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.
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.
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 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 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.
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.
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.
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 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.
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.
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 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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.