AHCCCS is required to renew its 1115 Waiver with the Centers for Medicare and Medicaid Services (CMS) every five years and will submit its waiver renewal request in December 2020. The waiver renewal request is the agency’s proposal to CMS outlining new and ongoing programmatic authorities. The COVID-19 public health emergency has shifted the agency’s focus to maintaining current services for our members and providers. Given that, and anticipated budgetary limitations, AHCCCS has elected to shift course and focus on a series of smaller-scale, cost-effective initiatives within the parameters of the existing Medicaid program and refrain, at this time, from the pursuit of a broader Whole Person Care Initiative in conjunction with its five-year 1115 Waiver renewal.
For example, AHCCCS and Health Current, Arizona’s Health Information Exchange (HIE), are sourcing a new technical tool for providers— a closed-loop referral system so providers can identify social risk factors and manage referrals to community based agencies who can address those specific needs.
Additionally, AHCCCS will award a contract to a single statewide housing administrator to manage all AHCCCS permanent supportive housing subsidies beginning October 2021.
Whole Person Care During the COVID-19 Pandemic
The AHCCCS Whole Person Care Initiative was designed to build upon the integrated service delivery model and to further the agency’s efforts to address the social risk factors that may contribute more to a person’s wellbeing than their access to health care. We know integrated, whole person health care is not only a cost-efficient approach to health care delivery, but the best opportunity to improve members’ health outcomes. We demonstrate our ongoing commitment to this initiative by the specific efforts we have made during the public health emergency to address exacerbated social risk factors, and by exploring options to expand whole person care while bending the cost curve in accordance with AHCCCS’ strategic plan.
Since March, the COVID-19 public health emergency has profoundly impacted our health care system. AHCCCS has focused efforts on ensuring that the two million enrolled members continue to seamlessly receive needed health care services. We have collaborated with our governing bodies, state and local partners, and community members to make that happen without interruption.
During the public health emergency, AHCCCS has collaborated with contracted Managed Care Organizations (MCOs), Regional Behavioral Health Authorities (RBHAs), Tribal Regional Behavioral Health Authorities (TRBHAs), Tribal ALTCS Contractors, and community based organizations to align efforts, expand resources, and increase awareness of available services for anyone impacted by COVID-19.
Following the onset of the public health emergency, AHCCCS requested federal flexibilities in order to address social risk factors where possible. The agency hosted weekly meetings with MCOs (including RBHAs) to ensure that members facing homelessness had access to the resources they needed during the pandemic. The Rehabilitation Services Administration/Vocational Rehabilitation program provided virtual services for clients, including the ability to sign vocational rehabilitation applications and Individualized Plans for Employment electronically, as well as other applicable forms. Medicaid providers were afforded the opportunity to provide services telephonically and bill for pre- and post- employment services. For individuals transitioning from the criminal justice system, AHCCCS provided educational resources to help members find available transportation to and from shelters and hospitals.
Recognizing the critical role that available transportation plays in determining health outcomes, AHCCCS established a fleet of non-emergency transportation (NEMT) providers willing to transport COVID-19 positive and presumptive positive members, allowing them to access ongoing treatment for conditions such as kidney failure and cancer. In recognizing NEMT providers as COVID-19 fleet partners, interested providers were required to submit proposals to AHCCCS regarding safety precautions including, but not limited to, driver training, personal protective equipment, and comprehensive disinfection strategies. Upon approving their participation in the COVID-19 fleet, AHCCCS established an add-on rate in recognition of these increased costs.
Access to stable, secure housing is one such social risk factor that the agency has been working for many years to address. Currently, AHCCCS provides housing subsidies for approximately 3,000 members statewide, focusing on persons with serious mental illnesses (SMI) as well as individuals with general mental health needs and substance use disorders. AHCCCS administers the SMI Housing Trust Fund, which provides $2 million a year to acquire, rehabilitate, construct or provide vouchers for members determined to have a serious mental illness, and manages referrals to over 1,400 housing units designed for members determined to have a serious mental illness. MCOs partner with community providers to offer Medicaid compensable supportive housing services which supply a full spectrum of supports to assist members in attaining and maintaining housing. Key services include: tenancy support; service coordination; assessment and case management; transportation; employment services and supports; socialization activities; and independent living skills
As a component of the AHCCCS employment program, providers engage in employment discussions with members and make referrals to the Rehabilitation Services Administration/Vocational Rehabilitation program (a service of the Arizona Department of Economic Security).
Criminal Justice Initiatives
AHCCCS collaborates with Arizona’s criminal justice partners to help incarcerated and detained individuals plan for and enroll in Medicaid when they transition from an correctional setting. Care coordination activities occur even before individuals are released. Once enrolled, services include physical and behavioral health, rehabilitation and peer support services.
AHCCCS is exploring new strategies to address the impact of social isolation on individuals enrolled in the Arizona Long Term Care System (ALTCS). This initiative seeks to leverage existing Medicaid providers and covered services to improve engagement for ALTCS members and foster greater community involvement.
Future Enhancements to Whole Person Care Delivery
AHCCCS will continue to evaluate and enhance delivery services and interventions that address social risk factors, leverage existing partnerships, and explore new strategies to expand initiatives outside of 1115 Waiver authority. We maintain our commitment to helping members and our community understand that good health and overall wellness is more than a regular doctor’s office visit - it's health care that considers the whole person.