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American Lung Association Asthma Guidelines-Based Care Initiative

Sponsoring Program Name: 
American Lung Association, Centers for Disease Control and Prevention

In 2015, the American Lung Association received a competitive award from the Centers for Disease Control and Prevention’s (CDC) National Center for Environmental Health to track asthma guidelines-based care in state Medicaid programs for the 23 CDC-funded National Asthma Control Program states. As part of this project, a group of key stakeholder organizations was convened to discuss key components of guidelines-based asthma care coverage for state Medicaid programs. 

 

This document defines benchmarks for asthma guidelines-based care for seven different criteria, which, if covered, together encompass key elements of the NAEPP EPR-3 guidelines, Community Guide and other relevant guidelines. Throughout the document, common barriers to care are cited as an impediment to guidelines-based care.

 

To conduct this review, ALA conducted its own primary research (publicly available) to determine state Medicaid program coverage for comprehensive asthma guidelines-based care. This research includes reviewing Medicaid State Plans and State Plan Amendments (SPA), formularies, preferred drug lists, member handbooks, provider manuals and any other related documents for each state Medicaid program. If the program has managed care plans, the process is repeated for each individual managed care plan and the data from each plan is then combined and interpreted to determine the overall coverage value.

 

Source List:

http://www.lung.org/assets/documents/asthma/asthma-care-coverage-master-source-list.pdf

All health plans are listed in each state along with links to member documents.

 

Database of State Coverage and Maps by Criteria:

http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/asthma-education-advocacy/asthma-care-coverage/database/

 

State Medicaid Coverage Map of Home Visits:

http://www.lung.org/assets/documents/asthma/6-Home-Visits-Map.pdf

Covered without barriers: CT, MA, OH, RI

Covered with barriers: ME, NH, WI

Some coverage: FL, GA, IN, MI, MN, OR

No coverage: CA, HI, IL, MO, MT, NM, NY, PA, UT, VT

Data on remaining states and D.C. not yet available

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