The National Council on Aging, with support from the Administration for Community Living (ACL), contracted with Health Management Associates (HMA) to provide research and strategy services to support their joint goal to increase the adoption of evidence-based health promotion and disease prevention programs (evidence-based programs or EBPs). EBPs include Chronic Disease Self-Management Education programs and falls prevention programs by Medicaid, Medicare and other health insurance markets.

This brief seeks to identify:

• Medicaid authorities and financing mechanisms through which states have adopted evidence-based health promotion programs
• Promising practices establishing reimbursable evidence-based health promotion programs and approaches that may be replicated in other states in Medicaid, Medicare Advantage and other emerging markets to support program sustainability beyond grant funding
• Barriers to adoption of evidence-based health promotion programs and actionable steps to avoid or address
• Actionable information to move forward relationships with state Medicaid programs or Medicaid managed care organizations

The most prevalent community-based organization (CBO) EBP funding is through the ACL. ACL offers evidence-based disease prevention and health promotion program support under the authority of the Older Americans Act Title III-D, established in 1987 to reduce the need for more costly medical interventions. In addition, the Affordable Care Act established the Prevention and Public Health Fund (PPHF) to provide expanded and sustained national investments in prevention and public health initiatives designed to improve health outcomes, and enhance health care quality. Through PPHF, ACL provides grants to state and local agencies and organizations that support implementation of EBPs. ACL funding is limited and designed to supplement existing support for dissemination of EBPs through other sustainable funding mechanisms, including the health care sector. CBOs, with the support of ACL, NCOA and non-profit CBO networks, are engaged in efforts to secure reimbursable relationships with payers such as Medicaid and Medicare to ensure long-term sustainability of their EBPs.

Some states have incorporated CBO EBPs as a covered benefit under Medicaid Section 1915(c) home and community- based services and 1115 Demonstration waiver programs. In a few states, health plans have incorporated CBO EBPs into their Medicaid managed long-term services and supports plan benefits; EBPs are also offered as a benefit covered by a limited number of Medicare Advantage plans. HMA research identified common themes across five target states and one city – California, Colorado, Maine, Massachusetts, Washington and New York City – selected for their publicly financed programs, i.e. Medicaid and/or Medicare adoption of EBPs as reimbursable services. Research included conducting a comprehensive literature review and interviews with stakeholders from state Medicaid and state and city Aging Agency officials, CBOs offering EBPs and organizations operating as a CBO network.

Read and share the report to learn more and join our call to action.