A comprehensive survey of state Medicaid programs reveals a growing trend of collaboration between Medicaid and public health agencies to enhance healthcare services and improve community health outcomes. The survey, conducted by KFF and Health Management Associates (HMA) in collaboration with the National Association of Medicaid Directors (NAMD), highlights new or expanded initiatives in various domains, including maternal and child health, children/youth mental health, opioid use disorder (OUD), lead screening, infectious disease, and workforce development. This analysis delves into these findings, offering a detailed exploration of the key areas of focus and the innovative strategies being employed to strengthen healthcare delivery and public health interventions.
Maternal and Child Health
The survey underscores the importance of maternal and child health, recognizing the critical role of early interventions in promoting long-term health outcomes. Medicaid, as the primary payer for approximately 41% of all births and 37% of children in the U.S., plays a pivotal role in ensuring access to essential healthcare services for this vulnerable population.
Data Sharing and Surveillance: States are implementing cross-agency data sharing initiatives to strengthen maternal and child health surveillance. For instance, the Oklahoma Medicaid Birth Certificate Linkage Project links vital records with Medicaid data, providing a comprehensive view of pregnancy and birth outcomes for Medicaid enrollees.
Rural Maternity Care: Collaborative efforts are being made to address rural maternal health needs, as individuals in rural areas often face access challenges due to the lack of local obstetric services and geographic barriers. Kentucky Medicaid, in partnership with the state's Department of Public Health, is working to identify maternity care deserts and develop solutions to connect pregnant individuals to essential care.
Workforce Development: States are collaborating with public health agencies to certify and support community health workers, including doulas and perinatal providers. Massachusetts, for example, provides training and technical assistance to Medicaid providers to strengthen care coordination and support the implementation of state maternal health legislation.
Transforming Maternal Health Model: The CMS's Transforming Maternal Health Model is being implemented in several states, aiming to integrate behavioral health and social determinants of health, ensuring care continuity in the postpartum period. California's Department of Health Care Services is utilizing federal funding to implement this model in five counties, focusing on access to care, infrastructure, workforce, quality improvement, and whole person care delivery.
Children/Youth Mental Health
The survey highlights the growing concerns about children's mental health and the significant role of Medicaid in funding school-based behavioral health services. Public health agencies are actively involved in assessing early childhood mental health, developing policies, and partnering with schools to maintain behavioral health services.
Workforce Development: States are working with public health agencies to connect primary care providers (PCPs) to child psychiatrist consultations, particularly in rural areas. Kentucky's Medicaid agency, in collaboration with the Department of Public Health, has implemented the KY MARK initiative to help PCPs better manage children's mental health issues.
Access to Care: States are collaborating with public health agencies to maintain and increase access to school-based services, which offer a convenient setting for delivering mental health services to students. Massachusetts' Medicaid agency, in partnership with the Department of Health, operates school-based health centers that provide comprehensive primary care and behavioral health services.
Opioid Use Disorder (OUD)
The opioid epidemic continues to pose a significant public health threat, with Medicaid playing a crucial role in covering OUD treatment for adults. Public health departments are employing harm reduction strategies and data surveillance to combat the crisis.
Data Sharing and Strategic Planning: States are engaging public health partners in data sharing initiatives to understand the OUD impact and prevent future deaths. Arizona's Medicaid agency shares data with the public health agency's drug overdose fatality review committee to determine system changes for prevention.
Addressing OUD in Pregnant and Parenting Populations: States are implementing initiatives to address OUD among pregnant and parenting populations, as discussed under the maternal and child health domain.
Lead Screening
Medicaid programs are leveraging public health expertise in lead screening to strengthen the identification of at-risk populations and expand the reach of services. States are maintaining data-sharing agreements with public health agencies to monitor lead screening rates and coordinate interventions.
Data Sharing and Coordination: Maine's Medicaid and public health agencies share blood lead level testing data and provide technical assistance to PCPs. The Medicaid agency has incorporated blood lead testing into an alternative payment model, incentivizing providers to improve testing and screenings.
Provider Guidance: States are working with public health agencies to develop lead screening guidance for providers and managed care plans, ensuring comprehensive support for at-risk children.
Infectious Disease
Infectious diseases remain a significant public health concern, requiring coordinated prevention, surveillance, and response efforts. Medicaid plays a crucial role in facilitating access to vaccines for children, adolescents, and adults.
Data Sharing and Surveillance: States are collaborating with public health agencies on disease-specific efforts and broader data sharing initiatives to improve population health monitoring. DC's Medicaid agency shares data with DC Health to support continuity of care for individuals with HIV following eligibility policy changes.
Workforce Development: States are implementing collaborative initiatives to strengthen the local response capacity of public health teams and clinical providers. Maine's Medicaid agency, in partnership with the Public Health agency, coordinates services and training for local response teams and providers during HIV outbreak responses.
Workforce Development
Provider shortages, particularly in low-income and rural communities, pose a significant challenge to healthcare access and outcomes. Community health workers, doulas, and other community-linked providers play a vital role in bridging gaps in care and addressing health-related social needs.
Rural Health Transformation Program: The 2025 reconciliation law introduced the Rural Health Transformation Program, providing $50 billion in funding for state grants to support rural areas in various ways, including workforce recruitment and system transformation. However, potential funding reductions in Medicaid may exceed the Rural Health Fund's allocation.
Provider Certification and Attraction: States are collaborating with public health agencies on initiatives to attract and retain providers through loan repayment, training, and certification programs. Massachusetts' Medicaid agency, in partnership with the Department of Public Health, implements the HRSA-funded Massachusetts Loan Repayment Program for healthcare professionals.
Multi-Agency Collaboration: States are participating in multi-agency workforce committees that include public health agency staff, fostering coordination and collaboration in healthcare workforce-related policies and initiatives.
