C-TAC has focused on federal policy from its inception. We engage with decision-makers in Congress and in the Administration to improve care for people living with serious illness and their families and are making steady progress.
Recently, C-TAC has also added a focus on state-based serious illness care efforts. We are working with partners at the Center to Advance Palliative Care (CAPC) and the National Academy for State Health Policy (NSHP) and have regular meetings with state coalition members to share information and support several states in their efforts to add a palliative care benefit to their Medicaid programs.
This year we have reached a tipping point with almost half of states pursuing some kind of palliative care effort:
- State palliative care task forces: 24 states have legislation around such task forces.
- Palliative care information programs: 21 states have such programs, 16 of which have legislative requirements for palliative care information programs which include information on continuing education, consumer education materials, best practices, etc.
- Palliative care legislative or budgetary progress: 13 states have made palliative care legislative or budgetary progress compared to 2022
Given all these activities across states, a few are very advanced in their efforts to add a palliative care Medicaid benefit:
- Hawaii: Finalizing application with the Centers for Medicare and Medicaid and are on track to get approval to add such a benefit via a state plan amendment, likely by the end of this year.
- Illinois: Advanced benefit requirements to cover pediatric palliative care services and are now looking to expand this authority to adults and dual eligible beneficiaries.
- Maine: Passed legislation in 2021 to add such a benefit and are now working out the financial and regulatory details to do so.
- New Jersey: Passed legislation this year and are now working to find funding to do the analytical work needed to move towards implementation.
- New York: Received funding to develop a set of policy recommendations and a payment methodology to cover palliative care services for Medicaid beneficiaries and to align these services to the state’s Master Plan on Aging.
- Oregon: Passed legislation to require coordinated care organizations to cover palliative care services to Medicaid beneficiaries throughout the state. This aligns with other requirements to cover services, including palliative care, through value-based payment.
States are also taking multiple routes to expand access to care for people with serious illness. If your state is thinking about this, you might consider the following options:
- Developing standalone Palliative Care Benefits
- Expansion through Health Homes, managed care contract requirements, and other value-based purchasing efforts
- Expansion through waiver programs for adults, children, or both
- Master plans on aging
- Health information exchange efforts
- Private payor collaborations
Finally, state agencies and payors need help from coalitions and leaders in serious illness to support the following policy and reimbursement activities:
- Determining who would be most appropriate for these services
- Determining provider capacity and the competencies and training needed to deliver services
- Understanding the “ideal” palliative care model
- Understanding the up-front capital investment needed to deliver services and ongoing costs, including staffing, administration, and other infrastructure
- Setting expectations for outcomes from services, including quality and reporting
- Identifying additional needs to support equity and access, including public engagement, provider education and training, and consumer protections
