Medicaid is the nation's public health insurance program for low-income Americans, financing health and long term care services for more than 50 million individuals. Federal and state spending on Medicaid beneficiaries has become a target for legislators intent on controlling health care costs. As an optional benefit in states, physical therapy services are often in line to be cut or eliminated. This section of the APTA website will help you understand more about Medicaid.
Alternative Payment Models
The Maternal Opioid Misuse (MOM) Model
This model will serve pregnant women with opioid use disorder (OUD) who are covered by Medicaid and the Children's Health Insurance Program and elect to participate in the model. Beneficiaries will be covered during the prenatal, peripartum, and postpartum periods. The model addresses the need to better align and coordinate care of this vulnerable population. The key participants are a state Medicaid agency and a health system or payer, which partners with clinicians to deliver care. The state Medicaid agency will be responsible for ensuring that beneficiaries participating in the model have access to a set of essential physical and behavioral health services. The model will have a 5-year performance period with funding to be provided in 3 phases: pre-implementation (Year 1); transition (Year 2); and full implementation (Years 3-5). Care delivery will begin in Year 2. Up to 12 states will be awarded funding for the model, and a Notice of Funding Opportunity is expected in early 2019 to solicit applications. The 5-year performance period is expected to run from fall 2019 to fall 2024.
InCK Model is a child-centered local service delivery and state payment model that aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children's Health Insurance Program (CHIP). The InCK Model will support state and local provider efforts to conduct early identification and treatment of children with behavioral and physical health-related needs. Participants will be required to integrate care coordination and case management across physical and behavioral health and other local service provider settings to provide child-and family-centered care. The key participants are a state Medicaid agency and a local entity designated as the lead organization. The model will include a 2-year pre-implementation period followed by a 5-year model implementation period. A Notice of Funding Opportunity is expected in fall 2018, with funding to be awarded as early as spring 2019.
Commercial / Utilization Management (UM)
APTA Fact Sheets and Summaries