CMS Launches ASPIRE, a Value-Based Medicaid Pilot for Pediatric Complex Care

Overview

• CMS, which announced the ASPIRE Model on Tuesday, set aside $125 million for a 10-year pilot that will select up to five state Medicaid agencies.
• The program targets children and youth up to age 21 with complex medical or behavioral needs or risks, a group that Medicaid and CHIP cover at about half of the national total.
• State awardees must run a 24/7 clinical advice line so caregivers have one point of contact who can view a child’s records and give real-time guidance.
• Awards can be used over eight years to coordinate physical and behavioral care with community supports and to expand wraparound services and needed infrastructure.
• Building on the InCK pilot that ends this year, ASPIRE shifts pediatric Medicaid toward value-based pay with team incentives, and applications will open later this year.