The Trump administration has revealed a new payment model that aims to support care management for children in Medicaid with complex medical or behavioral health needs.
Called ASPIRE, or Accelerating State Pediatric Innovation Readiness and Effectiveness, the program is a 10-year voluntary model that will include up to five states. The Centers for Medicare & Medicaid Services said in a post that the model will put Medicaid providers in a position to take on accountability for these populations.
The program will make it easier for states to offer whole-person, wraparound care for children and youth with complex needs, as well as those at risk of developing such conditions. The goal, CMS said, is to provide these patients with the right care at the right time, improving outcomes as well as their experience.
The model also aims to empower families and caregivers to be active participants in their child's care and to include long-term planning to support patients as they transition to adulthood.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, said in an accompanying video that families today often have to do much of the legwork themselves to manage care for a child with significant healthcare needs.
This includes coordinating appointments, filing paperwork and often repeatedly providing the same information to providers, specialists and other members of the care team. The CMS team, he said, wants to ease the burden on families while improving care for their children.
"For these families, this isn't' just a part of life, it literally is their life," he said. "This is overwhelming and can leave families feeling like they're left to navigate the system on their own."
The agency will select the participating states and then will offer funding under cooperative agreements to roll out the ASPIRE program. CMS said that the notice to apply for funding will be available this year, but did not specify when.
Through the program, states will work alongside managed care plans or accountable care organizations to manage the costs and improve care quality. These organizations must also partner with providers with experience treating high-risk children, CMS said.
CMS said that some of the funding offered through ASPIRE may be required to go toward enhancing care systems, such as to build the infrastructure necessary to offer wrap-around care. The agency added that the model would not apply limits to the care that eligible children receive.
"ASPIRE gives states new tools to transform how they use Medicaid and CHIP to deliver care for high- and rising-risk children," Sutton said.