1.
Leveraging Public Health Capacity to Increase Health System Efficiency<br />Sharon Moffatt<br />Association of State and Territorial Health Officials<br />October 5, 2010<br />

2.
State Health Agency Structure<br />

3.
Primary Statutory Public Health <br />Authority in State <br />

4.
State and Local Public Health Relationships<br />

5.
State Health Agency Roles in Health Reform<br />Previous Roles and New Roles in Response to Affordable Care Act<br />

6.
Health Reform Survey<br />ASTHO Survey 8/09<br />

7.
Health Reform Survey State Partners<br />Which other government agencies and non-governmental groups have you worked with to ensure the integration of health and wellness priorities in health reform efforts?<br />ASTHO Survey 8/09<br />

8.
New State Structures for Implementing Health Reform with Public Health as Identified Member<br />California<br />Colorado<br />Connecticut<br />Illinois<br />Maine<br />Maryland<br />Michigan<br />New Mexico<br />New York<br />Nevada<br />Pennsylvania<br />Vermont<br />Virginia<br />Washington State<br />Wisconsin<br />Wyoming<br />

9.
Public Health and Medicaid <br />

10.
District of Columbia<br />Louisiana<br />Maryland<br />Michigan<br />Missouri<br />Montana<br />Nebraska<br />New York<br />Utah<br />Wyoming<br />10 State Health Officials Have Responsibility for Medicaid<br />

11.
Chronic Disease Management (§ 4108)<br />2011: HHS grants to states that provide incentives for Medicaid beneficiaries to participate in healthy lifestyle programs.<br />Immunizations (§ 4106)<br />2013: States will receive a 1% increase in FMAP if they offer adult vaccines without cost sharing<br />Expansion of Family Planning Services (§ 2303)<br />States can expand services without a waiver<br />Opportunities for Public Health and Medicaid Collaboration <br />

12.
By October 1, 2010 states are required to cover comprehensive tobacco cessation services for pregnant women in Medicaid (§ 4107)<br /> State health departments have experience developing and promoting comprehensive tobacco use prevention and cessation strategies <br />Public Health and Medicaid Collaboration: Smoking Cessation<br />

13.
Massachusetts 2006 health reform mandated tobacco cessation coverage for Medicaid<br />Comparison of pre-benefit coverage to post-benefit coverage demonstrated a 26% decline in smoking rates<br />Example of Public Health and Medicaid Success: Massachusetts<br />

14.
Successful Public Health and Medicaid Collaboration: MA<br />14<br />Data Source: Massachusetts Behavioral Risk Factor Surveillance System<br />

15.
Patient Protection and Affordable Care Act<br />Bill shown is 1,990 page House version<br />

16.
CHALLENGES<br />Keeping focus on public health and prevention <br />State Budget Cuts<br />Huge volume of work for states<br />Timelines for decisions are short<br />2010 Election<br />

17.
Naples Herald, March 31, 2010<br />

18.
83% of state health agencies cut jobs<br />76% made cuts in FY09 and FY10<br />38% expect to lose more staff through layoffs and attrition<br />Impact of Budget Cuts on States<br />

19.
Asthma programs cut<br />Immunization outreach reduced<br />Eligibility for maternal child health programs reduced and waiting lists created<br />Teen pregnancy programs eliminated<br />Examples of State Program Budget Cuts<br />

20.
March 2010<br />

21.

22.
OPPORTUNITIES<br />“This is an historic, once in a lifetime investment in public health.” <br /> -Paul Halverson, DrPH, ASTHO President<br />$15B investment in public health over the next 10 years!<br />Home visiting funding<br />Section 317 immunization program reauthorized<br />Programs to address several critical health care and public health workforce shortages authorized<br />School based Health Centers: 50M<br />CMS Innovation grants<br />

23.
Setting priorities within the state health agency<br />Communication of need to Executive and Legislative Branch of government<br />Identification of lead for grant applications<br />Assuring quality and alignment of grant applications given short submission periods<br />State Health Official Role Funding Opportunities and Challenges<br />

24.
Strong relationship to the state health plan.<br />Strong relationship to priorities of new administration, legislature.<br />Expands or improves related initiatives already underway in Maine.<br />Support, resources and capacity available across stakeholders.<br />Minimal state funding required (dollars and in-kind funding); recognize the new funding will require new state money to be appropriated. <br />Enhances state’s ability to meet legal and financial obligations. <br />Promotes collaboration among providers and consumers and harmonization of delivery systems in communities.<br />Clear focus on broad populations and overall impact of the specific grant.<br />Flexibility of application and implementation process: Can the state delegate?<br />Sustainability after grant funding ends.<br />Promote interstate cooperation as appropriate<br />Criteria for Maine State Government to Seek and SupportGrant, Pilot and Demonstration Opportunities in the Federal Health Reform Law<br />

25.
Patient Protection and Affordable Care Act, March 2010.<br />Congressional Research Service (CRS)<br />Healthreform.gov<br />References and Resources<br />

26.
Sharon Moffatt <br />Chief of Health Promotion and Disease Prevention <br /> Association of State and Territorial Health Officials<br />2231 Crystal Drive, Suite 450<br />Arlington, VA 20112<br />202-371-9090<br />smoffatt@astho.org<br />www.astho.org<br />