Case Studies in Healthcare Financing of Healthy Homes Services

This multiyear project is working to document and demystify the landscape and opportunities surrounding healthcare financing for healthy homes services. In year one of the project, the National Center for Healthy Housing (NCHH) conducted a nationwide survey to identify states where healthcare financing for lead poisoning follow-up or home-based asthma services was already in place or pending.

In years two and three of the project, NCHH and a project team led by the Milken Institute School of Public Health conducted a series of interviews in key states identified by the survey. An interview guide was developed to ask key informants in each state questions about the extent and nature of Medicaid-supported services within the state, details of services covered, barriers to implementation, next steps for expanding services and increasing access, and lessons learned. In each state, the project team conducted interviews with at least one representative from the state Medicaid agency, a program contact in the state health department and one to two additional stakeholders (e.g., advocates, local programs, payers, or providers). The interviews were used to develop detailed case studies to distill lessons learned in states with Medicaid reimbursement for healthy homes services and ultimately to better equip other states in seeking reimbursement for these services.

Year three will also saw the publication of a summary paper designed to cultivate common themes and lessons learned across the full set of 10 case studies. This paper will help state and local agencies, nongovernmental organizations, and other stakeholders pursue healthcare financing of home-based lead poisoning and asthma services.

Childhood exposure to lead can have lifelong consequences including decreased cognitive function, developmental delays, and behavior problems; and, at very high levels it can cause seizures, coma, and even death. The Centers for Disease Control and Prevention (CDC) recommend follow-up services for children with blood lead levels at or above the current reference value of 5 μg/dL. This includes continued monitoring of the blood lead level, nutritional intervention, environmental investigation of the home, and lead hazard control based on the results of the environmental investigation. The regulatory and workforce infrastructure to provide these services exists in many states, but many children in at-risk communities still lack consistent access to lead follow-up services. Recent changes resulting from healthcare reform have increased opportunities for states to consider more sustainable and widespread implementation. Some states have already invested heavily in developing programs, policies, and  funding to provide lead follow-up services, but many may be unsure about how to translate these evidence-based practices into sustainable systems and policy.

These case studies summarizes the current healthcare financing landscape in Ohio and Rhode Island for lead follow-up services. Based on survey findings and interviews with each state’s Medicaid agency, its state health department, and other stakeholders, they describe the current state of healthcare, other important funding mechanisms, key barriers, next steps, and lessons learned. This information may be useful to stakeholders in other states that are seeking healthcare financing for lead follow-up or other preventive services, or for stakeholders within the respective state interested in a summary of current and future opportunities within the state.

Ohio: The project team conducted interviews with representatives from the Ohio Department of Health, the Ohio Department of Medicaid, and the Ohio Healthy Homes Network.

Rhode Island: The project team conducted interviews with representatives from the Childhood Lead Action Project, the Rhode Island Department of Health, the Rhode Island Healthy Homes Lead Poisoning Prevention Program, and the Rhode Island Executive Office of Health and Human Services.