With Medicaid Waiver Plan, Washington State Envisions 10 Community Hubs

In its request for an extension of its Section 1115 Medicaid demonstration waiver, Washington state said it plans to develop a “Taking Action for Healthier Communities (TAHC)” program that will create 10 “Community Hubs” to  further invest in multi-sector, community-based partnerships and approaches to better support individuals and families.

The state’s initial waiver, called the Medicaid Transformation Project (MTP), was approved in January 2017. In 2018 and 2020, the Centers for Medicare & Medicaid Services (CMS) also approved Washington state’s amendments for substance use disorder and mental health treatment in certain types of inpatient facility setting.

Now Washington is seeking a five-year renewal for what will be known as “MTP 2.0.”

In a June 29, 2022, letter to CMS Administrator Chiquita Brooks-LaSure, Gov. Jay Inslee said that, “through MTP, our state is focusing on whole-person care through integrated care and coordination with community services, such as housing, employment, and more. Washington has also leveraged a broad, collaborative regional approach to building healthier communities through Accountable Communities of Health (ACH).”

In its waiver renewal application, the state says that by supporting meaningful connections among communities, service providers, and managed care plans, TAHC will ensure that: Medicaid enrollees are able to access the services they need; care across the healthcare and health-related services continuum is coordinated; and regional capacity to offer these services grows over time. “This vision is critical to Washington’s goals of addressing long-standing underinvestment in marginalized communities and populations, removing systemic barriers to health, and advancing health equity,” the state says.

Washington says its regional Accountable Communities for Health will play a critical implementation role within the TAHC program. ACHs are uniquely positioned in supporting strong community engagement and multi-sector collaboration. They provide a lens that recognizes the importance of health equity and social determinants of health.

Washington is requesting expenditure authority for the development and operation of nine Community Hubs and one Native Hub. These hubs are centers for community-based care coordination that focus on health-related social needs. They will provide screening for and referral to community-based services for enrollees in Apple Health, the name for the state’s Medicaid program. Hubs will collaborate with other existing care coordination entities.

Nine of the Community Hubs will be overseen by existing ACHs—and a Native Hub will be developed and overseen by a to-be-determined entity. The state Health Care Authority will partner with Tribes to identify and select the appropriate Native Hub oversight entity. Guidance and coordination for creation of the Native Hub will be provided through the Governor’s Indian Health Advisory Council to serve the state’s tribal community statewide, in recognition of the government-to-government relationship with Tribes and tribal sovereignty.

Each ACH will be responsible for developing and managing the functions of a Community Hub.

The Community Hub is an evolution of work that began in MTP—embedded within the ACH infrastructure—and will align with recent efforts by the Care Connect Washington program.

MTP and Care Connect funding established a solid foundation of community information exchange that TAHC will leverage and expand upon to ensure Community Hubs have effective data-sharing capabilities between CBOs and healthcare organizations. The state will explore managed care flexibilities and contracting levers to support increased payment for community-based workforce through the Community Hub model. This demonstration will provide an implementation path that will be reinforced through MCO contracts and other accountability mechanisms, including the development of definitions and standards to support training and payment of community-based workers. The state stresses that ACHs are not evolving into Community Hubs. Rather, the ACH organizational infrastructure will remain, and each ACH will oversee, manage, and coordinate Community Hub functions. These functions will be performed by an ACH or entity contracted by the ACH.

Community Hubs will use community information exchange and resource and referral processes to support the coordination of and connection to community resources and organizations for Apple Health enrollees. Community Hubs will be instrumental in identifying unmet needs within the community and at the individual level, the state said. 

Community Hubs will work with networks of community organizations to ensure individuals are connected to the needed community services and supports, including promoting and coordinating health-related services, as the state looks to expand services that address unmet social needs throughout Washington.