recidivism Rates

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Creating Access to Care through Delivering High Quality Networks: Addressing the Unique Needs and Health Equity Considerations of Medicaid Members and Ensuring Network Adequacy

Transforming Medicaid: Integrating Whole Health and Sustainable Solutions for Healthy Aging

In this presentation, we will explore how Medicaid can be leveraged to deliver comprehensive care that addresses physical, mental, behavioral, and health-related social needs. We’ll focus on enhancing the consumer journey and ensuring sustainability in aging services by:

• Whole Health Approach for Aging Populations: Designing Medicaid solutions that integrate medical care with mental health and social needs, recognizing that mind and body are inseparable for effective, person-centered care.
• Addressing Health-Related Social Needs: Incorporating housing, nutrition, transportation, and social connectivity into Medicaid strategies to create a supportive environment for older adults.
• Enhancing Transitions of Care: Developing seamless care pathways from hospital to home or community to long-term care, aimed at reducing readmissions and improving health outcomes.
• Sustainable Models of Care Delivery: Leveraging cross-sector partnerships and value-based care to ensure continuity, access, and cost-effective care for aging populations.

Cocktail Reception

SPONSORED BY:

CARE DELIVERY(continued)

CASE STUDY: Leveraging Electronic Visit Verification (EVV) Data to Monitor Service Delivery:  Ensuring Services are Documented, Preventing Fraud and Abuse, and Managing Care and Resources Efficiently

Developing, Testing, and Evaluating Alternative Payment Methodologies: Delivering Medical and Administrative Cost Savings while Enhancing Clinical Quality

CASE STUDY: A Triple Crown of Care: Efficiency, Access, and Continuity with MCOs and KHIE

Managed Care Organizations (MCOs) derive substantial benefits from state-based Health Information Exchanges (HIEs) such as the Kentucky Health Information Exchange (KHIE), which enhance data sharing, improve interoperability, and facilitate superior care coordination, leading to better patient outcomes. KHIE enables MCOs to gain a comprehensive understanding of patient health, supporting effective management of complex and chronic conditions. HIEs like KHIE promote seamless collaboration across healthcare providers, ensuring coordinated and patient-centered care. This interconnected approach not only improves health outcomes but also results in significant cost savings, essential for MCOs aiming to manage expenses while delivering high-quality care. This presentation will illustrate how MCOs leverage KHIE data to deliver superior care with a more complete understanding of their patients.

CASE STUDY: How New Jersey Leveraged Medicaid-Funded Infrastructure to Expand Interoperability to LTCs

As long-standing facilitators of many statewide healthcare initiatives, the New Jersey Department of Human Services (NJDHS) and New Jersey Health Information Network (NJHIN) are leading the nation by driving cutting-edge interoperability efforts in their state while ensuring healthy outcomes for more than 2.2 million Medicaid beneficiaries.

COVID-19 was the catalyst for a widespread push to connect the state HIE to public health registries—a move that is paying dividends for providers today. Notably, New Jersey is also one of the only HIEs to meaningfully support long-term care facilities, an often-overlooked stakeholder in interoperability efforts. By leveraging existing Medicaid investments in technology infrastructure, 97% of LTCs seamlessly connected to the HIE in just 6 months—an unmatched rapid deployment for this provider cohort.

Today, NJHIN connects and streamlines actionable patient information and this real-time connectivity between public health and the private healthcare industry is key to enhancing information sharing, improving coordination, enabling proactive measures, and supporting data-driven decision making—ultimately leading to more effective and efficient public health ecosystem.

In this presentation, Jennifer D’Angelo, Chief Operating Officer and the Executive Vice President of NJII Healthcare Division will discuss how New Jersey collaborated to leverage established Medicaid funded infrastructure to support the most vulnerable patients across the care continuum. They will also share how other states can model their approach and stretch Medicaid grounded investments to expand interoperability programs to other stakeholders and support new use cases.

HEALTH EQUITY/HRSN

Panel Discussion: Operationalizing Health Equity Efforts in Medicaid: Identifying and Eliminating Barriers to Health Equity, Reducing Racial and Ethnic Disparities, and Closing Gaps to Accessing Essential Services

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Morning Refreshment Break

Cultural Innovations for Advancing Health Equity in Medicaid: Lessons from African Principles

This presentation will explore how African cultural practices and principles can play a transformative role in Medicaid innovations to advance health equity. With a focus on the integration of values such as Sankofa, Eban, Ubuntu, and Sawubona, we will demonstrate how these principles can be adapted into healthcare practices to reduce health disparities and improve the quality of care for Black, Indigenous, and Medicaid populations. By sharing stories of systemic issues in healthcare, this session will demonstrate how cultural values can foster trust, build community-driven solutions, and drive culturally competent care, creating a more equitable Medicaid system.

Application in Medicaid:
Medicaid could adopt a community-centered approach, providing a sense of security around patients. Incorporating community health workers who understand the cultural contexts and needs of Medicaid populations will build stronger bonds of trust, ensuring patients feel protected and respected within the system. Medicaid must create systems where patients, especially from marginalized communities, feel seen, heard, and valued so that healthcare providers can acknowledge and respond to the full humanity of each patient.

By the end of this presentation, participants will:

• Develop a deep understanding of how key African cultural principles can be applied to innovate Medicaid services and improve healthcare delivery for marginalized populations
• Learn how these values can serve as tools to foster cultural competency, helping healthcare providers to better connect with and serve Medicaid patients from diverse backgrounds
• Learn how to implement cultural frameworks that foster trust and respect within Medicaid, resulting in more equitable healthcare outcomes for Black, Indigenous, and Medicaid populations

CASE STUDY: Building a Community-Based Social Service Network: Partnering with CBO’s to Deliver Specific Social Needs

BEHAVIORAL HEALTH

Panel Discussion: Building Out the Behavioral Health Continuum of Care:  Integrating Behavioral and Physical Health, Improving Mobile Crisis Services, and Advancing Substance Use Services and Supports

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Luncheon

Providing Behavioral Health Services to Medicaid Patients in Primary Care: A Payer/Provider Collaboration

OhioRISE: Youth Behavioral Health System of Care Coordination

• History and goals of OhioRISE
• View of the first 18 months of the program
• Projecting the future of OhioRISE in meeting the needs of youth with complex BH needs

Supplementing and Expanding SUD Services: Leveraging On-site MMCO SUD Licensed Care Managers and Non-Licensed Peer Specialists

Outreach, Engagement and Whole Health for SMI: A Peer-Led Approach for Individuals Disconnected from Mainstream Services

Conclusion of Conference