CMS Introduces the ASPIRE Model for Youth in Medicaid and CHIP

The Centers for Medicare & Medicaid Services Innovation Center (CMS) has announced the launch of a new model targeting children up to age 21 with or at risk of developing complex medical and behavioral needs under Medicaid and the Children’s Health Insurance Program (CHIP).

Under the voluntary Accelerating State Pediatric Innovation Readiness and Effectiveness Model (ASPIRE), CMS will choose up to five state Medicaid agencies to participate, allocating $125 million. These states will collaborate with responsible entities that oversee total healthcare expenses for covered children, including managed care plans and accountable care organizations (ACOs).

A few key points listed by CMS:

• Problem: Children and youth with complex medical and/or behavioral health needs often encounter barriers to accessing essential care, which can lead to lifelong consequences such as poor health outcomes or the need for more intensive care outside of the community. Approximately half of this vulnerable group is covered by Medicaid and/or CHIP.
• Solution: ASPIRE will enable Medicaid providers to take responsibility for the quality and cost of care for these populations, offering children, youth, and their families care coordination and other supports across the full spectrum of physical and behavioral health, while integrating quality measures focused on outcomes. 
• Outcomes: Identifying and addressing the needs of children and youth early in life can promote timely diagnosis that enables early intervention, helping them thrive in the least restrictive settings, ensuring they receive the right care at the right time, and improving quality of life for children, youth, and their families.

“We’re also shifting away from a fee-for-service model that incentivizes siloed and often expensive treatments rather than the most effective ones,” wrote CMS Administrator Mehmet Oz, M.D., and Deputy Administrator Abe Sutton, in an announcement in STAT. “Instead, we’ll provide incentive payments for care teams that harmonize effectively, prioritize prevention, and demonstrate genuine improvements in efficiency, quality of care, and health and functional outcomes.”

The model will operate for 10 years. CMS stated that a funding notice will be released later this year.