GHN Community Hub - Frequently Asked Questions
What is the Medicaid Transformation Project (AKA MTP or Medicaid Waiver)?
The Medicaid Transformation Project (MTP) is Washington State’s Section 1115 Medicaid demonstration waiver between the Health Care Authority (HCA) and Centers for Medicare & Medicaid Services (CMS). MTP allows our state to create and continue to develop projects, activities, and services that improve Washington’s health care system.
On June 30, 2023, CMS approved MTP to continue for five more years. Our state’s MTP renewal, called MTP 2.0, will help widen our reach to provide more programs, services, and supports to our most vulnerable populations. Learn more about MTP and the MTP waiver renewal.
Through MTP, Washington State has nine designated Accountable Communities of Health (ACHs) which are independent, regional organizations. Greater Health Now serves as the ACH for Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, Whitman, Yakima Counties, and the Yakama Nation. ACHs work with their communities on specific health care and social needs-related projects and activities, and are committed to ensuring community needs, values, and priorities guide system transformation.
ACHs play an integral role in Washington’s MTP efforts. Although MTP 1.0 was Medicaid-focused, ACHs are working in many ways to improve the health of their communities as a whole. Learn more about ACHs.
Why the focus on Community-Based Care Coordination?
MTP 2.0 is more prescribed in its structure and its scope is narrower. MTP 2.0’s theme is “Taking action for healthier communities.” In part, it will accelerate care delivery and payment innovation focused on health-related social needs (HRSNs) and equity through:
- Community-based care coordination hubs – aka “Community Hub”
- Community-based workforce
- Funding for Health-Related Social Needs Services (HRSNs)
- Statewide Tribal Hub (led by HCA)
- Re-entry for short-term pre and post release services from corrections settings
- Health Equity programs (TBD)
ACHs’s roles are now focused on building and serving as regional Community Hubs that deliver case management services and health-related social needs (HRSN) benefits to the community. Community Hub funding will support capacity building for delivery of services provided by contracted Case Management Partners and HRSN service providers.
What is the GHN Community Hub?
Under MTP 2.0, a Community Hub is a community-centered entity that organizes and supports a collective of Hub Case Management partners providing case management services and connecting people to health-related social needs services and benefits. Its key functions include supporting:
- Community voice and engagement
- Sustainability and business operations
- Funding for Health-Related Social Needs Services (HRSNs)
- Care coordination operations and reporting
- Network management and capacity building
- Community-based workforce support
A hub is an administrative entity that centralizes administrative and operational functions/infrastructure including:
- Contracting with Case Management Partners
- Payment operations
- Managing and assigning referrals
- Service delivery compliance
- Technology infrastructure
- Information security
- Data collection and reporting
- Training/TA/QI support
GHN’s Hub includes community-based and clinical organizations, and agencies that receive referrals from the Hub to provide care coordination services to community members. The Hub honors and leverages the capacity of local community-based and healthcare organizations to provide culturally responsive services to community through a workforce that reflects the diversity of the community.
The GHN Community Hub is a centralized (but not single) place of coordination for referral to community-based resources. The Hub will provide warm handoffs to connect people to clinical care when needed, in partnership with Managed Care Organizations (MCOs) for their Medicaid enrollees.
What services does the Community Hub provide?
The Hub’s services are divided into two main categories:
Case Management
- Resource navigation
- Referrals to meet health-related social needs (HRSNs)
These services are the core of community-based care coordination. Case management services are available for everyone, regardless of their Medicaid eligibility.
Health-Related Social Needs Benefits
- Payment from Medicaid for a service that meets a clinically indicated health related social need for a defined population.
The populations, services, and protocols for HRSN benefits are still being finalized by HCA. Examples of the types of potential HRSN benefits in MTP 2.0 include the following:
- Nutrition supports (including medically tailored meals, nutrition counseling, health meal prep, pantry stocking, short-term grocery delivery).
- Housing supports, such as recuperative care and short-term post hospitalization housing, housing transition navigation services and deposits
- Community transition services (including non-medical transportation and personal care/homemaker services)
- Stabilization center
- Caregiver respite services
- Medically necessary environmental accessibility and remediation adaptations (home repairs)
How is MTP 2.0 different from 1.0?
MTP 2.0 is more prescribed in its structure and its scope is narrower. MTP 2.0’s theme is “Taking action for healthier communities.” In part, it will accelerate care delivery and payment innovation focused on health-related social needs (HRSNs) and equity through:
- Community-based care coordination hubs – aka “Community Hub”
- Community-based workforce
- Funding for Health-Related Social Needs Services (HRSNs)
- Statewide Tribal Hub (led by HCA)
- Re-entry for short-term pre and post release services from corrections settings
- Health Equity programs (TBD)
ACHs’s roles are now focused on building and serving as regional Community Hubs that deliver case management services and health-related social needs (HRSN) benefits to the community. Community Hub funding will support capacity building for delivery of services provided by contracted Case Management Partners and HRSN service providers.
What are Health Related Social Needs (HRSNS) and why are they important?
Health Related Social Needs (HRSNs) refer to the social and economic needs people experience that affect their ability to maintain their health and well-being. They include things like housing instability, food insecurity, employment and income, lack of transportation, and more.
HRSNs differ from the Social Determinants of Health (SDoH), which are the social and economic conditions in which people grow, work, play, live, worship and age, that contribute to health and quality of life outcomes. These conditions are shaped by distribution of money, power, and resource and are related to factors like institutional bias, discrimination, structural racism, and more.
HRSNs can be understood as more immediate individual or family needs stemming from SDOH. By addressing HRSNs and SDoH, we can advance health equity and reduce health disparities, which are core to GHN’s mission. It can also reduce health care utilization and costs. The Community Hub will provide case management services addressing HRSNs to anyone that needs help and assistance. Medicaid enrollees may be eligible for specific HRSN benefits depending on their diagnosis and treatment plan.
Who will the Hub serve?
Rooted in an equity-centered model, the Community Hub will serve the whole GHN area through case management services, moving beyond just the Medicaid population. We recognize that many communities aren’t Medicaid eligible but still have a need for care coordination/case management support, and people cycle on and off Medicaid. The Hub provides a “no wrong door” approach that is consistent with GHN’s values.
In serving our whole community including the full Medicaid population, GHN provides support and services that cater to diverse populations based on age, race/ethnicity, and preferred languages. Community members can enter the Hub through a case management partner organization to ensure cultural and linguistic appropriateness.
What don't we know yet about MTP 2.0?
Greater Health Now is currently waiting on further details from HCA and CMS regarding the following items:
- As of now, we do not know which HRSN benefits will be approved and for which specific populations (to be determined using a phased approach).
- Mechanisms by which care coordinators and/or the Hub can verify clinical indication for HRSN benefits.
- How GHN will be able to resource organizations for infrastructure needed to participate as a Hub Case Management Partner.
- The structure of the contracts for Case Management Partners, as well as performance metrics expected to be achieved.
- How the re-entry program will be structured and administered (2025).
We will update this FAQ as we learn more about each of these items and include updates in our outreach and engagement opportunities.