Asthma education and environmental management are evidence-based strategies that reduce asthma-related emergency department (ED) visits and hospitalizations and reduce health care costs. Despite the economic benefits, reimbursement for these strategies tends to be lower and/or less comprehensive than other recommended asthma management approaches.
Our goal is to expand access to evidence-based, home-based asthma education and environmental interventions for Illinois residents living with asthma through sustainable financing mechanisms. While there are a number of mechanisms described in this report that are available to accomplish this, we recommend the following for immediate exploration:
- Expand reimbursement for asthma educators, community health workers (CHW) and others currently outside of Illinois’ clinical licensure system;
- Establish a Health Homes Program that incorporates asthma care best practices;
- Apply for Section 1115 Research and Demonstration Waiver that includes home-based asthma education and environmental interventions;
- Utilize reimbursement through existing Medicaid channels such as early and periodic screening, diagnostic, and treatment and administrative costs;
- Amend contracts between state Medicaid and Medicaid Managed Care Organizations (MCO) to enable and provide guidance for the use of CHWs, and;
- Encourage Medicaid MCOs to expand in-home asthma education and environmental interventions, by providing these services or reimbursing other providers.