This commentary tells the story of Alicia, a pregnant woman looking for maternal support while incarcerated and pregnant with her second child. Thanks to Medicaid, she was assigned a doula who guided her through the rest of her pregnancy and the birth of her son.
This update to the methodology documentation for the Urban Institute’s Health Insurance Policy Simulation Model explains how they estimated health coverage in 2023, taking into account major uncertain issues such as Medicaid enrollment after the HHS public health emergency and the potential expiration of enhanced premium tax credits for Marketplace coverage in 2023.
This page provides communications resources designed to support states as they prepare for the various stages of work needed to inform stakeholders and consumers about the upcoming end of the Medicaid continuous coverage requirement. The end of the Medicaid continuous coverage requirement presents states with tremendous opportunities to keep individuals enrolled in Medicaid or transition to another form of health coverage.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period. (Under the Families First Coronavirus Response Act, Medicaid enrollees who typically lose coverage after 60 days postpartum cannot be disenrolled until the end of the month in which the public emergency period ends.)
This toolkit is designed to help state and local WIC agencies leverage data from Medicaid and SNAP to measure enrollment gaps and increase enrollment using tools to plan, launch, and/or strengthen data matching and targeted outreach to eligible families who are not receiving WIC benefits.
Broker Commissions for Mid-Year Enrollment in the Marketplaces: Options for State Marketplaces and Insurance Regulators to Prevent Discrimination
At the end of the Pubic Health Emergency, more than 15 million people may become uninsured if they cannot secure alternate sources of health coverage. This blog provides actions states should carefully consider to ensure that stakeholders, including insurers, are facilitating these critical transitions.
This blog explores how states can work with The Program of All Inclusive Care for the Elderly (PACE) and its organizations to provide a comprehensive, fully integrated package of Medicare and Medicaid services to elderly individuals who require a nursing home level of care.
This blog answers questions about the ACA's "family glitch," a flawed regulatory interpretation that has created barriers to coverage. The current administration is currently working to correct this interpretation that prevents 4.8 to 5 million individuals from accessing more affordable health insurance.
Mitigating Coverage Loss When the Public Health Emergency Ends: The Role of the Affordable Care Act Marketplaces
This blog discuss the important role that ACA marketplaces will play in mitigating coverage losses as they prepare for the end of the Public Health Emergency and identifies basic as well as more innovative strategies marketplaces can adopt to help consumers make a smooth transition to affordable, comprehensive coverage.
This blog explores how states are working to prepare for the end of the Public Health Emergency with the goal of modernizing benefits access to Medicaid, SNAP, and WIC rather than returning to pre-pandemic practices.
This toolkit is intended to assist state officials in evaluating their current estate recovery policies and understanding where they may have flexibility to make the policies less burdensome for affected low-income families.
A cost-growth benchmark program is a cost-containment strategy that limits how much a state’s health care spending can grow each year. This chart provides a snapshot of programs across the country including state efforts to improve care quality and outcomes in the program.
This blog provides model comments developed to inform and support state responses to the Centers for Medicare & Medicaid Services' RFI to achieve substantial reforms on access to coverage–namely, the processes for enrollment and eligibility redeterminations.
This interactive map summarizes state Medicaid reimbursement policies for all types of midwives including certified nurse-midwives and midwives who pursue alternative pathways to licensure, often referred to as certified professional midwives, certified midwives, or direct entry midwives depending on state regulations.
This commentary tells the story of Nicholas who requires some extra assistance with daily activities as a result of his autism. Medicaid helps afford all of his caretakers and provides him with transportation to and from his job as a COVID-19 front-line worker.
Understanding the Undercount of Medicaid Enrollees in the 2020 Current Population Survey Health Insurance Coverage Data
This blog, briefly reviews the research regarding the Medicaid undercount in the CPS, provides estimates of how it varies across states in 2020, and discusses the impact of assigning single coverage for those with multiple sources on the Medicaid undercount in the CPS.
This commentary tells the story of Margot C., who has limited mobility due to rheumatoid arthritis, fibromyalgia, and a spinal cord injury. Medicaid provided her housing in a residential care setting that her private insurance could not provide. Now, Margot helps her peers sign up for Medicaid.
This brief reviews the regulatory framework for network adequacy for Medicaid Managed Care Organizations and Marketplace qualified health plans and identifies policies and practices to ensure their networks include the number and mix of providers that enrollees need.
This commentary tells the story of Maddy K., a 23-year-old who has Asperger syndrome who is able to work two part-time jobs, volunteer frequently, and be part of a community organization for those with disabilities because of Medicaid's ability to provide her with essential transportation.
This blog explores strategies on how to invest in the development of Medicaid leaders to help states and territories improve the health and well-being of people served by publicly financed care.
Key tips include:
Always have a plan b, plan c, and plan d.
Build relationships and find a common thread.
Fill the void.
The Doctor Will Hear You Now: Audio-Only Telehealth and the Promise of Access, Equity, and Engagement in Medicaid
This commentary tells the story of Andre H., who after turning 23 was no longer able to afford medication and proper care to treat his sickle cell disease. After receiving Medicaid, he no longer had to choose between paying rent or buying the medication that keeps him alive.
Bolstered by Recovery Legislation, the Health Insurance Safety Net Prevented a Rise in Uninsurance between 2019 and 2021
This brief analyzes data from the National Health Interview Survey, the Current Population Survey, and the Health Reform Monitoring Survey to explore trends in coverage status and type between early 2019 and early 2021.
This blog summarizes key takeaways laid out in the new CMS guidance related to timelines and operational strategies states can leverage to mitigate churn when the federal Medicaid continuous coverage requirement ends.
This blog provides takeaways from the Massachusetts One Care Program, highlighting the impact of engaging members with disabilities in care planning and strategies that health systems and payers can use to advance health equity through improved engagement with people with disabilities.
This commentary tells the story of Dominique G., who spent most of her life in hospitals due to sickle cell disease. Medicaid coverage provided her regular hematologist visits, appropriate equipment and medications to make living at home possible.
This Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through November 2021 and enrollment detail by state across four eligibility categories:
Children (including those enrolled in CHIP)
Aged, blind, and disabled individuals
This brief projects Medicaid enrollment for the population under age 65 and federal and state Medicaid spending for 2022 and 2023, assuming the PHE is extended through the first, second, or third quarters of 2022.
This Blog explores Oregon's new kindergarten readiness incentive metric in its Medicaid program focused on social-emotional health to help solidify the connection between a child’s health and their success in school and beyond.
This report examines existing data and research to comprehensively describe the scope and prevalence of obesity and available obesity treatments in the US covered by fee-for-service Medicaid, Medicaid managed care, state employee health plans, and state essential health benefits benchmark plans.
This commentary tells the story of John and Bernie, who both turned to Medicaid after losing their jobs. Medicaid coverage gave Bernie access to needed medical care following a heart attack and provided John with coverage after he broke his leg.
This blog explores a set of primary care standards to help states explicitly make health equity a focus of primary care standards and incentivize practice-level activities aligned with broader state health equity goals.
Adoption of Value-Based, Alternative Payment Models: Where Are We Today and Where Do We Go from Here?
This blog explores value-based, alternative payment models as employer-sponsored health insurance costs have increased by 6.3 percent in the United States since 2010, with additional increases projected.
Tracking Medicaid Coverage Post the Continuous Coverage Requirement: Using Data Dashboards to Monitor Trends
This issue brief examines the current status of data collection to assess Medicaid enrollment and retention, summarizes potential forthcoming reporting requirements, and describes some of the best practices states should consider when developing a data dashboard to display this type of information.
Stratifying Data and Implementing Financial Incentives: How States Are Leveraging Medicaid Managed Care to Further Health Equity
This blog provides Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality initiatives, and procurement processes, to promote health equity and address health disparities.
Text Messaging: An Important Communication and Outreach Strategy as States Unwind the Federal Medicaid Continuous Coverage Requirement
This blog explores text messaging as a mechanism for outreach for state Medicaid and Children’s Health Insurance Program (CHIP) agencies to directly contact Medicaid and CHIP enrollees and communicate important information.
This blog examines some of the key factors and decision points states may want to consider as they build out mobile mental health crisis services and systems that qualify for enhanced federal medical assistance percentage funding; engaging a cross-agency team and a broad range of external stakeholders can help ensure full consideration of diverse state crisis needs.
This blog summarizes a phased set of priority measures and provides a model enrollment and retention dashboard template that states can use to monitor both the short-term impacts of phasing out public health emergency protections and continuous coverage requirements, as well as longer-term enrollment and retention trends.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.
This blog examines the Centers for Medicare and Medicaid Services' newly released State Health Official letter providing guidance on the scope of and enhanced payments for qualifying community-based mobile crisis intervention services for Medicaid enrollees experiencing a mental health or substance use disorder crisis.
Federal Declarations and Flexibilities Supporting Medicaid and CHIP COVID-19 Response Efforts Effective and End Dates
This chart summarizes temporary Medicaid and CHIP flexibilities enacted by the federal government to help states respond to the ongoing COVID-19 pandemic. The chart includes effective dates and expiration dates as dictated by law or agency guidance.
This blog post sheds light on how Pennsylvania has taken steps to better understand how to mitigate the racial bias by collecting information on how Medicaid Managed Care Organizations are using algorithms, the types of proxies being used, and the outcomes as a method to develop their health equity strategies.
This extensive report provides a communications planning guide and template communications resources designed to support state Medicaid agencies as they prepare for the upcoming end of the continuous coverage requirement.
This blog examines how state officials are actively planning for the eventual end of the Medicaid continuous coverage requirement that is currently associated with the federal COVID-19 public health emergency and enhanced federal Medicaid matching funds.
This commentary tells the story of Chrystal, who turned to Medicaid for health coverage during her time as a full time student in Milwaukee. Without Medicaid Chrystal would have been unable to afford the inhaler she needed to protect her from asthma attacks and medical appointments for her general well-being.
This commentary tells the story of Tania, who through Medicaid not only receives mental health care but is also approved to visit specialists who care for her autoimmune disorder, something that would be unaffordable otherwise.
This brief features key considerations for state policy makers for leveraging federal funds through the American Rescue Plan Act including: Maximizing and aligning Medicaid and other funding sources; Sustaining new crisis capacity; Providing crisis services in rural areas; Addressing endemic workforce challenges; Sharing data; and investing strategically.
This blog post describes how the COVID-19 pandemic has created historically large disruptions to the economy and health insurance coverage at a time when having access to health care is especially important.
Three in 10 Adults in California Immigrant Families with Low Incomes Avoided Safety Net Programs in 2020
This report examines how many immigrant families have avoided safety net and pandemic relief programs in recent years over concerns that their participation would have adverse immigration consequences.
In the Years before the COVID-19 Pandemic, Nearly 13 Million Adults Delayed or Did Not Get Needed Prescription Drugs Because of Costs
This brief explores how nearly 13 million adults delayed or did not get needed prescription drugs in the past year because of the cost, including 2.3 million elderly Medicare beneficiaries and 3.8 million nonelderly adults with private insurance, 1.1 million with Medicaid, and 4.1 million who were uninsured at any point during the year.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.
This report offers four recommendations for policymakers to integrate individuals with lived expertise as partners in program and policy design, implementation, and evaluation to more effectively address food insecurity.
Conceptualizing Performance Measurement for Social Care Interventions: An Issue Brief for State Medicaid Agencies
This issue brief explores opportunities for state Medicaid agencies to implement performance measures with contracted care entities that could strengthen their growing interest in social care and highlights several barriers to those applications.
This map features how states are using these one-time funds to support transitions from institutional settings into the community through housing navigation, employment placement, assistance with transition costs and other social determinant supports, as well as by investing in affordable and accessible housing for home-and community-based services populations to remain within the community.
The brief focuses on actions Medicaid agencies can pursue through their managed care programs or directly with provider organizations and highlights state interventions and collaborations that demonstrate promise in reducing disparities and begin to center equity in birth-related health policies.
This webinar provide an overview of strategies for states seeking to ensure that eligible enrollees are able to keep or transition to new affordable health coverage when the Medicaid continuous coverage requirement ends.
New Spending from Filling the Medicaid Coverage Gap Outweighs Cuts in Disproportionate Share Payments
This report estimates increases in federal subsidies under two provisions of the Build Back Better Act that would flow to people below the federal poverty limit in the 12 states that have not expanded Medicaid (people in the “Medicaid gap”).
They’re Not Just “Little Adults” ― Value-Based Payment Models that Include Children Must Focus on Their Needs
This brief highlights a Nevada program that aims to target oral health care gaps among children who rely on school-based sealant programs to prevent dental decay, the most common chronic condition among children.
Cross-Agency Partnerships for Health Equity: Understanding Opportunities Across Medicaid and Public Health Agencies
This brief examines how state Medicaid and public health programs can advance health equity for the communities they serve, especially for people of color, working both within their agency and through cross-agency partnerships.
This commentary tells the story of Adrian, who serves as an assistant director at the Hattiesburg, Miss., office of Youth Villages and oversees the Medicaid-funded Mississippi Youth Programs Around the Clock (MYPAC) effort, which currently has more than 500 people enrolled throughout the state.
State Policy and IT System Strategies to Prepare for PHE Unwinding: Updating Medicaid Enrollee Address Information and Responding to Returned Mail
This brief examines the information technology system, policy, and operational strategies states can consider to update key enrollee contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage at the end of the public health emergency.
The End of the COVID-19 Public Health Emergency: Data and IT “Table Stakes” for Retaining Coverage Gains
This issue brief reviews state Medicaid/Children's Health Insurance Program agency data and information technology system “table stakes”—strategies that will have the highest impact for states seeking to ensure that eligible enrollees are able to keep or transition to new affordable health coverage when the Public Health Emergency continuous coverage requirements end.
This issue brief presents a sustainable, hybrid coverage and funding approach for mobile crisis services in light of the new federal funding opportunities for states to improve access to behavioral health crisis services.
How Did the Affordable Care Act Medicaid Expansion Affect Coverage and Access to Care for Low-Income Parents Who Were Eligible for Medicaid Before the Law Was Passed?
This journal article assesses the impact of the Affordable Care Act (ACA) Medicaid expansion on coverage and access to care for a subset of low-income parents who were already eligible for Medicaid when the ACA was passed.
This brief explores how states propose using American Rescue Plan Act funds to bolster the workforce that provides home- and community-based services, including increasing reimbursement rates, providing new opportunities for professional advancement, and offering recruitment and retention incentives.
This report finds that generous funding to support policies related to home- and community-based services (HCBS) eligibility, caregiver wages, and services could drastically improve the lives of people in need and the workers who serve them.
This commentary presents strategies for state-based marketplaces to improve consumer outreach, provide enrollment assistant and clearly communicate with consumers with what health coverage options are available for them in 2022.
Building State Capacity To Facilitate Equitable Access To Testing And Treatment For HIV, Viral Hepatitis, STDs And TB
This paper includes considerations and approaches to promote equity and improve public health capacity to prevent, detect and respond to HIV, viral hepatitis, STDs and TB during the public health emergency and beyond.
This report provides updated excerpts of health disparities and health equity language from Medicaid managed care contracts and requests for proposals from 15 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California.
This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.
Engaging Families in Program and Policy Development to Ensure Equitable Health Outcomes for Children
This blog post explores seven key considerations for health care organizations, Medicaid programs, and advocacy organizations to facilitate family engagement in program and policy design and implementation.
This blog examines how states and other stakeholders have another chance to weigh in on Tennessee’s 10-year Medicaid funding demonstration which was approved by the Centers for Medicare & Medicaid Services in early January during the final days of the Trump administration.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.
This op-ed, authored by David Schaefer of the Georgia Budget Policy Institute, argues that closing the Medicaid coverage gap in Georgia will also increase access to health care and strengthen health infrastructure in rural communities.
Op-Ed: Kansas legislators should follow the will of their constituents. It’s time to pass Medicaid expansion.
This blog post outlines the potential coverage gains, state cost savings, and improved health outcomes that would occur if the remaining 12 nonexpansion states extending their Medicaid programs in accordance with the Affordable Care Act.
The blog highlights updates to a compendium providing Medicaid agencies with examples of how different states are leveraging their managed care programs, inclusive of contracts, quality programs, and procurement processes, to promote health equity and address health disparities.
States Use Appendix K and Emergency Waivers to Support Home- and Community-Based Services in Response to COVID-19
This National Academy for State Health Policy’s Appendix K interactive map, supported by The John A. Hartford Foundation, tracks each state’s new flexibilities in modified 1915 (c) and 1115 waivers and includes information about flexibilities in COVID-19 Public Health Emergency Demonstration 1115 waivers.
Explore Physician Acceptance of New Medicaid Patients through Two New Measures on SHADAC’s State Health Compare and in a New MACPAC Factsheet
This report highlights key findings from a survey, interviews, and literature scan to identify pathways to Medicaid leadership positions, challenges, and opportunities for developing a more diverse pool of future Medicaid executives, and the skills necessary to succeed in these roles.
This blog examines how Minnesota’s Medicaid expansion was a crucial resource during the COVID-19 pandemic for those who lost their jobs and/or their employer-sponsored health insurance coverage. It is estimated that approximately 29,500 Minnesotans lost their private health insurance coverage between April 2020-July 2020.
This podcast talks about the COVID-19 pandemic, ensuing recession, and amplification of issues related to health equity that have forced state Medicaid agencies to evaluate their budgets and investments to better serve Medicaid enrollees.
This brief examines how enrollment gains in public insurance helped offset declines in employer-sponsored insurance during the COVID-19 pandemic. Unlike previous recessions, the uninsurance rate did not change.
This commentary explains how increased flexibility in the delivery and payment of telehealth across many coverage programs, but particularly in Medicaid and CHIP, throughout the COVID-19 pandemic has been a significant shift for some states. Many state officials are considering if and how to adapt rapidly implemented telehealth policies as the nation emerges from the public health emergency.
This report assesses racial disparities in the quality of inpatient care using 11 patient safety indicators that measure rates of adverse patient safety events of hospital-acquired illnesses or injuries.
This commentary explains the federal government’s goal of reducing new HIV infections by 90% by 2030, the CDC has identified two policy strategies that states can employ for HIV prevention – provision of Pre-Exposure Prophylaxis medication and availability of Syringe Service/Exchange Programs.
This commentary examines how Washington implemented the nation’s first public option for the 2021 plan year and in the first six months of 2021, states made significant progress in advancing public option proposals, with public option legislation advancing in Colorado, Nevada, and Oregon.
This commentary examines how recent approval of the Alzheimer’s drug Aduhelm under the U.S. Food & Drug Administration’s Accelerated Approval Program is controversial for a range of reasons, including its projected impact on state Medicaid budgets which will be required to cover the drug, priced at $56,000 a year, despite inconclusive evidence of its clinical effectiveness.
This commentary analyzes how the U.S. Departments of Health & Human Services and Treasury have released a proposed rule governing the Affordable Care Act health insurance marketplaces and insurance standards for the plan year 2022.
This chart details the amounts and required oversight of COVID-19 federal funds allocated to hospitals, providers, and states by the Families First Coronavirus Response Act (Families First Act), the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Paycheck Protection Program and Health Care Enhancement Act (HR 266), the Consolidated Appropriations Act, 2021, and the American Rescue Plan Act of 2021.
This commentary explains that on June 17 the Supreme Court decisively rejected California v. Texas, the latest lawsuit before the Court that challenged the legality of the Patient Protection and Affordable Care Act of 2010.
This commentary explains how Medicaid leaders have significant opportunities to impact the health and well-being of millions but must balance a myriad of federal and state priorities related to fiscal stewardship, quality assurance, program integrity, and more.
This podcast discusses how People who live in rural areas often experience health disparities caused by barriers to health care, such as lack of transportation, a shortage of providers, and closures of rural hospitals.
State Opportunities to Strengthen Home and Community-Based Services through the American Rescue Plan
This blog examines how the The American Rescue Plan of 2021 (ARP) — signed into law on March 11, 2021 – provides states with a one-year, 10 percentage-point increase to the federal medical assistance percentage (FMAP) for Medicaid expenditures on home and community-based services (HCBS) for children and adults.
This blog outlines the Center for Health Care Strategies' recent interview with internist and pediatrician Nathan Chomilo, MD, Medical Director of Minnesota Medicaid and MinnesotaCare to get his perspectives on priority opportunities for addressing health equity for people served by the state’s Medicaid program.
This updated brief describes the American Rescue Plan Act’s home and community-based services enhanced federal medical assistance percentage (FMAP) provision, CMS’s recent implementation guidance, and considerations and next steps for state policymakers.
Collection of Race, Ethnicity, Language (REL) Data in Medicaid Applications: A 50-state Review of the Current Landscape
This podcast features Lynnette Rhodes, executive director of medical assistance plans at the Georgia Department of Community Health, and Cindy Beane, commissioner at the West Virginia Bureau for Medical Services, discussing leadership challenges and successes they have faced in developing equitable vaccine distribution strategies and the status of their respective states’ vaccine rollout.
Supporting Early Development and Learning Amid the COVID-19 Pandemic: Early Childhood and Medicaid Panel Discussion
This report examines how the pandemic and related economic downturn affected the need for safety net supports; actions states are taking to mitigate the immense hardship the pandemic has caused; implications for racial equity; and challenges, opportunities, and questions facing state leaders.
Leveraging Medicaid to Support Early Childhood and Parental Mental Health Amid the COVID-19 Pandemic and Beyond
This commentary draws from examples of states participating in the Aligning Early Childhood and Medicaid program and additional states to explore strategies for leveraging cross-agency collaborations and strengthening Medicaid to support early childhood and parental mental health during the COVID-19 pandemic crisis and beyond.
Opportunities for Early Childhood Programs to Support the Well-Being of Families During COVID-19 and Beyond
This webinar is the second in a three-part webinar series focusing on opportunities for early childhood and Medicaid programs to better support families with young children in the current and post-pandemic environment.
Assessing the Fiscal Impact of Medicaid Expansion Following the Enactment of the American Rescue Plan Act of 2021
This report describes the American Rescue Plan Act's (ARPA) Medicaid matching rate provision and also assesses its fiscal impact for each of the states that have not yet expanded Medicaid, while comparing the available new federal dollars to the cost of expansion.
Post-ACA, More Than One-Third of Women with Prenatal Medicaid Remained Uninsured Before or After Pregnancy
This brief describes the American Rescue Plan Act's home- and community-based services federal medical assistance percentage increase provision, the requirements for states receiving the enhanced federal funding, and considerations and next steps for state policymakers.
This commentary features discussions with several state Medicaid officials to learn more about how their agencies—and specifically their Medicaid managed care organizations—are leveraging partnerships and data to advance their vaccination efforts.
This report outlines key factors for governors and state leaders to consider when balancing state budgets and making difficult decisions about funding Medicaid during the COVID-19 crisis and subsequent economic downturn.
Highlights from the Updated Medicaid Managed Care Contract Language: Health Disparities and Health Equity
This brief provides updates to Medicaid Managed Care Contract Language: Health Disparities and Health Equity, published by SHVS which includes excerpts from managed care contracts, procurement questions, and other policy documents from twelve states and the District of Columbia.
This series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity for health.
This webinar features discussions on how states can use performance rates and disparities analyses from Medicaid managed care programs in other states to determine where disparities are likely to exist in their own state and develop interventions.
This report provides excerpts of health disparities and health equity contract language from Medicaid managed care contracts and requests for proposals from 12 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California.
This commentary tells the story of Kaui, whose daughter's complex medical needs were covered by a Medicaid waiver that allowed the family to access a health aide, ventilator, and other essential care services.
This commentary tells the story of Jamie, whose daughter was born with a genetic syndrome that led to complex medical needs. Medicaid covers her daughter's health needs so that she is able to continue living at home with her family.
Leveraging Value-Based Payment Approaches to Promote Health Equity: Key Strategies for Health Care Payers
This report identifies six connected strategies to guide payers, including Medicaid agencies and managed care organizations, in developing equity-focused value-based payment approaches to mitigate health disparities at the state and local levels.
Estimating Current-Law Health Care Spending of Medicare Advantage Enrollees for Use in Microsimulation Modeling of Medicare Policies
This report describes a model estimating program spending and out-of-pocket spending by Medicare Advantage enrollees at the county level using plan-level and county-level data sources from the Centers for Medicare & Medicaid Services.
CMS Guidance to States on Resuming Public Health Program Operations Post the COVID-19 Public Health Emergency
This brief provides a high-level summary of the Center for Medicare and Medicaid Services guidance related to: (1) conducting redeterminations for Medicaid enrollees who were continuously enrolled; (2) terminating, or extending where appropriate, temporary flexibilities; and (3) developing a consumer and provider communication strategy.
This commentary explores Michigan’s efforts in improving access and adherence to asthma medications and devices, as well as promoting the use of evidence-based interventions to improve access to important asthma devices and services.
Amid the COVID-19 Pandemic, Medicaid Expansion is More Important than Ever, and Young Adults Would Gain the Most
This brief summarizes key learnings from conversations with 50 leaders of state Medicaid programs across 14 states about implementing strategies to improve consumer engagement in policy and program planning.
This commentary reviews the key features of the Community Health Access and Rural Transformation Model, an initiative of the Centers for Medicare and Medicaid Services, and outlines considerations for states.
This commentary tells the story of Aliyah. A college graduate and social worker in her mid-20s, spent part of her youth in the Louisiana foster care system, which allowed her to access Medicaid services.
This commentary tells the story of Chrystal. Medicaid was her only option for health coverage when she was a full-time student in Milwaukee, but she was almost denied it when her scholarships and education grants were counted as income.
This commentary tells the story of Maria. When her son Tyler was diagnosed with Sotos syndrome shortly after his birth, his parents signed up for Medicaid through assistance at the hospital and the program has supported him since.
This commentary tells the story of Brianna, who signed up for Medicaid in 2016 and was able to receive diagnostic procedures that eventually determined that she suffers from endometriosis and fibromyalgia.
This brief explores the ways in which various organizations worked together to improve access to and use of tobacco cessation benefits among Minnesota's Medicaid population with the goal of reducing commercial tobacco use in this population.
This brief provides an introduction to screening for social risk factors, the first step most states are taking through their Medicaid managed care programs to address how social determinants of health influence enrollees' health status and spending.
This blog describes some of the limited actions states may take to alleviate fiscal pressure due to the COVID-19 pandemic through the management of their contracts with Medicaid managed care organizations.
This commentary tells the story of Latrice, an early learning educator, and her daughter Makayla, who was born with heart complications. Medicaid serves as secondary insurance for the first year of Makayla's life.
This commentary examines the impact that recent postal delays, COVID-19-related housing and economic crises, and natural disasters have had on state Medicaid and Children’s Health Insurance Program agencies.
This webinar features experts reviewing examples of specific strategies states implemented between April and August 2020 to increase payments to providers in financial distress as a result of decreased health care utilization.
This report examines examples from two state Medicaid programs and a nonprofit quality measurement and reporting organization of the data sources used to identify patients’ social risk factors when risk-adjusting payments or measuring quality.
This commentary summarizes recent guidance from the Centers for Medicare & Medicaid Services on permitting health insurance issuers to provide certain premium rebates for 2020 and the conditions rebates must meet.
Considerations for State Medicaid and CHIP Agencies As They Prepare to Unwind COVID-19 Eligibility and Enrollment Flexibilities
This commentary explores how states have been required to make numerous changes to their eligibility and enrollment systems, operations, and policies, in order to comply with the enhanced Federal Medicaid Assistance Percentages.
This commentary recommends specific steps for state Medicaid programs to ensure state residents receive needed services during the COVID-19 pandemic, with a specific focus on Medicaid managed care organization (MCO) enrollees.
This commentary discusses how state Medicaid, children’s health insurance programs, and health insurance marketplaces prepare for an expected increase in demand due to COVID-19, an economic downturn and ensuing budget crises, and unpredictable federal relief efforts.
This brief highlights how Nebraska’s Medicaid agency and its Division of Public Health partnered to share antibiotic prescribing information between Medicaid claims and evaluation and management codes to determine where targeted education and outreach efforts were needed.
Ensuring Access to LTSS During COVID-19: Exploring a State Resource Guide Produced by Manatt Health and The SCAN Foundation
In this webinar, experts present key findings from a new COVID-19 state resource guide on federal and state Medicaid flexibilities and how they are being deployed to help ensure access to long-term services and supports.
Health Insurance Coverage Declined for Nonelderly Americans Between 2017 and 2018, Leaving Nonexpansion States Further Behind
SHADAC Article in Journal of Aging & Social Policy Urges States to Use COVID-19 Flexible Medicaid Authority for LTSS Eligibility
This journal article focuses on how state-level Medicaid program flexibility and emergency waivers can expand Medicaid financial eligibility for long-term supports and services for at-risk individuals.
An Early Look at State Budget Actions in Response to COVID-19 and the Impact on State Health Programs
This report provides excerpts of health disparities and health equity contract language from Medicaid Managed Care contracts from five states, Washington, D.C., and the contract for California’s Health Exchange, Covered California.
COVID-19 Catalyzing Health Center Payment Reform: Addressing the Financial Stability of the Primary Care Safety Net in Crisis and Beyond
This commentary provides an overview of CMS relief guidance and flexibility to state hospitals, facilities, and providers on reporting measures for value-based purchasing and quality reporting programs.
This webinar presented results from a financial model examining the Medicaid fiscal implications of the interaction between the COVID-19 pandemic, the emerging economic downturn, and recent policy changes.
This commentary gauges the potential effects on coverage and cost if public options become available in the country's health insurance exchanges, based on observations from a RAND COMPARE microsimulation model.
Uninsured New Mothers’ Health and Health Care Challenges Highlight the Benefits of Increasing Postpartum Medicaid Coverage
This report documents access and affordability challenges facing uninsured new mothers using 2015–18 data from the National Health Interview Survey (NHIS). It also uses 2015–17 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to describe the health status of women who lost Medicaid coverage following their pregnancies.
This report shows how the additional levels of unemployment insurance provided through the Federal Pandemic Unemployment Compensation program affects eligibility for subsidized coverage in expansion and nonexpansion states.
In this podcast episode, Ed O’Neil, PhD, MPA, a leadership development expert, speaks with Hilary Kennedy, program director for Medicaid leadership at the National Association of Medicaid Directors, about strategies Medicaid leaders can use to continue developing their staff at a distance.
Strategies for Supporting and Strengthening Medicaid Information Technology During the COVID-19 Crisis
This report outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, and to secure current and future IT investments that enable ongoing Medicaid program operations and advance health information exchange.
This webinar reviews potential information technology (IT) investments in responding to COVID-19 and strategies for states to support these investments to secure current and potential IT investments that enable ongoing Medicaid program operations and advance health information exchange.
This commentary provides an overview of strategies that states can consider to help address gaps in coverage to ensure as many people as possible get access to comprehensive care as the country continues to respond and recover from the COVID-19 health and economic crisis.
This brief provides an overview of Children Health Insurance Program (CHIP) Health Services Initiatives (HSIs) and identifies ways that states can leverage them as part of their targeted response to the COVID-19 pandemic.
Potential Eligibility for Medicaid, CHIP, and Marketplace Subsidies among Workers Losing Jobs in Industries Vulnerable to High Levels of COVID-19-Related Unemployment
This report estimates the extent to which workers in industries most vulnerable to pandemic-related unemployment and their family members would be eligible for Medicaid, the Children’s Health Insurance Program, or marketplace subsidies if workers lose their jobs.
This commentary discusses the states that have rapidly amended their Medicaid home- and community-based services for older adults and their family caregivers to ensure access to long-term services and supports during the COVID-19 crisis.
Valerie and her husband Christopher wanted to adopt two sons from foster care, both with challenging health conditions, but were not sure if they could afford the medical bills. Valerie learned both children were automatically covered by South Dakota Medicaid because of their time in foster care.
April was born with sickle cell anemia, a genetic blood disorder that is deeply painful and must be managed with proper medication. Medicaid covered April’s treatment and her electric wheelchair, which empowers her in her new everyday life.
This commentary discusses the use of Telemedicine during the COVID-19 pandemic. It summarizes the federal legislation and guidance and discusses actions state departments of insurance can take to encourage greater access to telehealth services.
This commentary includes some of the options available to states to ensure that individuals with complex medical conditions and their families have access to necessary home- and community-based services during the coronavirus (COVID-19) crisis through waiver and state plan amendment applications.
This brief includes communication examples to help states answer questions on how health insurance covers COVID-related testing and treatment, encourage consumers to enroll in coverage, and engage with providers to keep them informed.
This webinar walks through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization. An accompanying toolkit is included that identifies the immediately available tools for states.
This brief examines the effect of a recently announced federal program allowing states to apply for Medicaid block grants or per capita caps in exchange for new flexibility to limit enrollment and benefits.
Moving the Needle on Maternal and Infant Mortality: A Conversation with New Jersey, Ohio, and Virginia
This report describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement.
Creating Meaningful Consumer Engagement in Medicaid: Perspectives from Colorado and Washington State
Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity
This report focuses on how Medicaid programs can use data from the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity.
CMS Guidance Authorizes Medicaid Demonstration Applications That Cap Federal Funding: Implications for States
This report reviews the key features of the proposed capped funding demonstrations and highlights the considerations for states. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) inviting states to apply for Section 1115 demonstration projects that would impose caps on federal Medicaid funding for the adult expansion and some other adult populations in exchange for new programmatic flexibility.
This report gives an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees, and also details how states are using these authorities to invest in supportive housing for diverse high-need Medicaid populations.
In this podcast, Connecticut’s Medicaid director Kate McEvoy and chief financial officer Mike Gilbert discuss their experiences working with partners in the executive and legislative branches to build trust and a shared vision for sustaining critical programs.
This blog from the Delta Center illustrates five key insights related to program design and evaluation from the productive partnership between the Partnership HealthPlan of California (PHC) and local community health centers (CHCs) to create a care coordination (CCM) program.
This issue brief draws from the experiences of states that were among the first to implement their substance use disorder waivers to profile how the American Society for Addiction Medicine (ASAM) Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.
Keeping Medicaid’s Promise: Strengthening Access to Services for Children With Special Healthcare Needs
This issue brief examines how state Medicaid agencies, families, advocates, providers and other stakeholders can partner to improve access to services for Medicaid-enrolled children with special health care needs.
This report explores what child care challenges parents with Medicaid work requirements may face, and suggests parents may struggle to find care that is affordable, good quality, accessible, and available for nontraditional or unpredictable work schedules.
This brief explores state variation in health insurance coverage changes during implementation of the primary health insurance coverage reforms of the Affordable Care Act (ACA) using data from the 2013 and 2017 American Community Survey.
Are Medicare Advantage Plans Using New Supplemental Benefit Flexibility to Address Enrollees’ Health-Related Social Needs?
This brief describes interviews with 10 Medicare Advantage plans, Medicare Advantage experts, and social service providers to discuss new benefits added under the Centers for Medicare & Medicaid Services' increased flexibility in plan year 2019.
Behavioral Health Provider Participation in Medicaid Value-Based Payment Models: An Environmental Scan and Policy Considerations
This webinar reviewed the Department of Homeland Security's final version of its public charge rule, highlighted changes from the proposed rule, and explored the rule’s potential impacts on consumers, states and providers.
Health Insurance Coverage Declined for Nonelderly Americans between 2016 and 2017, Primarily in States That Did Not Expand Medicaid
This report shares insights from in-depth interviews with 25 adults in immigrant families who reported that they or a family member avoided participating in safety net programs like Medicaid, SNAP, or housing assistance in 2018 because of immigration concerns.
In this blog, two former state medicaid directors demystify the distinct yet complementary roles of public health and health care — and how these state agencies can align efforts around prevention strategies to impact health and costs.
Precarious Work Schedules Could Jeopardize Access to Safety Net Programs Targeted by Work Requirements
This brief examines the prevalence of precarious work schedules among working adults whose families participate in federal safety net programs, using data from the December 2018 Well-Being and Basic Needs Survey.
How States Can Use Measurement as a Foundation for Tackling Health Disparities in Medicaid Managed Care
This study assesses potential barriers facing Medicaid enrollees in meeting work requirements through employment on a sustained basis, using pooled data from the September 2018 and March 2019 Health Reform Monitoring Survey.
Medicaid Leadership Exchange: A Candid Dialogue on What Works — and What Doesn’t — in Leading Today’s State Programs
Promoting Addiction Treatment in Medicaid: A Q&A with New Jersey’s Department of Human Services Commissioner Carole Johnson
This analysis examines some of the consequences should a case pending before the U.S. Court of Appeals for the Fifth Circuit be decided in favor of the plaintiffs, who argue that the entire Affordable Care Act (ACA) be eliminated.
This report examines monitoring and evaluation of work/CE demonstrations and reviews the data assets and infrastructure necessary to support states and their researcher partners in robust monitoring and evaluation efforts.
Using Medicaid Levers to Improve Health Outcomes and Reduce Disparities: Q&A with Louisiana’s Medicaid Director Jen Steele
States Join National Initiative to Align Early Childhood and Medicaid to Improve Outcomes for At-Risk Children
Eight states will join Aligning Early Childhood and Medicaid, a multi-state initiative aimed at improving the health and social outcomes of low-income infants, young children, and families through cross-agency collaboration.
This brief reviews the role that social and economic factors--such as housing, healthy food, and income--play in a “whole person” approach to health care, especially among Medicaid’s low-income enrollees.
This brief reviews the growing body of research on Medicaid's health and economic impacts, including access to care; self-reported health status; preventive health screenings; delaying care because of costs; hospital and ED utilization; and mortality rates.
This brief outlines the basics of the Medicaid program, including financing and eligibility, for new state policymakers in order to lay the groundwork for considering the challenges and opportunities that lie ahead.
This brief highlights priority issues for consideration and potential action, including: the structure of the Medicaid agency; enabling coverage and access; addressing the needs of special populations; and value-based payment policies.
Pregnant Women with Opioid Use Disorder and their Infants in Three State Medicaid Programs in 2013–2016
What Makes an Early Childhood Medicaid Partnership Work? Insights from Three Cross-Sector Collaborations
This report outlines the activities of three pilot sites pursuing Medicaid-driven strategies to support young children and their families, to help inform other cross-sector partnerships at varying stages of development.
This case study explores how Indiana’s Family and Social Services Administration is working to rethink how to optimize the integration and delivery of health and social services for Medicaid beneficiaries.
The Senate passed H.R. 6, The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT Act”) on October 3, 2018. This reviews major health provisions of the new law and implications for states.
The Department of Homeland Security’s (DHS) proposed rule, Inadmissibility on Public Charge Grounds, proposes significant changes to how it will determine whether an immigrant is likely to become a “public charge” including, for the first time, the use of Medicaid benefits as a key factor in that analysis.This resource answers popular questions about the rule.
The Effects of Medicaid Expansion Under the ACA: Select Articles Published Between January 1, 2018 and August 31, 2018
This resource highlights articles published since January 2018 that report on the impact of Medicaid expansion in 33 states and DC, organized by health access and outcomes, economic impacts, and coverage impacts.
This report explores changes in coverage type between 2013 and 2016 overall and for key demographic and income subgroups. Between 2013 and 2016, the share of Americans ages 64 and younger without health insurance fell from 17 percent to 10 percent.
This report provides detailed estimates of changes in health insurance coverage types between 2013 and 2016 by demographic, socioeconomic, and geographic characteristics. In addition, state fact sheets detail coverage changes by income group in all 50 states and DC.
This chart compares the social determinants 11 states targeted in their Medicaid contracts and contract guidance documents to enhance population health, as well as how states monitored outcomes and funded these efforts.
Work and Community Engagement Requirements in Medicaid: State Implementation Requirements and Considerations
CMS approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire; and additional states have submitted or are poised to submit similar waivers. This series of charts outlines the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program.
This report investigates the work patterns of Medicaid beneficiaries in Kentucky who are are potentially subject to Medicaid work requirements. It finds that the structure of Kentucky’s Medicaid waiver does not seem to align with the reality of some working enrollees’ lives, and that working enrollees losing coverage may not have access to an employer plan.
This webinar reviews the Stewart v. Azar decision and potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. The court’s findings may shape what analysis will be necessary to demonstrate that future waivers advance the Medicaid statute's objectives.
This webinar provided an overview of Centers for Disease Control and Prevention's 6|18 Initiative and highlighted recent accomplishments from participating Medicaid-public health teams. The CDC 6|18 Initiative is a framework to guide Medicaid-public health collaboration.
State officials can align prevention strategies with value-based payment goals through a variety of mechanisms outlined in this brief, which draws from state-based 6|18 Initiative implementation efforts to help Medicaid and public health officials make the case for investing in prevention strategies and aligning these efforts to achieve state VBP goals.
Webinar discusses the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD), including the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver.
States continue to identify and pursue strategies to further reduce the number of uninsured to make coverage more affordable for consumers and to improve access to care. This issue brief presents two possible models for a Medicaid buy-in program for states, and details the design considerations and authorities needed to implement each model.
We assessed rates of employer health insurance offer, take-up, and coverage in June 2013 and March 2017 among workers. Overall, offer rates remained stable, and take-up and coverage rates increased. In Medicaid expansion states, the share of workers with family incomes at or below 138 percent of the federal poverty level who had employer-based coverage held steady, while uninsurance rates declined.
This map tracks state Medicaid expansion decisions and approaches states are taking for expanding eligibility to 138 percent of the Federal Poverty Level. It also includes information on state legislative activity around Medicaid expansion, governors’ stances on the issue, and fiscal and demographic analyses from the state or other institutions. For states that are expanding Medicaid, but using an alternative to traditional expansion, the map also contains brief descriptions of these demonstration waivers.
In January 2018, the Centers for Medicare & Medicaid Services issued a new policy allowing states to implement work and community engagement requirements for certain Medicaid enrollees. States are permitted to seek federal approval to require non-elderly, non-pregnant, and non-disabled adults to participate in these types of activities to qualify for Medicaid or certain aspects of Medicaid coverage. This chart summarizes states’ pending and approved Section 1115 waivers, waiver renewals, and waiver amendments to implement work and community engagement requirements.
In this brief, we provide an overview of the lessons learned from work requirements for Temporary Assistance for Needy Families (TANF, or cash assistance) and Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) and discuss the implications of introducing or expanding work requirements.
In Morrison County, Minnesota, an innovative state approach to improve population health is also helping combat the opioid crisis and save money. The Unity Accountable Community for Health (ACH) initiative has saved the state’s Medicaid program $3.8 million over three years by reducing claims for prescription opioid and related drugs.
This article analyzes the impact of the Affordable Care Act on health insurance coverage for verterans in states that chose to expand Medicaid and in non-expansion states using data from the 2013 and 2014 American Community Survey. The analysis found a substantial 24 percent relative decline in the rate of uninsurance for U.S. veterans between 2013 and 2014. Coverage gains in rural areas were due to gains in Medicaid and individual market coverage. The increase in the insured rate was three times larger in Medicaid expansion states versus non-expansion states.
In January 2018, CMS approved Kentucky’s Section 1115 Medicaid demonstration waiver, which allows the state to require some beneficiaries to participate in “community engagement” activities for at least 80 hours a month to retain their Medicaid coverage. This brief revises an earlier analysis on who could be affected by Kentucky’s Medicaid work requirements based on new information posted on Kentucky’s website.
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet, only 1 in 5 people suffering from an OUD receive treatment. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
This article explores efforts by nine state Medicaid and public health agency teams to implement 6|18 interventions related to asthma control, tobacco cessation, and unintended pregnancy prevention. It was published in the Journal of Public Health Practice and Management and covers Colorado, Georgia, Louisiana, Massachusetts, Michigan, Minnesota, New York, Rhode Island, and South Carolina.
New Work and Community Engagement Requirements: Overview of Federal Activity and State Considerations
On January 11, CMS released a State Medicaid Director letter providing guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. In this webinar, State Health and Value Strategies and Manatt Health review the new guidance, including key design parameters, budget neutrality requirements, and monitoring and evaluation criteria.
State Medicaid programs are increasingly requiring their Medicaid managed care organizations (MCO) to implement APMs. It is important for states to develop ways to ensure that their MCOs are complying with the APM requirements within their contract, and monitoring the progress and challenges with the implementation of APM strategies with Medicaid providers. This report focuses on different ways in which states may set standard APM definitions to track MCO progress toward meeting state APM goals, and support comparison of APM implementation within a state and nationally.
This brief provides an analysis of legislation recently introduced in the U.S. Senate that would create a mechanism for states to offer their residents the opportunity to buy a Medicaid-based public insurance option.
On January 11, 2018, CMS released guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represent a significant departure from past Administrations’ positions. This webinar reviews the new guidance and discusses state legal, policy, and operational considerations.
RWJF’s SHVS together with experts from Manatt Health, host this webinar that highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. Conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states are discussed.
Uncertainty about the future of health insurance options and concern about the ability of Affordable Care Act (ACA) marketplaces to offer adequate competition and choice have spurred states to look for new coverage approaches. Innovative strategies states are proposing include allowing consumers to buy into state Medicaid programs and developing state-specific coverage options within the ACA’s framework.
This webinar features the Urban Institute's Dr. Fred Blavin, whose SHARE-funded research asks how medical spending burdens for near-poor families in non-expansion states would change if the states were to expand Medicaid.
Federal Guidance Aims to Streamline Section 1115 Demonstration and 1915 Waivers and State Plan Amendments Processes
CMS released two informational bulletins detailing a new, streamlined approach for the review and management of Section 1115 demonstrations and state plan amendments and 1915 waivers. The streamlined approach may enhance states' ability to design innovative health care delivery initiatives in their Medicaid programs. These changes come at a critical time as states develop new approaches to reduce health care costs and stem the opioid epidemic.
Impact: State Policy Decisions on Health Insurance Coverage, Out-of-Pocket Spending, and Demand for Care
The research included in this panel illustrates both the intended and unintended consequences of state policy decisions on a range of health systems outcomes and highlights the necessity of access to different types of federal surveys for the purposes of health policy evaluation. Federal survey data is especially critical when analyzing variation between states, as when comparing outcomes by Medicaid expansion status. As policy flexibility for states continues to grow, this ability to compare states to one another will continue to be essential.
This toolkit is designed to assist states interested in implementing value-based purchasing approaches with their Medicaid managed care organizations (MCOs). Using a value-based purchasing approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs.
States Could Gain More Flexibility to Manage Medicaid Programs: Lessons from the 1990s AFDC Flexibility Experience
The Administration signaled a willingness to give states more flexibility to address health and prevention in new and innovative ways under Section 1115 of the Social Security Act, allowing the Department of Health and Human Services to approve experimental and innovative projects that promote the goals of Medicaid. This comes at a pivotal time when many states are developing new ways to improve health care, reduce costs, and address health-related social needs such as housing.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. Social determinants include a broad array of social and environmental risk factors such as poverty, housing stability, early childhood education, access to primary care, access to healthy food, incarceration and discrimination. This report digs into opportunities that states have to account for SDOH in Medicaid programs.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. This report digs into opportunities that states have to account for SDOH in Medicaid programs.
CMS has signaled a willingness to evaluate new types of Medicaid proposals from states, such as Medicaid waiver applications that include programs to connect individuals to employment or incorporate features of private market coverage. In response to CMS’ letter, some states have developed proposals that include these types of requirements for certain individuals covered by the Affordable Care Act’s Medicaid expansion—and a few states are seeking similar changes for their non-Medicaid expansion populations.
Under the authority of Section 1115 demonstrations, some states have implemented DSRIP programs to improve care, improve health, and lower costs. DSRIP programs restructure Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals, which are used to measure success.
This report explores Louisiana’s permanent supportive housing program. The program, administered jointly by the state’s Medicaid agency and housing authority, is a cross-agency partnership that braids funding to serve vulnerable cross-disability populations, address homelessness, reduce institutionalizations, and save money for the state.
Medicaid can play a unique and critical role in responding to public health emergencies and health crises. This brief explores the role Medicaid has played in responding to events such as the opioid and HIV/AIDS epidemics, the 2001 World Trade Center attacks, the Flint, Michigan lead contamination crisis, and Hurricane Katrina.
Driven to improve care coordination and contain costs by moving away from a volume-based payment model, an increasing number of states are implementing risk-based managed care programs to deliver long-term services and supports (LTSS). As the primary payer for LTSS, state Medicaid programs have a significant interest in ensuring that entities with which they contract deliver high quality and cost-effective care to members. This report identifies ways states can learn from value-based payment models being applied elsewhere to create more accountability for the quality and cost of LTSS.
While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.
Recent state waivers can inform the question of whether and how low-income individuals could benefit from health savings accounts (HSAs) with high-deductible health plans. State experiences incorporating health savings accounts into Medicaid can be instructive, as policymakers consider the role of HSAs in proposed health care reforms. This brief looks at health savings and similar accounts in Michigan and Indiana.
State agencies across the country, from Medicaid to public health, to social services and corrections, are deeply engaged in multi-sector initiatives to reduce infant mortality. And for good reason: the United States ranks 25th among industrialized countries in infant mortality with a disproportionate number of being African Americans.
In order to assist states in the facilitation of Medicaid enrollment and renewal for eligible SNAP participants, this webinar presents some of the necessary considerations for leveraging these data for enrollment purposes.
In this brief, we explore two revenue sources states may deploy to fund the non-federal share of expansion: provider assessments and provider donations. Both are authorized by federal law and both have been used by states in connection with expansion.
This issue brief examines seven safety-net ACOs across five states to understand their origins, organization, characteristics and functions and to identify federal and state policy questions associated with their emergence. The issue brief identifies both challenges facing safety-net provider ACO aspirants and state strategies to support safety-net provider development of ACOs.
As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. Through their focus on improved health outcomes, patient satisfaction, and access to appropriate care, alternative payment methodologies can benefit FQHCs, the state purchaser, and most importantly Medicaid beneficiaries. This brief describes a number of state-level payment reform strategies that include FQHCs and offers strategies and considerations for states and FQHCs alike.
This report stems from technical assistance provided to California’s Department of Health Care Services (DHCS). The technical expert facilitated webinars and meetings with DHCS staff and medical directors of contracted MCOs, in order to share information about housing resources and emerging practices for improving care and achieving savings by linking more Medicaid beneficiaries with permanent supportive housing.