Palliative Care’s Evolving Role in Medicaid

The number of states introducing palliative care Medicaid reimbursement channels has been climbing in recent years. But questions proliferate around how to shape these programs.

More Medicaid palliative programs have evolved in recent years, but utilization of these services is not keeping pace with payment, according to Torrie Fields, strategic advisor at the Coalition to Transform Advanced Care (C-TAC). She is also CEO of Torrie Fields & Associates (TFA), a value-based health care consulting company.

At the crux is a lack of awareness of these state-funded programs, Fields said at Hospice News’ Palliative Care News Conference in Tampa, Florida.

“The utilization challenges are real, and that means we have to go and teach beneficiaries with serious illness that these services are covered,” Fields told Palliative Care News. “There needs to be a reliable care experience from the provider side so that patients and families understand when they qualify and what is expected of their provider and that care experience. Once you actually start to do that, you can see an increase over time in utilization of these services.”

Medicaid reimbursement growth

Expanding palliative care education among providers, payers and the public is a key to growing utilization of Medicaid benefits, according to Rena Robinson, palliative program director of California-based Anchor Health.

“Having access to it is one thing, but getting the information is another,” Robinson said at the Palliative Care Conference. “Utilization is a totally different ball of wax. You’re going little by little to communities where the community partners are, and giving education to hospitals, nursing homes, physician offices and practices. It sounds archaic, and it is. But each area is different [with] totally different demographics.”

Cristi Keith — Rena Robinson, palliative program director, Anchor Health, at the Palliative Care Conference.

At least 21 states had some form of palliative care-related public information program in place as of June 30, 2023, according to data from the National Academy for State Health Policy (NASHP).

These programs are most commonly featured on state public health department websites and are intended to educate both providers and the public about the nature of palliative services, identify providers within a region and explain the benefits of receiving this care, according to (NASHP).

A common thread among state palliative Medicaid programs is an interdisciplinary scope of services that addresses physical, mental and other types of care for seriously ill populations, NASHP reported.

“What’s interesting about palliative care in Medicaid is just the sheer number of states that have been advancing Medicaid benefits,” Fields said.

More than 15 states have established Medicaid palliative programs, according to Fields. These include states with some of the largest growing seriously ill populations, such as California, Colorado, Hawaii, Maine, Maryland, Oregon and Washington, among others, she added.

The path to Medicaid palliative programs is not universal, according to Robinson. Understanding geographic and demographic differences in palliative population needs is an important consideration in shaping policies that support them, Robinson said.

“It’s not just a cookie cutter [approach] once you have those policies,” Robinson told Palliative Care News. “It’s the implementation of them that you have to figure out. What are the demographics, who are you working with and who’s your audience?”

Advancing these benefits across the country requires a three-pronged approach, according to Fields.

An important first step is to establish some type of statewide mandate requiring managed care organizations and insurers to offer palliative benefits, she said. Another key involves creating sufficient payment rates for various palliative care services at the state level.

Collaboration between state and federal payers also plays an important role in shaping state Medicaid palliative programs, Fields indicated. But this involves proving that enough palliative providers exist within a geographic region to meet patient demand, she stated.

“[It’s] through a state plan amendment with the federal government,” Fields said. “What you have to do in order to add this as part of the state plan amendment is to prove that you have enough providers across the state to deliver palliative care services. If you don’t have that ability to really prove that, then there is an opportunity to go the pilot route, and that’s through a waiver program with Medicaid.”

Torrie Fields, strategic advisor at the Coalition to Transform Advanced Care, at the Palliative Care Conference.

Holly Vossel

Holly Vossel, senior reporter for Hospice News and Palliative Care News, is a word nerd and a hunter of facts with reporting roots sprouting in 2006. She is passionate about writing with an impactful purpose, and developed an interest in health care coverage in 2015. A layered onion of multifaceted traits, her interests include book reading, hiking with her dogs, roller skating, camping, kayaking and creative writing.