SRCD State Policy Fellow Professional Portfolio Abstracts: Alex Busuito, Ph.D.
Introduction: During the 2021-2022 fellowship year, it has been my privilege to work with the Perinatal and Early Childhood Health team at the Rhode Island Department of Health to further their goal of increasing access to quality physical and mental health care to underserved families and young children. I have enjoyed learning and leadership roles in a diverse portfolio of projects, including: expanding access to family home visiting by securing Medicaid funding; conducting research on factors associated with family engagement in home visiting; designing and preparing an evaluation plan for a large federal systems grant; and conducting a policy analysis of prenatal and early childhood systems.
Portfolio Entry 1: First Connections Medicaid Rate Increase Decision Package
Project Overview:
Background: First Connections is a short-term risk identification and response program that serves new and expectant families across the state of Rhode Island. Each year, approximately 60% (6,000) of all children born are identified as being at -risk for poor health and development outcomes and are referred to First Connections. Nearly 40% of families referred to First Connections receive at least one visit. The main purpose of First Connections is to connect families with services that meet existing needs, including but not limited to WIC, SNAP, Health Care, Early Intervention, Child Care, Housing, and other long-term family visiting programs.
Goal(s): The goal of this project is to increase reimbursement rates for, and sustainability of, First Connections services. First Connections nurses, social workers, and community health workers make 36%, 15% and 38% less, respectively, than their peers elsewhere in Rhode Island. This disparity in pay threatens the sustainability of First Connections by contributing to high staff turnover, staffing shortages, and burnout. Higher reimbursement rates will allow us to correct these gaps in compensation, and attract and retain skilled home visitors.
Contributions of Fellow:
- Compiled and synthesized information on First Connections program and funding from existing sources
- Used compiled information to write the Proposal Background and Evidence Base sections
- Reviewed and provided feedback on cost study and fiscal impact sections
Activity Focus Keywords: Document Review; Funding Proposal
Policy Area Keywords: Child Welfare; Family Engagement; Workforce; Home Visiting
Knowledge & Skills Keywords: Effective communication between researchers, practitioners, and policymakers
Portfolio Entry 2: First Connections Section 1115 Demonstration Waiver
Project Overview:
Background: First Connections is a short-term risk identification and response program that aims to connect Rhode Island families to services at the earliest possible opportunity. First Connections has primarily served families with children birth to age three years; the program receives prenatal referrals, but can serve a very limited number of pregnant people due to funding constraints. Given that both individual (e.g., child physical health) and economic outcomes (e.g., return on investment) increase the earlier intervention is received, First Connections should be expanded to serve more families prenatally through accessing Medicaid funding.
Goal(s): Secure permission to bill Medicaid for prenatal First Connections visits in order to engage more families earlier.
Contributions of Fellow:
- Engaged in and, later, led meetings with Rhode Island Medicaid and Centers for Medicare and Medicaid Services
- Wrote and edited 1115 Waiver Application
- With RI Medicaid, fielded and answered questions from CMS during the application process
Activity Focus Keywords: Cross-Agency Collaboration; Funding proposal
Policy Area Keywords: Family Engagement; Evidence-based Home Visiting; Centers for Medicare and Medicaid Services
Knowledge & Skills Keywords: Federal and state policy connections; Medicaid Funding
Portfolio Entry 3: Parents as Teachers State Plan Amendment
Project Overview:
Background: Parents as Teachers (PAT), which aims to enhance caregivers parenting knowledge and skills, is one of three evidence-based home visiting models delivered in Rhode Island. After years of funding slots exclusively with grant money, the state legislature approved Medicaid match funds for PAT in June 2020; however, the Department of Health does not have permission to bill Medicaid for the program. This Medicaid funding represents an opportunity to expand evidence-based home visiting in historically under-served communities in Rhode Island.
Goal(s): Secure permission to bill Medicaid for Parents as Teachers visits.
Contributions of Fellow:
- Engaged in and, later, led meetings with Rhode Island Medicaid and Centers for Medicare and Medicaid Services
- Wrote and edited State Plan Amendment application
- With RI Medicaid, fielded and answered questions from CMS during the application process
- Participated fully in the creation of the billing structure needed to access funds, including reimbursement rates and CPT codes
- Prepared and delivered presentation on progress towards accessing funds to state and advocacy leadership
Activity Focus Keywords: Cross-Agency Collaboration; Funding proposal
Policy Area Keywords: Family Engagement; Workforce
Knowledge & Skills Keywords: Evidence-based policymaking at the state level; Federal and state policy connections; Medicaid funding
Portfolio Entry 4: Access Medicaid Funds for Evidence-based Family Home Visiting
Project Overview:
Background: The Rhode Island Department of Health has CMS permission and state match funds to bill Medicaid for two evidence-based home visiting programs (Healthy Families America and Nurse Family Partnership). Both programs are currently delivered state-wide and have been shown to prevent poor physical and behavioral health outcomes in young children. Medicaid funds represent an opportunity to expand home visiting to vulnerable families and enhance the wellbeing of more young children across the state.
Goal(s): Develop and implement infrastructure to access Medicaid funds for Healthy Families America and Nurse Family Partnership
Contributions of Fellow:
- Completed document review of existing Medicaid billing policy briefs and facts sheets
- Conducted over 20 interviews with Medicaid billing and/or Home Visiting experts in state and federal government, policy research, and advocacy roles
- Completed a policy analysis of available mechanisms for accessing Medicaid billing permission and funds
- Participated fully in the creation of the billing structure needed to access funds, including reimbursement rates and CPT codes
- Prepared and delivered presentation on Medicaid billing process to state and advocacy leadership
- Engaged in and, later, led meetings with Rhode Island Medicaid and Centers for Medicare and Medicaid Services
Activity Focus Keywords: Conduct Interviews; Cross-Agency Collaboration; Policy Analysis; Presentation
Policy Area Keywords: Cost of Care; Workforce; Evidence-based Home Visiting; Centers for Medicare and Medicaid Services (CMS)
Knowledge & Skills Keywords: Federal and state policy connections; What information policymakers need; Medicaid funding
Portfolio Entry 5: Early Childhood Comprehensive Systems Grant Evaluation Plan
Project Overview:
Background: Rhode Island’s Early Childhood Comprehensive System grant, or RI/P3 initiative, supports efforts to improve the level and quality of integration of programs that serve families from pregnancy to child age three. The purpose of this initiative is to build an early childhood system that is comprehensive, sustainable, and equitable and able to enhance the wellbeing of children in families across all socioeconomic and ethnic backgrounds. The program evaluation of the RI/P3 initiative presents an opportunity to develop a nuanced understanding of the processes involved in achieving a more integrated and effective early childhood system.
Goal(s): To understand what policies are effective in growing and maintaining the doula workforce in underserved and underrepresented communities; to know whether we are increasing the number of P3 providers using RI’s CRP system, UniteUs, and whether the use of the system is effective; to learn what strategies are successful in improving outreach to and service provision for P-3 populations within RI’s Health Equity Zones (HEZs), delineated geographic areas in which a community comes together to build the infrastructure needed to eliminate or reduce barriers to health equity.
Contributions of Fellow:
- Convened meetings with stakeholders to determine evaluation areas of interest
- Identified relevant measures for evaluation plan
- Designed and prepared evaluation plan
Activity Focus Keywords: Administrative Data; Community Collaboration; Cross-Agency Collaboration; Evaluation Framework Development
Policy Area Keywords: Child Welfare; Continuous Quality Improvements (CQI); Workforce; Health Resources and Service Administration (HRSA)
Knowledge & Skills Keywords: Evidence-based policymaking at the state level; Conducting research that’s useful to policy and practice; Incorporating a diversity, equity, and inclusion lens