Final Report - RI Department of Children, Youth & Families

CHAPTER 4: FINANCING THE SYSTEM OF CARE
participation, and creating a comprehensive child and family budget coordinating services
across all of these policy domains. These federal funds are augmented by a number of state
budget appropriations, themselves scattered across a number of state agencies.
A coordinated and organized system of care requires a deliberate ongoing financial strategy
that supports the multiple and changing needs of children, adolescents, and their families, and
the changing landscape of service opportunities available within the community of
professional practice. The goals of the strategy are to marshal every resource available for the
care and treatment of the child and family, private and public, across all funds and programs,
to assure access to services and treatment and to use data to inform policy, program, and
budgetary decisions within an overall strategy.
The principles of a successful financing strategy include:
! Programs and services within a coordinated system must be designed to support the needs
of children and families rather than designed to fit the requirements of funding sources;
! The potential gain of maximizing financing from any single source of revenue must be
evaluated in light of its impact on program and service delivery, system design, and
accountability, as well as overall financial risk;
! The ongoing success (and therefore funding) of programs and services must be based on
the outcomes they produce, rather than the activity they perform;
! Rates of payment must be adequate to create and maintain service capacity and
rationalized in terms of the value they provide; incentives must support the long term
outcomes desired for the system as a whole; and
! Formal and dynamic partnerships between and among units of state and local government,
as well as the provider community, is essential.
Currently, 83,000 Rhode Island children receive Medicaid benefits through a variety of
delivery systems. Medicaid funding provides a broad range of health care services to children
and their families through DCYF, DHS, DOH, MHRH, and the local education authorities.
Medicaid funds comprehensive health insurance for many DCYF children, including
behavioral health services, through Rite Care as well as fee for service, and a large number of
children “touched” by DCYF services are enrolled. Further, it is clear that Medicaid’s value
to the system can only be realized if, at a minimum, current eligibility standards are
maintained – any change in this public policy reduces resources available for this system
change.
At the same time, Medicaid is a broad entitlement program with very stringent requirements
governing eligibility service definition, and reimbursement. Limits on utilization, provider
participation, or consumer choice are not permitted. This set of standards has clear
programmatic and budgetary implications, and may mean that Medicaid funding is not
universally attractive. However, it is also clear that Medicaid, particularly in light of the
mandate of EPSDT (Early Periodic Screening, Diagnosis, and Treatment), needs to be fully
leveraged.
This leverage can be accomplished by Comprehensive Care Networks being sufficiently
knowledgeable to be able to refer to and otherwise make use of services available to children
throughout the rest of the Medicaid system. In this way, Medicaid-financed services can
System of Care Task Force Report (January 2003) 38