Coalitions, policymakers, and other community leaders are advancing initiatives at the state and local levels to improve the care experience for people with serious illness.
There is so much movement at the state level that C-TAC has focused on supporting and advocating for the expansion of palliative care services at the state level as one of its main policy priorities.
By accelerating change at the state level, leaders can innovate to deliver new models and benefits that support those most in need of care – Medicaid beneficiaries – and can act as incubators for federal change. C-TAC recently convened a workshop of state Medicaid leaders, funders, and state policy experts, to identify strategies that can be used to expand access to palliative care services and benefits for people with serious illness qualifying for Medicaid. This workshop aimed to accelerate access to palliative care services for seriously ill patients. It is a part of the Law and Advanced Care project, which is a collaboration between C-TAC and The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. States shared their progress, barriers, and hopes to make palliative care services more accessible.
This workshop was part of a series of convenings focused on capturing the emerging trends in policy innovation that support people with serious illness at the state and national levels. Our April convening brought together national and local experts in implementing policies and benefits for Medicaid beneficiaries with serious illness that allowed us to make the case for the impact of state policy innovation on our Moonshot Goal. We convened state Medicaid leaders to lay out a framework for how they could be most effective in expanding access to palliative care services, allowed states the opportunity to share progress and insights, and identified critical barriers to successful implementation. Invited to the workshop were Medicaid and other agency leaders from 10 states from various regions across the country who have taken strides to expand access to palliative care services through legislative or regulatory means. Leaders were able to discuss the strategies and policy routes they are taking to expand access to services and identify the barriers they have faced in implementing these services.
Key takeaways from the workshop included:
- State leaders are looking for guidance at the federal level about what actions they can take to expand services and benefits for people with serious illness.
- Multiple states identified that dual eligible beneficiaries with serious illness would be an ideal population to support with palliative care benefits. States would like to have an endorsement from the Centers for Medicare Services (CMS) to ensure they would be able to extend benefits and services to this population
- State leaders identified the need for strong state coalitions to assist with gathering stakeholder feedback and to provide subject matter expertise about what should be done locally to support people with serious illness.
- State leaders acknowledged the need to focus on educating the public and health care practitioners about the value and availability of palliative care services so that policy recommendations can gain traction faster and more people can access services once benefits are in place.
National healthcare financing and policy experts Torrie Fields and Hope Glassberg led and facilitated the workshop, guiding leaders through a framework for expanding access to high-quality care for people with serious illness at the state level. This framework included specific action steps that state and federal leaders can take and advocate for to make it easier for states to expand access to palliative care services. This framework can be used as a catalyst for leaders to develop policy and programs that can improve the quality of life for people and families. As policies and benefits are implemented, it can be used to determine what additional steps must be taken to ensure optimal implementation and that the highest-quality care is delivered.
Examples of state activities include:
- Develop a standard definition for palliative care
- Partner with coalitions to implement a plan to increase access to palliative care services
- Advancing legislation to develop a benefit
- Determine patient needs and provider capacity to deliver care
- Determine the cost of delivering care
- Gather stakeholder input to ensure a proposed benefit meets the needs of the population most in need of care
- Develop technical guidance for optimal benefit implementation, including, public engagement and education, workforce and funding, and technology and data infrastructure
Examples of federal activities include:
- Conduct research to define what services are included in palliative care
- Develop guidance to develop a payment rate for palliative care services, and impact to total cost of healthcare
- Gather stakeholder input to ensure patient needs are met
- Support standardization across states and coverage types
- Develop technical guidance and recommendations for optimal implementation
- Direct funding to areas where infrastructure support is needed
Feedback from the workshop will be used to support C-TAC’s federal advocacy efforts with the Center for Medicaid and CHIP Services (CMCS), to disseminate best practices across state agencies in partnership with the National Academy for State Health Policy (NASHP) and the National Association of Medicaid Directors (NAMD), and to develop technical guidance for state agency leaders that can help to standardize palliative care benefits and services available to Medicaid beneficiaries and foster collaboration between states so that more people with serious illness have access to high-quality care regardless of their ability to pay.
C-TAC and Petrie-Flom will continue our exploration of how to expand access to high-quality care for people with serious illness by implementing palliative care services benefits within state Medicaid at our Annual Summit. Register today to hear more about the role of state coalitions and managed care organizations in supporting policy and benefit implementation that expand access to high-quality care for Medicaid beneficiaries.
Please join us at the C-TAC Summit in October where we will be talking about Medicaid programs and others that help support underserved populations with serious illness.
The C-TAC Summit brings leaders from across the country for a face-to-face gathering to empower, inspire, educate and connect as the mission continues. October 24-25, 2022 in Washington, DC.