16^th Annual Medicaid Innovations Forum

Pre-Conference Maternal Health Spotlight

Pre-Conference Chairperson’s Welcome

Linking Women to Equitable Clinical Interventions and Evidence-Based Community Supports

• There are significant perinatal health disparities by race, ethnicity, age, insurance type, and geography.
• Building a culturally, racially, and linguistically congruent workforce is a best practice strategy to reduce unacceptable health disparities.
• The State of Rhode Island through the Department of Health and the Medicaid program are advancing community-based workforce development initiatives concerning perinatal doulas, community health workers, peer recovery workers, professional midwives, lactation counselors, and perinatal mental health specialists

MassHealth’s Perinatal and Maternal Health Policies: How Massachusetts Medicaid is Improving Equitable Care for Birthing Families

• MassHealth is Massachusetts' combined Medicaid program and Children's Health Insurance ​Program (CHIP) covering nearly 40% of births in the commonwealth, or about 25,000 births annually.
• MassHealth seeks to improve the health outcomes of our diverse pregnant and birthing​ members and their infants by providing equitable access to high quality health care services ​and supports.
• To that end, MassHealth has implemented several policies including doula coverage, quality and equity incentives for perinatal care, robust postpartum depression screening requirements, and much more.

Panel Discussion: Transforming Medicaid to Combat the Maternal Health Crisis: Reducing Disparities and Advancing Improved Access to Critical Services that Impact Maternal Morbidity and Support Healthy Outcomes

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Conclusion of Pre-Conference Sessions

Continental Breakfast

Sponsored by:

Chairperson’s Welcome

MEDICAID 2025 LANDSCAPE

Taking a Look at the Political Landscape: What Election Results Mean for the Future of Medicaid

Value-Based Contracting:  Stop Swimming Against the Tide and Build a Boat

• Current state of value-based contracting
• Where it works and doesn’t and why
• What are we really trying to do, and maybe better ways to do it
• How do we go forward?

Panel Discussion: Addressing Social Needs through Medicaid: Screening for SDoH and Mitigating the Negative Health Impacts of Unmet HRSN

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CASE STUDY: Bending the Cost Curve: North Carolina’s Successful Strategy Investing in Whole Person Health

Eighty percent of what shapes our health happens outside the exam room. Factors such as safe housing, healthy food, stable transportation, employment opportunities, and behavioral health support all play a critical role in what makes us healthy. The North Carolina Department of Health and Human Services is dedicated to making sure everyone has the tools to be healthy and thrive. With targeted investments through programs like our Healthy Opportunities Pilots, we’re connecting people to basic needs like food, housing, and job support, alongside their healthcare. We’re also strengthening behavioral health care across the state, giving people better access to mental health and substance use treatment in their communities. The recent expansion of Medicaid and tackling medical debt means that more people are getting the care they need without worrying about the cost. North Carolina’s whole person health approach is leading the way, showing that when we work together to support people’s needs, we can improve lives and make healthcare more affordable for everyone.

Morning Refreshment Break

Panel Discussion: Managing the Evolving Pharmacy Benefit in Medicaid

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Risk Adjustment and Revenue Integrity…then what? Discover the Main Reason Your Plan is Underperforming

Fraud, waste, and abuse (FWA) cost healthcare payers billions every year, negatively impacting operational efficiencies. Is your organization ready to detect, prevent, and effectively combat these issues?

Join us for this valuable session to gain actionable insights for strengthening your company’s defenses against FWA. We’ll walk you through the essential steps of creating a comprehensive FWA program. This expert-led session will cover:

• Types of Fraud, Waste, and Abuse: Understand the various forms of FWA and how they impact your organization.
• Techniques and Tools to Identify FWA: Learn about the most effective technologies and strategies that help detect FWA at its earliest stages while also uncovering complex abuse.
• Scheme Predicting: Discover how forecasting can provide a barricade for fraudulent behaviors and proactively prevent losses.
• Challenges with Data and Beyond: Gain insights into common hurdles in data management, as well as solutions that go beyond data for a holistic approach to FWA.
• Improving Operating Efficiencies and Results: Explore best practices for integrating FWA management into your operations for enhanced efficiency and measurable outcomes.
• Reporting and Documentation Requirements: Learn how to stay compliant with industry standards and regulations through proper reporting and documentation.

CARE DELIVERY

CASE STUDY: Integrating Community Health Workers into Healthcare Teams: Leveraging These Key Resources for Health System Navigation and Resource Coordination, Health Promotion and Education, and Screening and Assessment

• The impact of Community Health Workers (CHWs) in a community with marginalized populations
• Integrating CHWs into health navigation, outreach, and enrollment teams
• Exploring ways to sustain efforts and funding for CHW work in the community.
• Identifying new locations for CHWs to do their work that could be applicable to attendees.

Luncheon

Panel Discussion: Leveraging a Care Integration Strategy to Optimize the Patient Experience and Advance Whole Health: Addressing Coverage Barriers and Care Gaps for High-Cost, High-Risk Populations

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Hospital to Home Continuity of Care for NICU Graduates

Developing a D-SNP Model of Care: Addressing the Barriers that the Dual Eligible Population Faces through Tailored Solutions within a Unified Framework

• Describe the limits of current regulatory framework for the unique needs of a dually eligible population
• List several strategies to streamline the member and provider experience
• List strategies to financially and operationally sustain a D-SNP program

Leveraging Chronic Care Models that Advance Health Equity and Drive Improved Outcomes

• Break through engagement barriers by exploring the intersection of Social Determinants of Health (SDoH) and member decision-making, gaining actionable insights into the unique challenges faced by hard-to-reach populations.
• Implement strategies with impact  by leveraging practical tools and step-by-step approaches designed to boost member engagement rates to 80% or higher, improving outcomes across diverse populations.
• Learn directly from Aetna about how their collaboration with Vheda Health has successfully engaged members across various chronic conditions, driving improved health outcomes and advancing equity.
• Achieve measurable health equity gains  through collaborative innovations that create tangible, lasting improvements in access to care and health outcomes for underserved communities.

Afternoon Refreshment Break

Panel Discussion: Facilitating Transitions from Incarceration into the Community: Ensuring Continuity of Coverage, Reducing Disparities in Care, and Decreasing Recidivism Rates

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Transforming Medicaid: Integrating Whole Health and Sustainable Solutions for Healthy Aging

This presentation explores how Medicaid can deliver comprehensive care addressing physical, mental, behavioral, and social needs. We’ll focus on enhancing the customer journey and ensuring sustainability in services for the elderly, frail, and individuals with disabilities or special needs—many of whom are dual eligibles. Key topics include:

• Whole Health for Healthy Aging: Designing Medicaid solutions that integrate medical, mental health, and social services for effective, person-centered care.
• Addressing Health-Related Social Needs: Incorporating housing, nutrition, transportation, and social connectivity to create a supportive environment for older adults.
• Enhancing Transitions of Care: Facilitating seamless and continuous transitions between hospitals, long-term care facilities, homes, and communities to improve health outcomes and reduce readmissions.
• Sustainable Care Models: Leveraging community partnerships and value-based care to ensure continuity, access, and cost-effective services for aging populations.

Cocktail Reception

SPONSORED BY:

CARE DELIVERY(continued)

Continental Breakfast

A Triple Crown of Care: Efficiency, Access, and Continuity with MCOs and KHIE

Managed Care Organizations (MCOs) derive substantial benefits from state-based Health Information Exchanges (HIEs) such as the Kentucky Health Information Exchange (KHIE), which enhance data sharing, improve interoperability, and facilitate superior care coordination, leading to better patient outcomes. KHIE enables MCOs to gain a comprehensive understanding of patient health, supporting effective management of complex and chronic conditions. HIEs like KHIE promote seamless collaboration across healthcare providers, ensuring coordinated and patient-centered care. This interconnected approach not only improves health outcomes but also results in significant cost savings, essential for MCOs aiming to manage expenses while delivering high-quality care. This presentation will illustrate how MCOs leverage KHIE data to deliver superior care with a more complete understanding of their patients.

CASE STUDY: How New Jersey Leveraged Medicaid-Funded Infrastructure to Expand Interoperability to LTCs

As long-standing facilitators of many statewide healthcare initiatives, the New Jersey Department of Human Services (NJDHS) and New Jersey Health Information Network (NJHIN) are leading the nation by driving cutting-edge interoperability efforts in their state while ensuring healthy outcomes for more than 2.2 million Medicaid beneficiaries.

COVID-19 was the catalyst for a widespread push to connect the state HIE to public health registries—a move that is paying dividends for providers today. Notably, New Jersey is also one of the only HIEs to meaningfully support long-term care facilities, an often-overlooked stakeholder in interoperability efforts. By leveraging existing Medicaid investments in technology infrastructure, 97% of LTCs seamlessly connected to the HIE in just 6 months—an unmatched rapid deployment for this provider cohort.

Today, NJHIN connects and streamlines actionable patient information and this real-time connectivity between public health and the private healthcare industry is key to enhancing information sharing, improving coordination, enabling proactive measures, and supporting data-driven decision making—ultimately leading to more effective and efficient public health ecosystem.

In this presentation, Jennifer D’Angelo, Chief Operating Officer and the Executive Vice President of NJII Healthcare Division will discuss how New Jersey collaborated to leverage established Medicaid funded infrastructure to support the most vulnerable patients across the care continuum. They will also share how other states can model their approach and stretch Medicaid grounded investments to expand interoperability programs to other stakeholders and support new use cases.

HEALTH EQUITY/HRSN

Outreach, Engagement and Whole Health for SMI: A Peer-Led Approach for Individuals Disconnected from Mainstream Services

Panel Discussion: Operationalizing Health Equity Efforts in Medicaid: Identifying and Eliminating Barriers to Health Equity, Reducing Racial and Ethnic Disparities, and Closing Gaps to Accessing Essential Services

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Cultural Innovations for Advancing Health Equity in Medicaid: Lessons from African Principles

This presentation explores how African cultural principles like Sankofa, Eban, Ubuntu, and Sawubona can be integrated into Medicaid to advance health equity. Drawing from the Afrocentric paradigm and evidence-based models like the Eban Intervention, we’ll show how these values foster culturally competent care, reduce disparities, and build trust for Black, Indigenous, and Medicaid populations. Attendees will gain insights into how Medicaid systems can adopt community-centered, culturally resonant approaches to improve care.

By the end of this session, participants will:

1. Develop an understanding of African cultural principles—and how they can be systematically integrated to advance health equity within Medicaid, fostering cultural competency and trust.
2. Identify strategies to apply community-centered models that support a holistic, culturally informed approach to care, addressing systemic biases and building resilience within marginalized populations.
3. Learn evidence-based methods for applying Afrocentric paradigms in health interventions to bridge cultural gaps, improve patient-provider relationships, and achieve more equitable health outcomes for diverse Medicaid populations.
4. Discover how Blue Cross Blue Shield of Minnesota has incorporated these principles by engaging Community Health Workers (CHWs) and doulas to provide culturally attuned support to members, resulting in stronger patient-provider relationships and more equitable health outcomes

Morning Refreshment Break

CASE STUDY: Building a Community-Based Social Service Network: Partnering with CBO’s to Deliver Specific Social Needs

BEHAVIORAL HEALTH

Panel Discussion: Building Out the Behavioral Health Continuum of Care:  Integrating Behavioral and Physical Health, Improving Mobile Crisis Services, and Advancing Substance Use Services and Supports

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Luncheon

Behavioral Health in Primary Care

Supplementing and Expanding SUD Services: Leveraging On-site MMCO SUD Licensed Care Managers and Non-Licensed Peer Specialists

• On-site Care Management & Peer Support Specialists SUD
  • Program Design
    • Face-to-face engagement
    • Assessing strengths and barriers to recovery
    • Engagement post-discharge
• Program Evaluation and Outcomes

Conclusion of Conference