Tracy Washington Enger, M.S. Indoor Environments Division U.S. Environmental Protection Agency Building on the Momentum

The Calling Heroic Journey 2

Answering the Call 3 Equip health, housing, environmental and health insurance programs to effectively support the delivery, infrastructure and/or sustainable financing of environmental asthma interventions at home and school.

Poor and Minority Children Have a Greater Asthma Burden 4

Asthma Prevalence Among Children Percent of total U.S population of 0-17 year olds (2013) 5 Source: CDC/NCHS, National Health Interview Survey,

Federal Efforts to Combat Asthma Disparities 6 May 2013 Foundation: Effective asthma care must be comprehensive & address the environment & self management skills Focus: Environment, in-home asthma care, local capacity

Key Considerations for Securing Sustainable Financing 7 Delivery Provider – Community Health Worker – Nurse, RT, other licensed practitioner Program Components – Education – Environmental assessment – Intervention/Remediation Community Support System & Infrastructure – Link with clinical care – Connection to housing & environment programs  Population served  Program Outcomes & Return on Investment

The Role of Medicaid 8 Source: ahrq.gov, 2005.

Stakeholders Who Drive Change within State Medicaid Programs 9 Key Interests Represented People paying for services State Medicaid/Legislature Health Plans People delivering services People supporting and driving change Regional health, housing and environment

Our Approach: Securing Sustainable Financing for In-Home Asthma Care Services 10 Equip 300 health, housing, environmental and health insurance programs to effectively support the delivery, infrastructure and/or sustainable financing of environmental asthma interventions at home and school. Influence Health Plans, State Medicaid & Key Stakeholders Equip Programs to Act

Federal Agencies Working to Expand Access to In-Home Asthma Care Services 11

12 Communities in Action

Financing In-Home Asthma Care Resources are bucketed for ease of use and to highlight key topic areas.

Financing In-Home Asthma Care

Understanding Sustainable Financing Options Financing In-Home Asthma Care Bringing multiple streams of funding together to cover the full spectrum of in-home asthma care is often referred to as "braided funding." The illustration here represents ways that funding for home-based asthma care services can be combined to cover critical in-home asthma care needs.

16 Promote coverage of in-home asthma care services by Medicaid programs and private insurers (summits held in: Cleveland, Kansas City, Baltimore, Denver, Philadelphia and Los Angeles. HUD lead with assistance from EPA, CDC, and HHS Asst. Sec for Health. EPA is active collaborator and participant (highlights work from “local champions” and organizations that have made progress on the issue). Materials from summits are posted on EPA’s Asthma Community Network website: ences/ ences/

Call to Action 17 “One thing I have found is that in health care, you don’t get the kind of health care that science dictates or that is even economically prudent. You get the health care that you negotiate and that is politically motivated….We can do it. It’s economically sensible to do. We just haven’t had the political will.” A. Thomas McLellan, Co-founder of the Treatment Research Institute Speaking in “All Things Considered” February 25, 2016

What is Your Calling? What is it you are called to do? Whom are you called to serve?

 Open to Assuming a leadership role in changing the landscape for Asthma  Aggressively implementing effective, financially sustainable in-home interventions  Seeking out and sharing best practices and transformative results  Focused on Committing to Actions You and Your Organization Can Take NOW  Leaders in Service to One Another  PRESENT! How to “Be”

What does it mean to be “Present”? Present- I am here Present- In the moment Present – A gift Presence – I am here, in the moment as a gift.

Reasons Why We Cannot Do It What We Can Do to Reach The Goal Source: Enlightened Leadership Institute Net Forward Energy: More Positives Than Negatives