What does it take for states to expand access to substance use disorder treatment and build stronger, more sustainable partnerships between Medicaid and public health? In Massachusetts, leaders changed policies around provider models to increase access to care for opioid use disorder: Frances McGaffey, Manager of Substance Use Prevention and Treatment Initiative at The Pew Charitable Trusts, explains how pairing providers with dedicated nursing support has helped remove barriers to prescribing buprenorphine, expand the addiction workforce, and dramatically increase access to care. She also shares why the state’s decision to extend this model to alcohol and stimulant use disorders is a critical response to a changing overdose crisis, and what other states can do to replicate this success. Then, Corey Caldwell, Senior Policy Analyst at the National Association of Medicaid Directors discusses the new Medicaid Leaders Playbook for Building Public Health Partnerships, developed in collaboration with ASTHO. Corey outlines practical, real-world steps Medicaid and public health agencies can take to align priorities, address funding and workforce challenges, launch small but impactful pilot projects, and build trust across systems.Understanding Current U.S. Measles Outbreaks and Elimination Status | ASTHO
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This is Public Health Review
Morning Edition for Thursday,
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January 29th, 2026.
I'm John Sheehan for the
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Association of State and
Territorial Health Officials.
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Today, how Massachusetts is
expanding access to substance
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use disorder treatment and
building stronger, more
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sustainable partnerships between
Medicaid and public health.
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Our guest.
Is Frances Mcgaffey.
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Manager of substance use
prevention and treatment
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initiative at The Pew Charitable
Trusts.
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She'll explain how policies and
practices that incentivize
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Office Based Addiction
treatment, or OBAT, like
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Massachusetts shift to pairing
providers with dedicated nursing
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support, have helped remove
barriers to prescribing
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buprenorphine, expanded the
addiction workforce, and
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dramatically increased access to
care.
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Later on, Corey Caldwell, senior
policy analyst at the National
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Association of Medicaid
Directors, we'll discuss the new
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Medicaid Leaders Playbook for
Building Public Health
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Partnerships, which was
developed in collaboration with
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ASTO.
He'll outline practical, real
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world steps Medicaid and public
health agencies can take to
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align priorities, address
funding and workforce
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challenges, and launch small but
impactful pilot projects.
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But first, here's Frances
Mcgaffey explaining how
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Massachusetts initiated new
incentives to integrate opioid
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use disorder treatment with
primary care using the Nurse
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Care Manager model.
The Nurse Care Manager Model for
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OUD treatment or opioid use
Disorder treatment enables
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providers like doctors and nurse
practitioners to serve more
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patients by giving them the
resources of a dedicated nursing
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staff who can monitor patients
and coordinate their care while
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they're receiving buprenorphine.
And the state's been very
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successful just by one metric.
In 2023, 79% of Massachusetts
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Medicaid enrollees with OUD
received medication, which is
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higher than the national median.
Why do you think that this model
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is so successful?
So the model addresses a lot of
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the barriers to prescribing
buprenorphine that providers
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have been talking about for a
long time.
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The lack of time to address
complex needs, the lack of
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nursing support and care
coordination to help patients
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with opioid use disorder stay
retained in care and achieve
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their goals.
So by giving that support in
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Massachusetts, they went from
just a handful of providers
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offering this care to now over
40 providers over the state.
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The increase in access made it
possible for more people to get
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the care that they need.
And what other kinds of care of
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treatments?
What else is being rolled into
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this model?
Yes.
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So the model originally started
to treat people with opioid use
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disorder and in 2022 eligibility
was expanded to people with
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alcohol and simulant use
disorders.
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Alcohol use disorder can also be
treated with medication in a
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primary care setting, and
there's even some off label
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medications that can be used for
simulant use disorder.
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So by allowing people with these
conditions to get the care that
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they need, Massachusetts is able
to address the changing needs of
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the overdose crisis.
And I know other states are
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already sort of looking to
Massachusetts as first in class
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in this this kind of care.
What can other states do that
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want to replicate your success?
The biggest take away from what
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Massachusetts did is that they
drew on a workforce that already
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opted into providing addiction
care.
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If you think 20 years ago in
Massachusetts and in other
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states, primary care providers
didn't really see a role for
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themselves in treating substance
use disorders.
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But now through the nurse care
manager model in Massachusetts,
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a lot of providers already said,
I get it, there is something I
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can do about opioid use
disorder.
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And so in Massachusetts said you
can also provide these services
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to people with alcohol and
stimulant use disorders.
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They stepped up to the plate.
As long as they have the
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training and support that they
needed, they were willing to do
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that.
And other states that have also
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developed an addiction workforce
through their efforts to
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increase buprenorphine can do
that same thing.
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So it sounds like.
Sort of an expansion of
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Workforce.
Definitions of how primary care
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providers think of themselves
now sort of taking this, this
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extra level of care and
treatment that wasn't once part
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of their world and taking it on.
That's right.
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And what we have seen is that in
Massachusetts and across the
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country, a lot of primary care
providers have now recognized
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that they cancer people with
opioid use disorder.
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And as long as they have the
training and technical
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assistance, you know, the
education they maybe didn't get
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in Med school, they'll take on
other SU DS as well, as long as
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it's also paired with
reimbursement that pays for them
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to deliver those services.
And you touched on this a bit,
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but do you have advice for other
policy makers who are looking to
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to start this in their state?
The first thing is to start with
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what you have.
There is other ways of providing
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office based opioid treatment
and those services can be
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leveraged to treat other SU DS
and in states that haven't
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really incentivized that
approach they should start.
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We know that if you provide
adequate reimbursement and
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training and technical
assistance, you can really
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expand your addiction workforce
and get more people the care
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that they need.
So again, it's really about
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making it a priority and
expanding definitions of what of
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where that treatment.
Can happen and building skills
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for this workforce.
That's right.
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So many times people think that
addiction medicine, addiction
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treatment only happens in a 30
or 90 day residential setting.
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And of course that's an
important part of the treatment
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ecosystem, but it's not the only
way to deliver care.
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And so we need to have other
options that maybe fit into
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people's lives better or provide
that continuing care after they
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leave those settings.
And Francis, so do you have any
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final thoughts in this program?
It's been so successful.
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What this program shows is the
need to think bigger than opioid
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use disorder.
So much of our policy, state and
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federal, has been focused on
opioid use disorder and
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appropriately, because we had
and still are in an opioid
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overdose crisis.
But that crisis is changing.
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More overdose deaths involve
stimulants than ever before, and
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alcohol is a leading driver of
substance use related deaths.
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So states like Massachusetts are
showing that it's possible to
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address these other SU DS and
really meet the needs of
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residents.
Francis McAfee.
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Is manager of substance use
prevention and treatment
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initiative at The Pew Charitable
Trusts.
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Now let's hear from Corey
Caldwell, senior policy analyst
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at the National Association of
Medicaid Directors.
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I asked him about the new
Medicaid Leaders Playbook for
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Building Public Health
Partnerships, which was
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developed in collaboration with
ASTO.
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At its core, the Playbook is
really designed to be practical
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and hands on.
It's draws directly from the
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experiences of leaders in both
the Medicaid and public health
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space with a focus on what
actually works in States.
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And the goal really was designed
to give Medicaid readers clear
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and actionable strategies for
collaborating with public health
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partners, not just in theory and
in kind of complex guides, but
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in day-to-day practice and
operation and operations.
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And the playbook walks through
concrete steps for learning
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priorities, navigating
structural and cultural
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differences between agencies and
really is designed to support
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and improve kind of work between
the two agencies.
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And it really does provide kind
of a road map to support that
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higher level collaboration that
I know in AMD and Aslow has been
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working together on.
And so Medicaid and public
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health are are different
systems.
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They share goals, but they're
very different.
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What are some steps that
agencies can take to sort of
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build those partnerships?
Well, that's a, a really great
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question.
And I, I will note that it's
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something here in AMD we've been
thinking a lot about over the
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past year.
And one key theme that came
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through as we were developing
this playbook is that the best
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place to start is often with
relationships built on
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understanding.
So it sounds very, very simple,
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but even though Medicaid and
public health serve a lot of the
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same populations, they often
work under different mandates,
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funding structures, and even
timelines.
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And because of this,
collaboration doesn't always
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happen automatically.
For for Medicaid leaders, it
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starts with getting a clear
picture of statewide public
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health priorities.
So thinking through things like
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maternal health, chronic disease
prevention, or even behavioral
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health initiatives, and then
finding those areas where
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Medicaid and public health
overlap.
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And from there, it's all about
starting conversations with
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shared goals and in mind.
And the playbook really doesn't
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urge leaders to take it step by
step.
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It's about starting small and
being very intentional.
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Picking one or two common issues
or populations to focus on can
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really help build that trust
between the two agencies to
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achieve some pilot projects or
even joint planning.
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And even simple steps like
attending each other's meetings,
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sharing program updates or
lining around existing
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initiatives and go a long way
and creating a strong
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foundation.
And really the key here is just
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transparency, mutual benefit,
and so the breeding, those early
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wins that build confidence for
bigger collaboration down the
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road.
And since certainly Kovid, but
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also in recent years, the public
health system has faced a lot of
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funding uncertainties.
No surprises there.
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What can what can Medicaid do to
sort of help shore up those
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funding gaps?
Well, that's a really important
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question, especially right now.
In historically, Medicaid and
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public health have played
different but very complementary
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roles with each other.
Public health funding is often
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grant based, which makes it
great for piloting new ideas and
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testing what works.
Medicaid, by contrast, is
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jointly funded by the state
governments and the federal
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government, so it's in a much
better position to scale things
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up and keep them going.
Overtime, especially in public
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health funding, can be
unpredictable.
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At the same time, I I think it's
very important to be realistic
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about what states are dealing
with.
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Both Medicaid agencies and
public health departments are
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under real budget pressure right
now with slowing state revenues
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and the end of COVAD era
emergency funding.
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Medicaid also has very specific
federal rules about what it can
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pay for.
Its dollars have to be tied to
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define services and eligible
populations, so it's not able to
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fully replace broad public
health funding.
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But with that, with that being
said and within those limits,
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Medicaid can still play a
meaningful role.
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One key opportunity is
reimbursing for services that
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public health departments or
agencies are already delivering.
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Think about things like
community based supports or
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preventative services.
Moving those activities from
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short term grants into Medicaid
reimbursement can make that that
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work more stable and even more
sustainable.
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Medicaid can can also support
public health and less direct
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but still important ways.
An example can include states
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better aligning Medicaid
incentives and quality measures
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of public health goals.
They can also invest in shared
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data systems that support both
program oversight and public
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health monitoring.
So I think just that the main
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point to your question here is
while Medicaid can't fill every
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gap left by the end of the
COVID-19 emergency funding, it
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can help sustain critical
services, reinforce core
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infrastructure, and make sure
public health efforts continue
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to reach the people who depend
most on both systems.
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Along those lines, another
challenge facing the public
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health system is is workforce
shortages.
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Are there opportunities there
for Medicaid to help with
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workforce?
Certainly, and this is a really
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important issue for states right
now.
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Workforce shortages are one of
the biggest challenges facing
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both Medicaid and public health,
and you can really see the
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effects almost everywhere.
Providers are stretched, then
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public health teams are
understaffed and communities can
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often struggle to get the care
and the services that they need.
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And one of the the big takeaways
from the playbook is that states
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can make real progress when when
Medicaid and public health are
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intentional about working
together and really play to
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their respective state,
respective strengths across
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states.
We've seen some promising
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approaches emerge and one that
comes up a lot is expanding the
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use of non traditional provider
roles.
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So think through things like
community health workers,
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doulas, or peer support
specialists.
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And public health agencies are
often well positioned to handle
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things like training and
community outreach for these
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roles.
While Medicaid can help by
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00:12:39,680 --> 00:12:42,520
creating sustainable
reimbursement pathways, when
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00:12:42,520 --> 00:12:45,120
those pieces are aligned, states
can start building long term
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00:12:45,120 --> 00:12:48,840
workforce pipelines rather than
relying on short term grants or
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00:12:48,880 --> 00:12:51,760
short term funding.
Data sharing also plays an
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00:12:51,760 --> 00:12:54,800
important role.
Public health contributes
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population level data and
Medicaid brings claims and
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00:12:58,120 --> 00:13:00,760
utilization information.
And when states bring those data
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00:13:00,760 --> 00:13:03,280
sources together, they get a
much clearer picture of where
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00:13:03,280 --> 00:13:06,440
workforce shortages are most
acute and where investments or
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00:13:06,440 --> 00:13:08,560
new care models can have the
greatest impact.
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Lastly, we're we're also seeing
states coordinate more closely
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on recruitment and training
through shared internships,
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community based pipelines or
partnerships with local
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00:13:18,200 --> 00:13:21,120
colleges.
And these efforts are especially
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00:13:21,120 --> 00:13:23,040
important for rural and
underserved committees that
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often faced face the toughest
staffing challenges.
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00:13:26,960 --> 00:13:30,400
Another point in the playbook,
and something you've mentioned a
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00:13:30,400 --> 00:13:35,040
couple Times Now, are how states
could utilize small pilot
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00:13:35,040 --> 00:13:38,040
projects.
Could you give us some examples
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00:13:38,040 --> 00:13:40,240
of what that means?
Absolutely.
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00:13:40,440 --> 00:13:43,360
One of the things that Playbook
really emphasizes is starting
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00:13:43,360 --> 00:13:45,720
small.
Those focused pilot projects are
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00:13:45,720 --> 00:13:48,560
often the most effective way for
Medicaid and public health to
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00:13:48,560 --> 00:13:51,960
begin working together.
They give both sides room to
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00:13:52,040 --> 00:13:54,960
test ideas, build trust, and
work through differences in
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00:13:54,960 --> 00:13:58,280
things like funding timelines or
even data systems without the
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00:13:58,280 --> 00:14:00,840
pressure of having to launch a
huge kind of statewide
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initiative out of the gate or
right away.
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We've seen some really strong
examples of this in practice,
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00:14:06,480 --> 00:14:09,360
especially around the kind of
programmatic areas of maternal
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00:14:09,360 --> 00:14:10,960
health and managed care
procurement.
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00:14:11,480 --> 00:14:14,760
On the maternal health side,
public health agencies often
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00:14:14,760 --> 00:14:17,440
already have deep connections in
the community through programs
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00:14:17,440 --> 00:14:20,000
like home visiting programs or
partnerships with local
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00:14:20,000 --> 00:14:23,000
providers.
Successful pilots build on that
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00:14:23,000 --> 00:14:25,400
foundation, with Medicaid
stepping in to support
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00:14:25,400 --> 00:14:28,400
reimbursement and align managed
care expectations so pregnant
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00:14:28,400 --> 00:14:30,480
women get consistent outreach
and support.
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00:14:31,360 --> 00:14:34,400
Even fairly modest pilots
focused on higher risk
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00:14:34,400 --> 00:14:37,800
pregnancies have led to better
engagement, stronger health
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00:14:37,800 --> 00:14:40,000
education and smoother care
coordination.
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00:14:40,080 --> 00:14:42,760
It's a great example of how
Medicaid's financing and
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00:14:42,760 --> 00:14:44,800
clinical structure can
complement public health's
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00:14:44,800 --> 00:14:47,680
community reach.
Another area where pilots have
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00:14:47,680 --> 00:14:49,400
made a real difference is
managed care.
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00:14:49,840 --> 00:14:53,120
In these cases, states test test
ways to better align
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00:14:53,120 --> 00:14:55,720
preventative health priorities
and managed care contracts with
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00:14:55,720 --> 00:14:57,480
input from their public health
colleagues.
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00:14:57,880 --> 00:15:00,840
That alignment helps ensure
managed care organizations are
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00:15:00,840 --> 00:15:03,400
focusing on prevention and
population health in ways that
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00:15:03,400 --> 00:15:05,120
support broader public health
goals.
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00:15:06,120 --> 00:15:08,800
Even small efforts here can lead
to noticeable improvements in
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00:15:08,800 --> 00:15:11,200
preventative service delivery
and stronger connections between
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00:15:11,200 --> 00:15:12,880
clinical care and in public
health.
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00:15:14,440 --> 00:15:21,240
And finally, Corey, what would
one step be that an agency or an
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00:15:21,240 --> 00:15:24,520
official could could take to
sort of strengthen their
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00:15:24,520 --> 00:15:27,400
relationship with with their
Medicaid colleagues?
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00:15:27,840 --> 00:15:30,600
One of the most effective things
public health leaders can do
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00:15:30,600 --> 00:15:32,680
right now is actually very, very
simple.
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00:15:32,680 --> 00:15:34,720
It's just starting the
conversation.
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00:15:34,840 --> 00:15:37,200
Reaching out to Medicaid
leadership to set up a short and
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00:15:37,200 --> 00:15:40,240
trajectory meeting can go a long
way in laying the groundwork for
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00:15:40,240 --> 00:15:42,640
trust, which our playbook really
highlights as essential for
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00:15:42,640 --> 00:15:46,200
those long term partnerships.
In that first conversation, it
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00:15:46,200 --> 00:15:49,960
can help to have a very clear
and focused dialogue so public
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00:15:49,960 --> 00:15:53,080
health leaders can share things
like high level snapshots of
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00:15:53,080 --> 00:15:55,600
their current priorities,
especially ones that have
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00:15:55,600 --> 00:15:57,800
natural overlap with Medicaid
goals.
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00:15:58,360 --> 00:16:00,840
I want to notice well that
Medicaid leaders are often
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00:16:00,840 --> 00:16:04,280
managing a lot of regulatory and
operational complexity and they
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00:16:04,280 --> 00:16:07,080
may not always have full
visibility into the programs,
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00:16:07,080 --> 00:16:09,960
partnerships, or even data that
public health agencies can bring
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00:16:09,960 --> 00:16:12,720
to the table.
So even a quick overview can
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00:16:12,720 --> 00:16:14,760
surface opportunities that
neither side had really
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00:16:14,760 --> 00:16:17,800
considered before.
It's also useful to come in with
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00:16:17,800 --> 00:16:20,720
a few concrete examples of our
alignment already exists.
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00:16:20,720 --> 00:16:23,280
So pointing out areas where
public health work is supporting
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00:16:23,280 --> 00:16:25,720
Medicaid populations, whether
that's their community based
317
00:16:25,720 --> 00:16:28,480
supports, maternal and child
health efforts or population
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00:16:28,480 --> 00:16:31,400
level data help us both sides
see where collaboration could
319
00:16:31,400 --> 00:16:34,400
realistically start.
And the big take away that I
320
00:16:34,400 --> 00:16:37,240
think both public health leaders
and Medicaid leaders should kind
321
00:16:37,240 --> 00:16:40,240
of glean from our playbook as
well as the the podcast today is
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00:16:40,240 --> 00:16:42,880
that it doesn't have to be
complicated to initiate
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00:16:42,880 --> 00:16:45,000
partnership or even begin
partnership.
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00:16:45,240 --> 00:16:48,280
Sometimes a single well time
conversation is enough to spark
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00:16:48,280 --> 00:16:50,480
interest, build report and
really open the door to things
326
00:16:50,480 --> 00:16:53,120
like small pilot projects or
more regular communication.
327
00:16:53,120 --> 00:16:56,080
It may sound like a modest first
step, but it often turns into
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00:16:56,080 --> 00:16:58,040
the beginning of a much stronger
and more coordinated
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00:16:58,040 --> 00:17:00,080
relationship between public
health in Medicaid.
330
00:17:01,840 --> 00:17:04,560
Corey Caldwell is senior policy
analyst at the National
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00:17:04,560 --> 00:17:06,480
Association of Medicaid
Directors.
332
00:17:07,160 --> 00:17:10,280
Earlier we heard from Francis
Mcgaffey, manager of substance
333
00:17:10,280 --> 00:17:13,160
use prevention and treatment
initiative at the Pew Charitable
334
00:17:13,160 --> 00:17:17,520
Trusts.
Measles was declared eliminated
335
00:17:17,520 --> 00:17:21,000
in the US more than 20 years
ago, but that progress is now at
336
00:17:21,000 --> 00:17:23,160
risk.
After the worst year from
337
00:17:23,160 --> 00:17:26,599
measles cases in decades, public
health officials are reassessing
338
00:17:26,599 --> 00:17:30,520
what elimination really means,
why outbreaks are growing, and
339
00:17:30,520 --> 00:17:33,280
what's at stake if we lose that
status altogether.
340
00:17:33,960 --> 00:17:36,960
With most cases occurring among
unvaccinated communities and
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00:17:36,960 --> 00:17:40,400
outbreak response costing 10s of
thousands of dollars per case,
342
00:17:40,800 --> 00:17:44,280
the message is clear.
Vaccination, trust and strong
343
00:17:44,280 --> 00:17:47,680
public health systems matter.
Learn what's driving today's
344
00:17:47,680 --> 00:17:50,520
measles outbreaks and what
public health agencies are doing
345
00:17:50,520 --> 00:17:53,000
to stop them.
Find a link in the show notes.
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00:17:54,160 --> 00:17:56,160
This has been Public Health
Review Morning Edition.
347
00:17:56,360 --> 00:17:58,800
I'm John Sheehan for the
Association of State and
348
00:17:58,800 --> 00:18:00,240
Territorial Health Officials.
00:00:00,920 --> 00:00:03,640
This is Public Health Review
Morning Edition for Thursday,
2
00:00:03,640 --> 00:00:07,080
January 29th, 2026.
I'm John Sheehan for the
3
00:00:07,080 --> 00:00:09,880
Association of State and
Territorial Health Officials.
4
00:00:10,440 --> 00:00:13,640
Today, how Massachusetts is
expanding access to substance
5
00:00:13,640 --> 00:00:16,480
use disorder treatment and
building stronger, more
6
00:00:16,480 --> 00:00:19,560
sustainable partnerships between
Medicaid and public health.
7
00:00:20,120 --> 00:00:21,760
Our guest.
Is Frances Mcgaffey.
8
00:00:21,960 --> 00:00:24,240
Manager of substance use
prevention and treatment
9
00:00:24,240 --> 00:00:26,400
initiative at The Pew Charitable
Trusts.
10
00:00:26,880 --> 00:00:30,000
She'll explain how policies and
practices that incentivize
11
00:00:30,000 --> 00:00:33,440
Office Based Addiction
treatment, or OBAT, like
12
00:00:33,440 --> 00:00:36,240
Massachusetts shift to pairing
providers with dedicated nursing
13
00:00:36,240 --> 00:00:39,240
support, have helped remove
barriers to prescribing
14
00:00:39,240 --> 00:00:42,360
buprenorphine, expanded the
addiction workforce, and
15
00:00:42,360 --> 00:00:44,480
dramatically increased access to
care.
16
00:00:45,440 --> 00:00:48,840
Later on, Corey Caldwell, senior
policy analyst at the National
17
00:00:48,840 --> 00:00:52,400
Association of Medicaid
Directors, we'll discuss the new
18
00:00:52,400 --> 00:00:55,240
Medicaid Leaders Playbook for
Building Public Health
19
00:00:55,240 --> 00:00:58,080
Partnerships, which was
developed in collaboration with
20
00:00:58,080 --> 00:01:00,760
ASTO.
He'll outline practical, real
21
00:01:00,760 --> 00:01:03,840
world steps Medicaid and public
health agencies can take to
22
00:01:03,840 --> 00:01:06,800
align priorities, address
funding and workforce
23
00:01:06,800 --> 00:01:10,600
challenges, and launch small but
impactful pilot projects.
24
00:01:11,360 --> 00:01:13,720
But first, here's Frances
Mcgaffey explaining how
25
00:01:13,720 --> 00:01:17,120
Massachusetts initiated new
incentives to integrate opioid
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00:01:17,120 --> 00:01:20,760
use disorder treatment with
primary care using the Nurse
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00:01:20,760 --> 00:01:25,320
Care Manager model.
The Nurse Care Manager Model for
28
00:01:25,600 --> 00:01:29,320
OUD treatment or opioid use
Disorder treatment enables
29
00:01:29,320 --> 00:01:33,000
providers like doctors and nurse
practitioners to serve more
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00:01:33,000 --> 00:01:37,440
patients by giving them the
resources of a dedicated nursing
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00:01:37,440 --> 00:01:41,640
staff who can monitor patients
and coordinate their care while
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00:01:41,640 --> 00:01:45,320
they're receiving buprenorphine.
And the state's been very
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00:01:45,320 --> 00:01:51,400
successful just by one metric.
In 2023, 79% of Massachusetts
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00:01:51,400 --> 00:01:55,640
Medicaid enrollees with OUD
received medication, which is
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00:01:55,720 --> 00:01:59,480
higher than the national median.
Why do you think that this model
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00:01:59,480 --> 00:02:02,280
is so successful?
So the model addresses a lot of
37
00:02:02,280 --> 00:02:05,560
the barriers to prescribing
buprenorphine that providers
38
00:02:05,560 --> 00:02:07,200
have been talking about for a
long time.
39
00:02:07,760 --> 00:02:12,240
The lack of time to address
complex needs, the lack of
40
00:02:12,240 --> 00:02:15,800
nursing support and care
coordination to help patients
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00:02:15,800 --> 00:02:19,560
with opioid use disorder stay
retained in care and achieve
42
00:02:19,560 --> 00:02:23,680
their goals.
So by giving that support in
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00:02:23,680 --> 00:02:26,840
Massachusetts, they went from
just a handful of providers
44
00:02:26,840 --> 00:02:30,720
offering this care to now over
40 providers over the state.
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00:02:31,520 --> 00:02:34,280
The increase in access made it
possible for more people to get
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00:02:34,280 --> 00:02:38,880
the care that they need.
And what other kinds of care of
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00:02:38,880 --> 00:02:41,920
treatments?
What else is being rolled into
48
00:02:42,680 --> 00:02:44,000
this model?
Yes.
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00:02:44,000 --> 00:02:48,000
So the model originally started
to treat people with opioid use
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00:02:48,000 --> 00:02:52,720
disorder and in 2022 eligibility
was expanded to people with
51
00:02:52,720 --> 00:02:54,920
alcohol and simulant use
disorders.
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00:02:55,600 --> 00:02:59,120
Alcohol use disorder can also be
treated with medication in a
53
00:02:59,120 --> 00:03:02,000
primary care setting, and
there's even some off label
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00:03:02,000 --> 00:03:05,080
medications that can be used for
simulant use disorder.
55
00:03:05,680 --> 00:03:09,400
So by allowing people with these
conditions to get the care that
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00:03:09,400 --> 00:03:13,760
they need, Massachusetts is able
to address the changing needs of
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00:03:13,760 --> 00:03:17,080
the overdose crisis.
And I know other states are
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00:03:17,080 --> 00:03:19,920
already sort of looking to
Massachusetts as first in class
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00:03:19,920 --> 00:03:24,360
in this this kind of care.
What can other states do that
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00:03:24,360 --> 00:03:28,520
want to replicate your success?
The biggest take away from what
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00:03:28,520 --> 00:03:33,400
Massachusetts did is that they
drew on a workforce that already
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00:03:33,400 --> 00:03:35,640
opted into providing addiction
care.
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00:03:36,400 --> 00:03:39,600
If you think 20 years ago in
Massachusetts and in other
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00:03:39,600 --> 00:03:43,360
states, primary care providers
didn't really see a role for
65
00:03:43,360 --> 00:03:46,720
themselves in treating substance
use disorders.
66
00:03:46,840 --> 00:03:50,120
But now through the nurse care
manager model in Massachusetts,
67
00:03:50,120 --> 00:03:53,840
a lot of providers already said,
I get it, there is something I
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00:03:53,840 --> 00:03:55,840
can do about opioid use
disorder.
69
00:03:56,200 --> 00:04:00,000
And so in Massachusetts said you
can also provide these services
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00:04:00,000 --> 00:04:02,520
to people with alcohol and
stimulant use disorders.
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00:04:03,080 --> 00:04:05,680
They stepped up to the plate.
As long as they have the
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00:04:05,680 --> 00:04:08,640
training and support that they
needed, they were willing to do
73
00:04:08,640 --> 00:04:11,160
that.
And other states that have also
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00:04:11,160 --> 00:04:14,720
developed an addiction workforce
through their efforts to
75
00:04:14,720 --> 00:04:17,680
increase buprenorphine can do
that same thing.
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00:04:18,560 --> 00:04:21,440
So it sounds like.
Sort of an expansion of
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00:04:21,440 --> 00:04:24,840
Workforce.
Definitions of how primary care
78
00:04:24,840 --> 00:04:28,880
providers think of themselves
now sort of taking this, this
79
00:04:28,880 --> 00:04:33,520
extra level of care and
treatment that wasn't once part
80
00:04:33,520 --> 00:04:36,760
of their world and taking it on.
That's right.
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00:04:36,760 --> 00:04:39,920
And what we have seen is that in
Massachusetts and across the
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00:04:39,920 --> 00:04:43,280
country, a lot of primary care
providers have now recognized
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00:04:43,520 --> 00:04:46,880
that they cancer people with
opioid use disorder.
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00:04:47,280 --> 00:04:50,440
And as long as they have the
training and technical
85
00:04:50,440 --> 00:04:53,480
assistance, you know, the
education they maybe didn't get
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00:04:53,480 --> 00:04:57,840
in Med school, they'll take on
other SU DS as well, as long as
87
00:04:57,840 --> 00:05:01,680
it's also paired with
reimbursement that pays for them
88
00:05:01,680 --> 00:05:04,840
to deliver those services.
And you touched on this a bit,
89
00:05:04,840 --> 00:05:09,080
but do you have advice for other
policy makers who are looking to
90
00:05:09,320 --> 00:05:12,560
to start this in their state?
The first thing is to start with
91
00:05:12,560 --> 00:05:15,760
what you have.
There is other ways of providing
92
00:05:15,760 --> 00:05:20,400
office based opioid treatment
and those services can be
93
00:05:20,400 --> 00:05:24,480
leveraged to treat other SU DS
and in states that haven't
94
00:05:24,480 --> 00:05:27,640
really incentivized that
approach they should start.
95
00:05:27,680 --> 00:05:32,560
We know that if you provide
adequate reimbursement and
96
00:05:32,560 --> 00:05:35,640
training and technical
assistance, you can really
97
00:05:35,640 --> 00:05:38,800
expand your addiction workforce
and get more people the care
98
00:05:38,800 --> 00:05:41,400
that they need.
So again, it's really about
99
00:05:41,400 --> 00:05:45,360
making it a priority and
expanding definitions of what of
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00:05:45,360 --> 00:05:47,880
where that treatment.
Can happen and building skills
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00:05:47,880 --> 00:05:50,320
for this workforce.
That's right.
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00:05:50,320 --> 00:05:54,760
So many times people think that
addiction medicine, addiction
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00:05:54,760 --> 00:05:59,760
treatment only happens in a 30
or 90 day residential setting.
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00:06:00,280 --> 00:06:02,680
And of course that's an
important part of the treatment
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00:06:02,680 --> 00:06:06,120
ecosystem, but it's not the only
way to deliver care.
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00:06:06,480 --> 00:06:09,520
And so we need to have other
options that maybe fit into
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00:06:09,520 --> 00:06:12,960
people's lives better or provide
that continuing care after they
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00:06:12,960 --> 00:06:16,280
leave those settings.
And Francis, so do you have any
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00:06:16,280 --> 00:06:18,520
final thoughts in this program?
It's been so successful.
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00:06:19,040 --> 00:06:23,000
What this program shows is the
need to think bigger than opioid
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00:06:23,000 --> 00:06:28,600
use disorder.
So much of our policy, state and
112
00:06:28,600 --> 00:06:32,080
federal, has been focused on
opioid use disorder and
113
00:06:32,080 --> 00:06:37,160
appropriately, because we had
and still are in an opioid
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00:06:37,160 --> 00:06:40,040
overdose crisis.
But that crisis is changing.
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00:06:40,800 --> 00:06:45,120
More overdose deaths involve
stimulants than ever before, and
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00:06:45,120 --> 00:06:48,920
alcohol is a leading driver of
substance use related deaths.
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So states like Massachusetts are
showing that it's possible to
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address these other SU DS and
really meet the needs of
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residents.
Francis McAfee.
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Is manager of substance use
prevention and treatment
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initiative at The Pew Charitable
Trusts.
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Now let's hear from Corey
Caldwell, senior policy analyst
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at the National Association of
Medicaid Directors.
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I asked him about the new
Medicaid Leaders Playbook for
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Building Public Health
Partnerships, which was
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developed in collaboration with
ASTO.
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At its core, the Playbook is
really designed to be practical
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and hands on.
It's draws directly from the
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experiences of leaders in both
the Medicaid and public health
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space with a focus on what
actually works in States.
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And the goal really was designed
to give Medicaid readers clear
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and actionable strategies for
collaborating with public health
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partners, not just in theory and
in kind of complex guides, but
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in day-to-day practice and
operation and operations.
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And the playbook walks through
concrete steps for learning
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priorities, navigating
structural and cultural
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differences between agencies and
really is designed to support
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and improve kind of work between
the two agencies.
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00:07:53,440 --> 00:07:56,240
And it really does provide kind
of a road map to support that
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00:07:56,240 --> 00:07:58,800
higher level collaboration that
I know in AMD and Aslow has been
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working together on.
And so Medicaid and public
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health are are different
systems.
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They share goals, but they're
very different.
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What are some steps that
agencies can take to sort of
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build those partnerships?
Well, that's a, a really great
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00:08:16,120 --> 00:08:18,240
question.
And I, I will note that it's
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00:08:18,240 --> 00:08:21,120
something here in AMD we've been
thinking a lot about over the
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past year.
And one key theme that came
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00:08:24,040 --> 00:08:27,040
through as we were developing
this playbook is that the best
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00:08:27,040 --> 00:08:29,600
place to start is often with
relationships built on
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00:08:29,600 --> 00:08:31,640
understanding.
So it sounds very, very simple,
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00:08:31,640 --> 00:08:35,200
but even though Medicaid and
public health serve a lot of the
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00:08:35,200 --> 00:08:38,400
same populations, they often
work under different mandates,
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00:08:38,400 --> 00:08:40,240
funding structures, and even
timelines.
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00:08:40,240 --> 00:08:42,480
And because of this,
collaboration doesn't always
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00:08:42,480 --> 00:08:45,120
happen automatically.
For for Medicaid leaders, it
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00:08:45,120 --> 00:08:47,200
starts with getting a clear
picture of statewide public
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health priorities.
So thinking through things like
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00:08:49,840 --> 00:08:52,720
maternal health, chronic disease
prevention, or even behavioral
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00:08:52,720 --> 00:08:54,920
health initiatives, and then
finding those areas where
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00:08:54,920 --> 00:08:56,520
Medicaid and public health
overlap.
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00:08:56,880 --> 00:08:59,240
And from there, it's all about
starting conversations with
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shared goals and in mind.
And the playbook really doesn't
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00:09:02,440 --> 00:09:04,280
urge leaders to take it step by
step.
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It's about starting small and
being very intentional.
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Picking one or two common issues
or populations to focus on can
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really help build that trust
between the two agencies to
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00:09:13,040 --> 00:09:15,520
achieve some pilot projects or
even joint planning.
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00:09:15,520 --> 00:09:19,080
And even simple steps like
attending each other's meetings,
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sharing program updates or
lining around existing
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initiatives and go a long way
and creating a strong
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foundation.
And really the key here is just
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transparency, mutual benefit,
and so the breeding, those early
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00:09:28,240 --> 00:09:30,760
wins that build confidence for
bigger collaboration down the
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road.
And since certainly Kovid, but
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also in recent years, the public
health system has faced a lot of
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funding uncertainties.
No surprises there.
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00:09:45,240 --> 00:09:48,760
What can what can Medicaid do to
sort of help shore up those
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00:09:48,760 --> 00:09:51,080
funding gaps?
Well, that's a really important
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question, especially right now.
In historically, Medicaid and
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00:09:54,880 --> 00:09:57,800
public health have played
different but very complementary
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00:09:57,800 --> 00:10:00,600
roles with each other.
Public health funding is often
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00:10:00,600 --> 00:10:03,440
grant based, which makes it
great for piloting new ideas and
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00:10:03,440 --> 00:10:06,240
testing what works.
Medicaid, by contrast, is
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00:10:06,240 --> 00:10:08,280
jointly funded by the state
governments and the federal
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00:10:08,280 --> 00:10:11,400
government, so it's in a much
better position to scale things
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00:10:11,400 --> 00:10:14,000
up and keep them going.
Overtime, especially in public
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00:10:14,000 --> 00:10:15,640
health funding, can be
unpredictable.
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00:10:16,240 --> 00:10:20,120
At the same time, I I think it's
very important to be realistic
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about what states are dealing
with.
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00:10:21,680 --> 00:10:24,560
Both Medicaid agencies and
public health departments are
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00:10:24,560 --> 00:10:27,600
under real budget pressure right
now with slowing state revenues
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00:10:27,600 --> 00:10:29,800
and the end of COVAD era
emergency funding.
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00:10:30,640 --> 00:10:34,120
Medicaid also has very specific
federal rules about what it can
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00:10:34,120 --> 00:10:36,120
pay for.
Its dollars have to be tied to
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00:10:36,120 --> 00:10:39,600
define services and eligible
populations, so it's not able to
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00:10:39,600 --> 00:10:41,960
fully replace broad public
health funding.
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00:10:42,080 --> 00:10:45,160
But with that, with that being
said and within those limits,
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Medicaid can still play a
meaningful role.
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One key opportunity is
reimbursing for services that
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public health departments or
agencies are already delivering.
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00:10:54,000 --> 00:10:56,160
Think about things like
community based supports or
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00:10:56,160 --> 00:10:59,480
preventative services.
Moving those activities from
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00:10:59,480 --> 00:11:02,960
short term grants into Medicaid
reimbursement can make that that
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00:11:02,960 --> 00:11:05,080
work more stable and even more
sustainable.
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00:11:05,800 --> 00:11:08,960
Medicaid can can also support
public health and less direct
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00:11:08,960 --> 00:11:12,760
but still important ways.
An example can include states
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better aligning Medicaid
incentives and quality measures
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00:11:15,640 --> 00:11:18,600
of public health goals.
They can also invest in shared
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00:11:18,600 --> 00:11:21,560
data systems that support both
program oversight and public
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00:11:21,560 --> 00:11:23,800
health monitoring.
So I think just that the main
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00:11:23,800 --> 00:11:26,800
point to your question here is
while Medicaid can't fill every
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00:11:26,800 --> 00:11:29,960
gap left by the end of the
COVID-19 emergency funding, it
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00:11:29,960 --> 00:11:32,800
can help sustain critical
services, reinforce core
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00:11:32,800 --> 00:11:35,040
infrastructure, and make sure
public health efforts continue
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00:11:35,040 --> 00:11:37,480
to reach the people who depend
most on both systems.
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00:11:38,080 --> 00:11:41,360
Along those lines, another
challenge facing the public
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00:11:41,360 --> 00:11:44,680
health system is is workforce
shortages.
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00:11:45,320 --> 00:11:47,960
Are there opportunities there
for Medicaid to help with
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00:11:47,960 --> 00:11:51,840
workforce?
Certainly, and this is a really
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00:11:51,840 --> 00:11:53,640
important issue for states right
now.
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00:11:54,360 --> 00:11:57,600
Workforce shortages are one of
the biggest challenges facing
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00:11:57,600 --> 00:12:00,000
both Medicaid and public health,
and you can really see the
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00:12:00,000 --> 00:12:03,400
effects almost everywhere.
Providers are stretched, then
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00:12:03,400 --> 00:12:05,720
public health teams are
understaffed and communities can
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00:12:05,720 --> 00:12:08,360
often struggle to get the care
and the services that they need.
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00:12:08,360 --> 00:12:12,000
And one of the the big takeaways
from the playbook is that states
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can make real progress when when
Medicaid and public health are
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00:12:14,760 --> 00:12:17,120
intentional about working
together and really play to
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00:12:17,120 --> 00:12:20,360
their respective state,
respective strengths across
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00:12:20,360 --> 00:12:22,040
states.
We've seen some promising
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00:12:22,040 --> 00:12:26,120
approaches emerge and one that
comes up a lot is expanding the
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00:12:26,120 --> 00:12:28,000
use of non traditional provider
roles.
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00:12:28,000 --> 00:12:30,200
So think through things like
community health workers,
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00:12:30,600 --> 00:12:32,520
doulas, or peer support
specialists.
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00:12:32,520 --> 00:12:35,760
And public health agencies are
often well positioned to handle
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00:12:35,760 --> 00:12:38,000
things like training and
community outreach for these
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00:12:38,000 --> 00:12:39,680
roles.
While Medicaid can help by
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00:12:39,680 --> 00:12:42,520
creating sustainable
reimbursement pathways, when
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00:12:42,520 --> 00:12:45,120
those pieces are aligned, states
can start building long term
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00:12:45,120 --> 00:12:48,840
workforce pipelines rather than
relying on short term grants or
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00:12:48,880 --> 00:12:51,760
short term funding.
Data sharing also plays an
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00:12:51,760 --> 00:12:54,800
important role.
Public health contributes
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00:12:55,080 --> 00:12:58,120
population level data and
Medicaid brings claims and
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00:12:58,120 --> 00:13:00,760
utilization information.
And when states bring those data
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00:13:00,760 --> 00:13:03,280
sources together, they get a
much clearer picture of where
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00:13:03,280 --> 00:13:06,440
workforce shortages are most
acute and where investments or
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00:13:06,440 --> 00:13:08,560
new care models can have the
greatest impact.
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00:13:09,720 --> 00:13:12,160
Lastly, we're we're also seeing
states coordinate more closely
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00:13:12,160 --> 00:13:15,360
on recruitment and training
through shared internships,
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00:13:15,360 --> 00:13:18,200
community based pipelines or
partnerships with local
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00:13:18,200 --> 00:13:21,120
colleges.
And these efforts are especially
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00:13:21,120 --> 00:13:23,040
important for rural and
underserved committees that
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00:13:23,040 --> 00:13:25,920
often faced face the toughest
staffing challenges.
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00:13:26,960 --> 00:13:30,400
Another point in the playbook,
and something you've mentioned a
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00:13:30,400 --> 00:13:35,040
couple Times Now, are how states
could utilize small pilot
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00:13:35,040 --> 00:13:38,040
projects.
Could you give us some examples
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00:13:38,040 --> 00:13:40,240
of what that means?
Absolutely.
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00:13:40,440 --> 00:13:43,360
One of the things that Playbook
really emphasizes is starting
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00:13:43,360 --> 00:13:45,720
small.
Those focused pilot projects are
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00:13:45,720 --> 00:13:48,560
often the most effective way for
Medicaid and public health to
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00:13:48,560 --> 00:13:51,960
begin working together.
They give both sides room to
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00:13:52,040 --> 00:13:54,960
test ideas, build trust, and
work through differences in
264
00:13:54,960 --> 00:13:58,280
things like funding timelines or
even data systems without the
265
00:13:58,280 --> 00:14:00,840
pressure of having to launch a
huge kind of statewide
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00:14:00,840 --> 00:14:02,960
initiative out of the gate or
right away.
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00:14:03,600 --> 00:14:06,480
We've seen some really strong
examples of this in practice,
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00:14:06,480 --> 00:14:09,360
especially around the kind of
programmatic areas of maternal
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00:14:09,360 --> 00:14:10,960
health and managed care
procurement.
270
00:14:11,480 --> 00:14:14,760
On the maternal health side,
public health agencies often
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00:14:14,760 --> 00:14:17,440
already have deep connections in
the community through programs
272
00:14:17,440 --> 00:14:20,000
like home visiting programs or
partnerships with local
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00:14:20,000 --> 00:14:23,000
providers.
Successful pilots build on that
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00:14:23,000 --> 00:14:25,400
foundation, with Medicaid
stepping in to support
275
00:14:25,400 --> 00:14:28,400
reimbursement and align managed
care expectations so pregnant
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00:14:28,400 --> 00:14:30,480
women get consistent outreach
and support.
277
00:14:31,360 --> 00:14:34,400
Even fairly modest pilots
focused on higher risk
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00:14:34,400 --> 00:14:37,800
pregnancies have led to better
engagement, stronger health
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00:14:37,800 --> 00:14:40,000
education and smoother care
coordination.
280
00:14:40,080 --> 00:14:42,760
It's a great example of how
Medicaid's financing and
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00:14:42,760 --> 00:14:44,800
clinical structure can
complement public health's
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00:14:44,800 --> 00:14:47,680
community reach.
Another area where pilots have
283
00:14:47,680 --> 00:14:49,400
made a real difference is
managed care.
284
00:14:49,840 --> 00:14:53,120
In these cases, states test test
ways to better align
285
00:14:53,120 --> 00:14:55,720
preventative health priorities
and managed care contracts with
286
00:14:55,720 --> 00:14:57,480
input from their public health
colleagues.
287
00:14:57,880 --> 00:15:00,840
That alignment helps ensure
managed care organizations are
288
00:15:00,840 --> 00:15:03,400
focusing on prevention and
population health in ways that
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00:15:03,400 --> 00:15:05,120
support broader public health
goals.
290
00:15:06,120 --> 00:15:08,800
Even small efforts here can lead
to noticeable improvements in
291
00:15:08,800 --> 00:15:11,200
preventative service delivery
and stronger connections between
292
00:15:11,200 --> 00:15:12,880
clinical care and in public
health.
293
00:15:14,440 --> 00:15:21,240
And finally, Corey, what would
one step be that an agency or an
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00:15:21,240 --> 00:15:24,520
official could could take to
sort of strengthen their
295
00:15:24,520 --> 00:15:27,400
relationship with with their
Medicaid colleagues?
296
00:15:27,840 --> 00:15:30,600
One of the most effective things
public health leaders can do
297
00:15:30,600 --> 00:15:32,680
right now is actually very, very
simple.
298
00:15:32,680 --> 00:15:34,720
It's just starting the
conversation.
299
00:15:34,840 --> 00:15:37,200
Reaching out to Medicaid
leadership to set up a short and
300
00:15:37,200 --> 00:15:40,240
trajectory meeting can go a long
way in laying the groundwork for
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00:15:40,240 --> 00:15:42,640
trust, which our playbook really
highlights as essential for
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00:15:42,640 --> 00:15:46,200
those long term partnerships.
In that first conversation, it
303
00:15:46,200 --> 00:15:49,960
can help to have a very clear
and focused dialogue so public
304
00:15:49,960 --> 00:15:53,080
health leaders can share things
like high level snapshots of
305
00:15:53,080 --> 00:15:55,600
their current priorities,
especially ones that have
306
00:15:55,600 --> 00:15:57,800
natural overlap with Medicaid
goals.
307
00:15:58,360 --> 00:16:00,840
I want to notice well that
Medicaid leaders are often
308
00:16:00,840 --> 00:16:04,280
managing a lot of regulatory and
operational complexity and they
309
00:16:04,280 --> 00:16:07,080
may not always have full
visibility into the programs,
310
00:16:07,080 --> 00:16:09,960
partnerships, or even data that
public health agencies can bring
311
00:16:09,960 --> 00:16:12,720
to the table.
So even a quick overview can
312
00:16:12,720 --> 00:16:14,760
surface opportunities that
neither side had really
313
00:16:14,760 --> 00:16:17,800
considered before.
It's also useful to come in with
314
00:16:17,800 --> 00:16:20,720
a few concrete examples of our
alignment already exists.
315
00:16:20,720 --> 00:16:23,280
So pointing out areas where
public health work is supporting
316
00:16:23,280 --> 00:16:25,720
Medicaid populations, whether
that's their community based
317
00:16:25,720 --> 00:16:28,480
supports, maternal and child
health efforts or population
318
00:16:28,480 --> 00:16:31,400
level data help us both sides
see where collaboration could
319
00:16:31,400 --> 00:16:34,400
realistically start.
And the big take away that I
320
00:16:34,400 --> 00:16:37,240
think both public health leaders
and Medicaid leaders should kind
321
00:16:37,240 --> 00:16:40,240
of glean from our playbook as
well as the the podcast today is
322
00:16:40,240 --> 00:16:42,880
that it doesn't have to be
complicated to initiate
323
00:16:42,880 --> 00:16:45,000
partnership or even begin
partnership.
324
00:16:45,240 --> 00:16:48,280
Sometimes a single well time
conversation is enough to spark
325
00:16:48,280 --> 00:16:50,480
interest, build report and
really open the door to things
326
00:16:50,480 --> 00:16:53,120
like small pilot projects or
more regular communication.
327
00:16:53,120 --> 00:16:56,080
It may sound like a modest first
step, but it often turns into
328
00:16:56,080 --> 00:16:58,040
the beginning of a much stronger
and more coordinated
329
00:16:58,040 --> 00:17:00,080
relationship between public
health in Medicaid.
330
00:17:01,840 --> 00:17:04,560
Corey Caldwell is senior policy
analyst at the National
331
00:17:04,560 --> 00:17:06,480
Association of Medicaid
Directors.
332
00:17:07,160 --> 00:17:10,280
Earlier we heard from Francis
Mcgaffey, manager of substance
333
00:17:10,280 --> 00:17:13,160
use prevention and treatment
initiative at the Pew Charitable
334
00:17:13,160 --> 00:17:17,520
Trusts.
Measles was declared eliminated
335
00:17:17,520 --> 00:17:21,000
in the US more than 20 years
ago, but that progress is now at
336
00:17:21,000 --> 00:17:23,160
risk.
After the worst year from
337
00:17:23,160 --> 00:17:26,599
measles cases in decades, public
health officials are reassessing
338
00:17:26,599 --> 00:17:30,520
what elimination really means,
why outbreaks are growing, and
339
00:17:30,520 --> 00:17:33,280
what's at stake if we lose that
status altogether.
340
00:17:33,960 --> 00:17:36,960
With most cases occurring among
unvaccinated communities and
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00:17:36,960 --> 00:17:40,400
outbreak response costing 10s of
thousands of dollars per case,
342
00:17:40,800 --> 00:17:44,280
the message is clear.
Vaccination, trust and strong
343
00:17:44,280 --> 00:17:47,680
public health systems matter.
Learn what's driving today's
344
00:17:47,680 --> 00:17:50,520
measles outbreaks and what
public health agencies are doing
345
00:17:50,520 --> 00:17:53,000
to stop them.
Find a link in the show notes.
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00:17:54,160 --> 00:17:56,160
This has been Public Health
Review Morning Edition.
347
00:17:56,360 --> 00:17:58,800
I'm John Sheehan for the
Association of State and
348
00:17:58,800 --> 00:18:00,240
Territorial Health Officials.