State Discontinues $15 Million Federal Integrated Kids Care Program
After spending $3.219 million and not serving a single client, the Oregon Health Authority has shut down a pilot program to improve care for children with behavioral and physical health-related needs. The state agency is blaming onerous data collection requirements for ending the federally funded project. State officials say they are disappointed but have learned important lessons from their work on the program, which they hope to put to use in the future.
In June 2019, the state applied to the Centers for Medicare & Medicaid Services and the Center for Medicare & Medicaid Innovation’s Integrated Care for Kids pilot program — known as InCK — and its proposal was one of eight approved around the country. The state was slated to receive $15.4 million in federal funding over seven years.
Officials intended to use the funds to link up disparate programs including at the Medicaid-funded Oregon Health Plan to help youths younger than 21 in Jefferson, Deschutes, Crook, Polk and Marion counties. The project would “improve health outcomes, enhance access to home and community-based services, and reduce unnecessary health care costs in Oregon,” according to the state’s June 6, 2019 application. “There are persistent poor health outcomes and health disparities for children in this region, driven by the social determinants of health and adverse childhood experiences, which we plan to address through the InCK Model. Our partners in the InCK Model service area have eagerly signed on to participate on the Partnership Council and are ready to hit the ground running should we be awarded,” the application stated.
But after working for two years on the pre-implementation phase, state officials said they realized the federal government was not going to bend on certain standardized screening requirements intended for data collection and evaluation. The officials said the federal requirements stiffened after Oregon made its initial application.
“Over the summer and early fall, the Oregon team received clarifications from the federal funder regarding the Integrated Care for Kids (InCK) Model and their expectations,” said an email sent to OHA staff by the InCK staff on Oct. 18. “A number of these clarifications require significant changes to the Oregon InCK Model and reporting requirements for 2022 that our collective teams feel are not viable to implement, as they would require us to divert our focus from the integration of services to data collection and data reporting.”
Office of Health Policy Director Stephanie Jarem used more explicit language in a draft letter intended for the co-chairs of the human services subcommittee of the Legislature’s budget committee, Ways & Means, according to emails obtained through a records request. There, she said the federal requirements would have hurt services to children, not helped. The Center for Medicare & Medicaid Innovation’s “clarifications and requirements cannot be operationalized in a way that honors the feedback, intent and vision that our partners helped to co-create for the InCK model in Oregon,” she wrote. “The focus on screening and measurement to the exclusion of improved services for children would be detrimental to our goal to achieve health equity, reflect community priorities and align with existing and planned Medicaid policy.’”
Officials stressed that the spending of federal funds included just over $855,000 for staff costs and $2.1 million for contractors, including $1.3 million to the Oregon Health & Science University-Oregon Pediatric Improvement Partnership and $665,620 to PacificSource Community Solutions.
In an interview with The Lund Report, Jarem said state staff were “surprised” at federal officials’ resistance to Oregon’s concerns and did not start to realize the program might not work out until this fall. “It was only in the fall that we started to experience some resistance to how our model was designed,” she said.
“I think it’s certainly a disappointment that we did not have an opportunity to implement the model the way that we envisioned and that (it) was designed. I do think that we learned a lot from this experience. And I don’t have regrets about it. It was an incredible amount of work … there’s a lot of positivity that came out of it, even though we’re not going to see it move forward in a way that we had envisioned two years ago.”
She and Health Policy & Analytics Division Director Jeremy Vandehey said that dropping the program doesn’t mean the efforts won’t be pursued.
“The big wildcard we weren’t expecting was the pandemic in the middle of this,” he said. “As you know, providers have been very, very stressed the last couple years. But we’re trying to try to find a path where we can do the screenings but not require providers who are already doing these screenings to do something completely different than what they’re already doing.”
“We’'ve learned a lot around what data we have, what data we don’'t have, how we could do this work differently going forward. So while the grant is coming to an end … we think this has spurred some really great conversations and collaborative work on the ground that we hope will continue.”
Correction: An earlier version of this story contained a typo characterizing program spending. The article has been updated to reflect accurate information. The Lund Report regrets the error.