Wraparound Milwaukee, Wisconsin is a county-based managed care program operating with a blended funding pool. Medicaid, child welfare, juvenile justice and mental health agencies all contribute resources. Medicaid pays on a capitated basis, the other agencies pay case rates. Thus each agency knows the cost of services to children it refers to the system.
Vermont has operated a braided funding system for the past 15 years, using child welfare, juvenile justice, mental health and special education funds to develop innovative community-based treatment plans for children, adolescents and their families with the most intensive and complex needs. For the past 10 years, mental health, juvenile justice and child welfare have blended funds to operate a comprehensive immediate- response system in each of the 12 regions of the state.
Michigan, in 17 counties, uses a case-rate and wraparound approach to blend funding from mental health, juvenile justice, child welfare and education to serve children with serious mental or emotional disorders. Funding is separately tracked for accounting purposes, but at the child-family level the source of appears to be a single pool.
New Jersey, in a new statewide initiative, combines blending and braiding approaches. The payment source for a specific service is unknown to providers and families, who see only a flexible pot of funds available for the child’s services. The state contracts with an administrative services organization to address payment issues and to support individualized service planning at the local level. The ASO identifies the payment source for each identified service or support for the child and family. This is facilitated through the creation of a single electronic record. Funds for the initiative (Medicaid and non-Medicaid funds) are held by the state Medicaid agency and the Medicaid agency handles all reimbursement through its existing financial management system.
The Dawn Project in Indiana has braided funds from mental health, special education, child welfare and juvenile court to create a case rate paid per member per month to be used flexibly by providers in the system to finance an individualized and comprehensive plan of care for each child and family. Agencies contribute to the case rate based on established eligibility criteria. The project uses clinical-management software which can integrate clinical and fiscal data. These data are used to handle cost approval and analysis and claims adjudication.