Medicaid Reimbursement for Naloxone: A Toolkit for Advocates

Naloxone is an opioid antagonist drug used to counter the effects of an opiate overdose. It can be administered in medical settings, such as an emergency room, or prescribed as a take‑home medication to be used in case of an emergency. Currently, most types of insurance will cover and reimburse for naloxone administered directly in a medical setting. However, coverage of prescription take‑home naloxone is limited. The Medicaid program provides health insurance for a large and growing number of Americans. Therefore, securing coverage for take‑home naloxone—including costs of counseling/training and for the medicine itself—within Medicaid should be a critical priority for advocates. This toolkit is designed to facilitate advocacy for that goal. It provides background information on naloxone, the Medicaid program, and Medicaid drug coverage policies. It then outlines an action plan for advocating that state Medicaid programs cover take‑home naloxone. The toolkit concludes with success stories from Washington State, North Carolina, California and New York, highlighting important lessons for advocates

Building on the Affordable Care Act to Make the Health System Work for Young Gay Men: An Action Plan

The Affordable Care Act (ACA), the health reform law that was enacted in 2010, is expected to greatly expand access to stable and affordable insurance coverage for millions of Americans. Extensive research has documented that insurance matters; people with insurance coverage are less likely to report going without necessary care due to inability to pay and are more likely to report positive health outcomes than people who are uninsured.1 Young gay men, however, are a population with distinct needs that has rarely been the focus of attention for the health system. They may be among the least likely to automatically translate having insurance coverage into receiving consistent, high quality medical care. Therefore, focused efforts are needed to explain the importance of health coverage, facilitate enrollment in coverage, address structural barriers to care, and support their engagement with the health system once they obtain coverage. With the ACA developing new systems of care and new ways of paying for services, there is a fresh opportunity to examine key aspects of the healthcare delivery system to ensure that it is designed to facilitate good care and improved health outcomes for program beneficiaries and health plan enrollees. Indeed, the ACA includes several key provisions that create new protections and new opportunities to more proactively meet the needs of lesbian, gay, bisexual, and transgender (LGBT) individuals, including important protections against discrimination on the basis of sexual orientation and gender identity

The Changing Roles of Community Health Workers

Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts. This report provides a snapshot of the varied landscape of CHW programs to better understand how CHWs are integrating with the health system both in terms of the structural elements of these programs, and the relational elements of CHW-health system interaction that make integrated models succeed. Authors suggest that there is no blueprint for success; rather, there are certain unifying structural elements of various integration types, and certain useful mechanisms that enable the preservation of the CHW concept

Alternate Payment Models for Ryan White HIV/AIDS Program Funded Services: Strategies Used by Nine Grantees

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) offers Ryan White HIV/AIDS Program (RWHAP) Part A and Part B grantees some flexibility in determining the method used for paying subgrantees for core medical and support services. Many Part A and Part B grantees use a traditional “cost-based reimbursement” approach, in which subgrantees submit budgets that include personnel costs, other direct costs related to the provision of funded services, and capped indirect costs (IDCs). Some grantees, however, have developed alternative reimbursement models for core medical and/or support services. This report summarizes the reimbursement approaches taken by nine RWHAP grantees. While not an exhaustive list, the seven Part A and two Part B grantees demonstrate a range of payment methods that might provide ideas for other grantees