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August 15, 2016
Home interventions to remediate many of the housing conditions that trigger asthma are proven, evidenced-based and cost effective. Interventions are recommended by the foremost authority on asthma care in the country, the National Asthma Education and Prevention Program’s Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR-3). Yet few state Medicaid programs cover home intervention services, despite their efficacy at preventing asthma episodes in children. Last month, the American Lung Association (ALA) released results of its Asthma Care Coverage Project that tracks state Medicaid programs’ coverage of asthma care. GHHI was asked to be part of the advisory group for the project and provided expertise on environmental asthma trigger reduction. The results found that out of 23 states surveyed, only four (4) states covered home visits and interventions without barriers. Three (3) states had coverage but with barriers, another six (6) states had some coverage but barriers were not necessarily always present, and ten (10) states had no coverage for home visits (see map).
ALA looked at seven categories of evidenced-based asthma care management as defined by EPR-3’s Guidelines and similar expert documents, including the Guide to Community Preventive Services. In the category of ‘Home Visit and Interventions’, a state was considered covered if there was a low-intensity service that had two of three components (education, assessment, or intervention), and addressed either integrated pest control or two other asthma triggers (smoke, mold, pets, dust mites, VOCs, combustion sources) This means that even if a state does not conduct interventions, such as carpet removal, venting of bathrooms, or water infiltration repair, it can still be rated as having home visits and interventions covered.
Even with this relatively low bar, in the 23 states that were part of the study, only four (4) states covered home visits and interventions without barriers. (ALA first studied the 23 states that had CDC-supported state asthma programs, and will be looking at the remaining states this fall.)
For a condition as prevalent and serious as asthma, causing over 3,000 deaths each year, these findings are unacceptable. Home interventions are proven, evidenced-based, and cost effective. GHHI’s study, Improving Health, Economic and Social Outcomes Through Integrated Housing Intervention as published in Environmental Justice in 2014, found that home interventions reduced asthma-related hospitalizations by 65 percent and emergency room visits by 27 percent. The Guide to Community Preventive Services found that home interventions have a $5.3 to $14 return for every $1 invested. In GHHI’s work around the country, we’ve found that the greatest barrier to covering these home interventions is the perception that services are not “medical care”. But should states leave millions of Americans without adequate care coverage because of misperceptions?
We do see promising developments that may herald Medicaid coverage for home interventions. GHHI is working in ten states to move the bar forward, and is in the midst of discussions on how more comprehensive home services to address asthma fit within the movement in Medicaid toward value-based payments. The purpose of the ALA study is to gather information so that states will move toward covering every part of guidelines-based care.
 The seven categories are: Quick relief medications, Controller medications, Devices, Allergen testing, Allergen immunotherapy, Home visit and interventions, Self-management education