Building the Case to Expand Medicaid and Private Insurance for Early Intervention
Updated September 30, 2024, 5:59 AMThese video interviews recounting state stories, a planning tool, and related presentations are integrated components to maximize your learning and provide the information you need to be successful expanding coverage for Early Intervention. The materials were produced during a a cross-state cohort of Part C state staff and stakeholders, in collaboration with ITCA, DaSy and OSEP staff.
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State Stories
Several states have successfully built the case to expand the use of Medicaid and/or private insurance to support IDEA Part C Early Intervention systems and services. Effective strategies included:
- building a network of relationships,
- establishing state context of Early Intervention with those stakeholders, and
- conducting relevant data analyses to use in crafting a document demonstrating the need for expansion of Medicaid and/or private insurance.
This video series features current and past state IDEA Part C Early Intervention coordinators and staff, speaking about their efforts to maximize Medicaid and private third-party insurance funding for Early Intervention. The interviews address the impetus for these changes, key stakeholders who informed and leveraged the process, essential data that was used to make the case for change, amounts of additional revenue generated, logistics for billing, and recommendations for states considering a similar approach.
Connecticut: Using a State Plan Amendment to Expand Medicaid under EPSDT
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Alice Ridgway (Connecticut Part C Coordinator) about the state's experiences doing a State Plan Amendment to expand Medicaid funding under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to cover early intervention services. Alice also talks about implications on family fees and private insurance under the early intervention third party insurance legislation. (36 min.)
Resources:
- Connecticut State Insurance Statutes
- Connecticut State Rates and DSS Department of Social Services (DSS) Information
- Connecticut Procedures on Payment to Programs
- Connecticut Birth to Three overview on the DSS webpage: DSS is the single State agency responsible for administering all Connecticut Medical Assistance Programs, including adherence to all Medicaid requirements.
- Related resources specific to the Connecticut State Plan Amendment and the Early Intervention Services waiver under EPSDT
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Alice Ridgway (Connecticut Part C Coordinator) about the state's experiences doing a State Plan Amendment to expand Medicaid funding under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) to cover early intervention services. Alice also talks about implications on family fees and private insurance under the early intervention third party insurance legislation. (36 min.)
Resources:
- Connecticut State Insurance Statutes
- Connecticut State Rates and DSS Department of Social Services (DSS) Information
- Connecticut Procedures on Payment to Programs
- Connecticut Birth to Three overview on the DSS webpage: DSS is the single State agency responsible for administering all Connecticut Medical Assistance Programs, including adherence to all Medicaid requirements.
- Related resources specific to the Connecticut State Plan Amendment and the Early Intervention Services waiver under EPSDT
District of Columbia: Using an Administrative Rule to Expand Use of Medicaid
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Allan Phillips (District of Columbia Part C Coordinator) about the district's experiences to use an administrative rule rather than a State Plan Amendment to expand use of Medicaid for early intervention services. (15 min.)
Resources
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Allan Phillips (District of Columbia Part C Coordinator) about the district's experiences to use an administrative rule rather than a State Plan Amendment to expand use of Medicaid for early intervention services. (15 min.)
Resources
Virginia: Maximizing Medicaid and Private Insurance
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Catherine Hancock (Virginia Part C Coordinator) and Kyla Patterson (Virginia Team Leader) about the state's experiences expanding Medicaid under the authority of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and a legislative mandate for private third-party insurance to cover early intervention services. (15 min.)
Resources
- Early Intervention Practice Manual, Chapter 11: Finance and Billing
- Early Intervention Practice Manual, Chapter 12: Personnel
- Administrative Code 12VAC35-225-430. Certification required for early intervention professionals and early intervention specialists.
- Virginia Medicaid Early Intervention Manual
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Catherine Hancock (Virginia Part C Coordinator) and Kyla Patterson (Virginia Team Leader) about the state's experiences expanding Medicaid under the authority of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) and a legislative mandate for private third-party insurance to cover early intervention services. (15 min.)
Resources
- Early Intervention Practice Manual, Chapter 11: Finance and Billing
- Early Intervention Practice Manual, Chapter 12: Personnel
- Administrative Code 12VAC35-225-430. Certification required for early intervention professionals and early intervention specialists.
- Virginia Medicaid Early Intervention Manual
New Mexico: Establishing an Insurance Mandate
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Andy Gomm (former New Mexico Part C Coordinator) about the state's experiences establishing state legislation mandating private third-party insurance coverage for early intervention services. (26 min.)
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Andy Gomm (former New Mexico Part C Coordinator) about the state's experiences establishing state legislation mandating private third-party insurance coverage for early intervention services. (26 min.)
Colorado: Creating an Administrative Trust to Manage Third-Party Reimbursement
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Christy Scott (Colorado Part C Coordinator) about the state's experiences with private third-party insurance legislation, and the creation of an Early Intervention Services Insurance Trust to manage reimbursement for early intervention services. (21 min.)
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Christy Scott (Colorado Part C Coordinator) about the state's experiences with private third-party insurance legislation, and the creation of an Early Intervention Services Insurance Trust to manage reimbursement for early intervention services. (21 min.)
IDEA Fiscal Academy 2022: Rhode Island's Story
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Jennifer Kaufman (Rhode Island Part C Coordinator) about their experiences. (13 min.)
Ron Benham (Consultant, IDEA Infant-Toddler Coordinators' Association) interviews Jennifer Kaufman (Rhode Island Part C Coordinator) about their experiences. (13 min.)
Planning Tool
This planning tool is designed for state teams wanting to expand funding— either Medicaid and/or private insurance— to cover early intervention supports and services. It includes detail on the considerations, information and data needed to craft a document that makes a compelling argument for the expansion. The tool serves as a guide and provides a means to capture the objective, as well as the process and information used in the expansion effort. Having an archive of the work is key. Attempts at expansion may not always be successful. A documented plan supports subsequent efforts for the expansion as personnel, stakeholders, priorities, and other circumstances within state context change over time.
Planning Tool: Building the Case to Expand Medicaid and Private Insurance
1. Solidify the Objective
Think about what you would like to achieve, keeping in mind that refining the objective will be part of the process. This early decision will provide direction and inform the additional information needed to move forward.
Think about what you would like to achieve, keeping in mind that refining the objective will be part of the process. This early decision will provide direction and inform the additional information needed to move forward.
2. Build a Network of Partners
In the end, it's all about relationships. Partners play a critical role in helping to make a convincing argument for the expansion. Be strategic and intentional in selecting relevant stakeholders who will support the objective. Anticipate those who might be resistant and connect with them to address their concerns.
In the end, it's all about relationships. Partners play a critical role in helping to make a convincing argument for the expansion. Be strategic and intentional in selecting relevant stakeholders who will support the objective. Anticipate those who might be resistant and connect with them to address their concerns.
3. Ascertain Political Context
Be current and clear about competing priorities among state leadership, individual motivation to either support or oppose the desired expansion, the status of the state budget and any pressing issues on the legislative agenda. Use this information to target additional stakeholders of influence.
Be current and clear about competing priorities among state leadership, individual motivation to either support or oppose the desired expansion, the status of the state budget and any pressing issues on the legislative agenda. Use this information to target additional stakeholders of influence.
4. Establish the Context of Early Intervention
It cannot be assumed that state leadership with decision-making authority has a comprehensive understanding of early intervention supports and services in the state. Details on system infrastructure, flow of funds, current billing practices, funding sources used, and the identified need for the expansion should be provided and summarized in a succinct format.
It cannot be assumed that state leadership with decision-making authority has a comprehensive understanding of early intervention supports and services in the state. Details on system infrastructure, flow of funds, current billing practices, funding sources used, and the identified need for the expansion should be provided and summarized in a succinct format.
5. Conduct Data Analysis
Identify the elements and analysis needed to make a compelling case effectively and efficiently for the expansion. Having multiple formats for sharing the data analysis, including data visualizations, honors adult learning styles and boosts the likelihood of consumption and use of the data.
Identify the elements and analysis needed to make a compelling case effectively and efficiently for the expansion. Having multiple formats for sharing the data analysis, including data visualizations, honors adult learning styles and boosts the likelihood of consumption and use of the data.
6. Make the Sell: Project Impact and Develop Options
All the information gathered is used to identify the costs and anticipated impact of the expansion, both fiscally and programmatically. Cost categories include personnel, infrastructure (e.g., data system enhancement) which may exceed revenue generated, especially in the first year of implementation. Return on investment should be projected over time, with detail on the investments that are needed and by whom.
All the information gathered is used to identify the costs and anticipated impact of the expansion, both fiscally and programmatically. Cost categories include personnel, infrastructure (e.g., data system enhancement) which may exceed revenue generated, especially in the first year of implementation. Return on investment should be projected over time, with detail on the investments that are needed and by whom.
7. Develop an Action Plan and Timeline
Having a written plan of action provides direction and assures accountability to the expansion effort. The plan brings clarity and transparency by articulating the necessary steps in the process, and the persons responsible for carrying out those steps. The plan also serves as an archive of the work, which supports subsequent attempts for the expansion as personnel, stakeholders, priorities, and other circumstances within state context change overtime.
Having a written plan of action provides direction and assures accountability to the expansion effort. The plan brings clarity and transparency by articulating the necessary steps in the process, and the persons responsible for carrying out those steps. The plan also serves as an archive of the work, which supports subsequent attempts for the expansion as personnel, stakeholders, priorities, and other circumstances within state context change overtime.
Presentation Files
The following three PowerPoint presentations address the key content areas state teams need to consider when making the case to expand coverage for Early Intervention. They include video clips from the State Stories and prompt use of the Planning Tool.
Session 1: Getting Started and Building Relationships
This session addresses that states teams must build the foundation of their case to expand coverage for Early Intervention by refining an action statement specifying what they want to achieve, how they recommend their State accomplish the objective, and identify who needs to be engaged in the process.
Session 2: Establishing State Context
This session addresses the importance of establishing State context, both of the Early Intervention system and other state priorities, to ensure baseline understanding about the need for expansion and leverage buy-in from key stakeholders, including high-level decision makers.
Session 3: Conducting Relevant Data Analysis
This session covers the data elements and analysis needed to make the case for expansion, including how to use data visualizations to effectively demonstrate the need and viability to sell the case.
in collaboration with:
