The opioid epidemic continues to devastate communities across the United States, affecting individuals of all ages and demographics. For pregnant women and children, the effects can be particularly severe, with opioid use disorder (OUD) causing a range of complications for both mothers and their children. In response to this crisis, the Center for Medicare & Medicaid Innovation (CMMI) at the Centers for Medicare & Medicaid Services (CMS) has announced the state awardees for two new models designed to help curb the effects of the opioid epidemic on vulnerable populations. These models — the Maternal Opioid Misuse (MOM) model and the Integrated Care for Kids (InCK) model — aim to provide comprehensive, integrated care that improves health outcomes while reducing costs for mothers and children impacted by opioid use.
The MOM and InCK models represent a significant step in addressing the opioid crisis by focusing on prevention, coordination of care, and sustainable payment systems. These state-specific models provide funding and flexibility for states to design their interventions and create systems that work best for their local populations. Let’s dive into the details of these models and their potential impact.
The Maternal Opioid Misuse (MOM) Model: Addressing Opioid Use Disorder in Mothers
The MOM model is aimed at improving the treatment of opioid use disorder (OUD) in pregnant and postpartum women who are Medicaid beneficiaries. Opioid use during pregnancy has a host of detrimental effects on both the mother and the baby, including an increased risk of preterm birth, low birth weight, neonatal abstinence syndrome (NAS), and maternal morbidity. Despite the growing awareness of these risks, the care systems for pregnant women with OUD remain fragmented, which complicates efforts to provide effective, coordinated care.
The MOM model seeks to address these issues by improving care coordination, integrating services, and expanding access to care. By doing so, the model aims to reduce the fragmentation of services that often hampers the treatment of opioid use disorder in mothers, while also reducing overall healthcare costs. The ultimate goal is to create a more effective, sustainable way to provide care for pregnant women with OUD that ensures better health outcomes for both mothers and their babies.
Under the MOM model, ten states have been selected to receive funding, including Colorado, Indiana, Louisiana, Maine, Maryland, Missouri, New Hampshire, Tennessee, Texas, and West Virginia. Each state will receive up to $64.5 million over five years to transition to and fully implement the new model. The funding will be used to support initiatives such as expanding infrastructure, improving access to treatment, and developing sustainable payment mechanisms for care coordination.
Goals of the MOM Model
- Care Coordination: One of the primary goals of the MOM model is to address the fragmentation of care that many women with opioid use disorder face. This model emphasizes a coordinated, holistic approach to care that brings together maternal health services, addiction treatment, and mental health services.
- Improving Access: By expanding access to services and building the necessary infrastructure, the MOM model seeks to provide comprehensive care to women who have traditionally been underserved, especially in rural or underserved urban areas.
- Cost Reduction: The model also aims to reduce overall healthcare costs by providing more effective and integrated care, thereby decreasing the need for emergency care or long-term medical interventions due to poor maternal or child health outcomes.
- Sustainability: The MOM model encourages states to develop sustainable payment systems that support long-term care coordination, ensuring that these interventions can continue beyond the initial grant period.
The Integrated Care for Kids (InCK) Model: Supporting Children and Caregivers Affected by the Opioid Crisis
While the MOM model focuses on mothers, the InCK model is designed to improve care for children affected by the opioid epidemic, along with their caregivers. Children and families impacted by opioid use disorder often experience a cascade of challenges, including exposure to substance use, neglect, instability, and disrupted family structures. These disruptions can result in a higher incidence of adverse childhood experiences (ACEs), which are known to have long-term negative effects on physical and mental health.
The InCK model focuses on improving the health of Medicaid and Children’s Health Insurance Program (CHIP)-covered children and their caregivers, with an emphasis on preventing the need for foster care placement and improving health outcomes for these vulnerable children. The model seeks to address the full range of physical, mental, and behavioral health needs of children affected by opioid use disorder, as well as the social determinants of health that may contribute to negative health outcomes.
InCK also focuses on integrating services across medical, behavioral, and community-based organizations. The model is designed to break down silos between healthcare, child welfare, educational systems, housing, and other critical services. This holistic approach seeks to provide comprehensive support for children and their families, creating an environment where families can thrive together rather than experiencing separation or neglect.
Goals of the InCK Model
- Improving Health Outcomes: The primary goal of InCK is to improve the overall health of children and their caregivers by ensuring that they have access to the medical, behavioral, and community-based services they need. This includes services such as mental health care, addiction treatment, housing support, and educational services.
- Keeping Families Together: One of the most important aspects of InCK is the emphasis on keeping children at home, preventing foster care placements, and reducing the impact of the opioid crisis on family structures. By integrating care and providing wraparound services, the model aims to strengthen family bonds and reduce the trauma associated with family separation.
- Creating Sustainable Payment Models: Like the MOM model, InCK also focuses on developing sustainable payment systems that allow for continued care integration beyond the initial model funding. This ensures that the services provided through InCK can continue long-term, even after the program’s funding cycle ends.
- Flexibility and Community-Based Solutions: States participating in the InCK model are given flexibility to design interventions that are tailored to the specific needs of their communities. This approach allows states to address local challenges in unique ways, creating solutions that are more likely to be effective and sustainable.
States Awarded Funding for the InCK Model
The states selected for the InCK model include Connecticut, Illinois (two awards), New Jersey, New York, North Carolina, Ohio, and Oregon. These states will receive funding to launch the seven-year program beginning in January 2020. The funding will be used to implement and sustain integrated care initiatives aimed at reducing the effects of the opioid epidemic on children and their caregivers.
Looking Ahead: Impact and Potential of MOM and InCK Models
Both the MOM and InCK models represent promising steps forward in addressing the complex challenges posed by the opioid epidemic. By focusing on vulnerable populations — mothers with opioid use disorder and children affected by opioid abuse — these models aim to provide more coordinated, accessible, and sustainable care.
The models are designed to not only improve health outcomes for those affected by opioids but also to reduce costs by preventing more severe health issues down the line. Through these new models, states have the opportunity to implement creative, community-driven solutions that can create lasting change.
As the opioid crisis continues to affect millions of Americans, the MOM and InCK models offer hope that a more integrated, compassionate, and effective approach to care can help curb the epidemic’s devastating effects on mothers, children, and families. By investing in care coordination and expanding access to comprehensive services, these initiatives have the potential to create real, lasting change for those who need it most.
