CAASP Funding & Financing 2 — Questions and Answers
Question 1: Medicaid's EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) benefit is significant for CAASP because it:
- Limits the mental health services billable to Medicaid for children under age 18
- Requires states to cover any medically necessary service for enrolled children, even if not in the state plan (Correct answer)
- Provides block grant funding directly to counties for youth behavioral health services
- Establishes income eligibility thresholds for children's behavioral health services
Correct answer: Requires states to cover any medically necessary service for enrolled children, even if not in the state plan
EPSDT mandates that states cover any service determined medically necessary for a Medicaid-enrolled child, giving systems authority to cover a broad range of behavioral health interventions.
Question 2: Which Medicaid waiver type gives states the most flexibility to test innovative children's mental health delivery models by waiving standard Medicaid requirements?
- State Plan Amendments (SPAs)
- 1915(c) Home and Community-Based Services Waivers
- 1115 Demonstration Waivers (Correct answer)
- CHIP Matching Grants
Correct answer: 1115 Demonstration Waivers
1115 Demonstration Waivers allow states to waive standard Medicaid rules to pilot new approaches, making them the most flexible tool for testing innovative children's behavioral health models.
Question 3: Wraparound Milwaukee's financing model is frequently cited as a CAASP best practice because it:
- Relies exclusively on SAMHSA block grant dollars with no local contribution
- Pools Medicaid, child welfare, and juvenile justice funds into a single capitated per-child budget (Correct answer)
- Funds all services through a local property tax levy with federal matching
- Uses only fee-for-service billing with no inter-agency cost sharing
Correct answer: Pools Medicaid, child welfare, and juvenile justice funds into a single capitated per-child budget
Wraparound Milwaukee pioneered pooling funds from multiple child-serving systems into a single per-child capitated budget managed by a care coordination entity, enabling flexible individualized services.
Question 4: In a CAASP context, formal 'cost-sharing' agreements between child-serving agencies typically refer to:
- Clients splitting service costs with their insurance company through co-pays
- Two or more agencies agreeing to share financial responsibility for serving mutually eligible youth (Correct answer)
- States requiring counties to match federal mental health block grant dollars
- Medicaid managed care plans sharing actuarial risk with contracted providers
Correct answer: Two or more agencies agreeing to share financial responsibility for serving mutually eligible youth
Inter-agency cost-sharing involves formal agreements where systems such as mental health, child welfare, and education share the financial responsibility for youth who are eligible across multiple systems.
Question 5: The Children's Health Insurance Program (CHIP) extends behavioral health coverage to children who:
- Are already enrolled in Medicaid and need supplemental mental health coverage
- Exceed Medicaid income limits but whose families cannot afford private insurance (Correct answer)
- Are in foster care placements regardless of family income
- Have a documented disability qualifying them for Supplemental Security Income (SSI)
Correct answer: Exceed Medicaid income limits but whose families cannot afford private insurance
CHIP covers children in families with incomes too high for Medicaid but too low to afford private insurance, extending behavioral health coverage to a broader population of children.
Question 6: Under a Medicaid managed care arrangement, a behavioral health 'carve-out' means that:
- Mental health services are excluded from Medicaid coverage entirely for managed care enrollees
- Behavioral health benefits are separated from physical health and managed by a specialized behavioral health organization (Correct answer)
- Only crisis services are covered within the managed care contract
- Behavioral health providers receive fee-for-service reimbursement outside the managed care plan
Correct answer: Behavioral health benefits are separated from physical health and managed by a specialized behavioral health organization
A behavioral health carve-out separates mental health and substance use services from the general managed care contract, placing them under a specialized behavioral health managed care organization.
Question 7: Federal financial participation (FFP) in Medicaid is provided to states through:
- A per-child, per-year flat rate regardless of actual expenditures
- A block grant awarded annually regardless of state enrollment levels
- A matching formula (FMAP) where the federal government pays a percentage of each eligible state expenditure (Correct answer)
- A competitive grant process where states submit annual funding proposals
Correct answer: A matching formula (FMAP) where the federal government pays a percentage of each eligible state expenditure
Medicaid uses the Federal Medical Assistance Percentage (FMAP) formula, under which the federal government matches a state-specific percentage of every eligible Medicaid expenditure.
CAASP Funding & Financing 2
Medicaid's EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) benefit is significant for CAASP because it: