This issue brief examines examples from two state Medicaid programs and one nonprofit quality measurement and reporting organization of the data sources they use to identify patients’ social risk factors when risk-adjusting payments or quality measure performance. Within the brief, we will examine both their approaches to risk adjustment based on social risk factors and how each entity filled their gaps in data on social risk factors. To inform this issue brief, the author reviewed publicly available documentation and articles on the three profiled examples of risk adjustment based on social risk factors.
Strategies for Supporting and Strengthening Medicaid Information Technology During the COVID-19 Crisis
As states face the extraordinary challenges of the COVID-19 crisis, information technology (IT) is an essential tool to support access to health coverage and the safe and effective evaluation, testing, and treatment of patients nationwide. Under the current statutory and regulatory framework, state Medicaid agencies are authorized to receive federal funding for Medicaid IT and associated activities, and much of it at an enhanced federal matching level. This issue brief outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, as well as secure current and future IT investments that enable Medicaid program operations. The issue brief also highlights the Medicaid authorities and the provisions that may allow states more expeditious access and flexible use of these funds.
As the coronavirus (COVID-19) crisis continues, state Medicaid and Children Health Insurance Program (CHIP) agencies are rapidly pursuing multiple financing strategies to support their responses. CHIP Health Services Initiatives (HSIs) can provide additional financial support to states and local communities serving low-income children. This issue brief provides an overview of CHIP HSIs and identifies ways that states can leverage them as part of their targeted response to the COVID-19 pandemic.
This issue brief 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. In some cases, the Medicaid agency will be responsible for implementing these policies; in other cases, the Medicaid agency can lead collaboration with other state agencies such as the public health department or the state marketplace.
Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity
State Medicaid programs are increasingly seeking to understand and address social factors that contribute to poor health—such as food insecurity, unstable housing, and a lack of access to social supports—in order to lower costs, improve outcomes for their members, and advance health equity. To inform this work of addressing the social determinants of health (SDOH) and advancing health equity, states and Medicaid officials need data in order to identify priority areas of unmet social and economic needs, execute SDOH initiatives, and monitor and evaluate the impacts of these programs. Increasingly, states are leveraging a broad array of data sources to support efforts to address health equity. While those sources closest to the Medicaid program are the most widely used, each has advantages and disadvantages. This brief focuses on how Medicaid programs can use data from one federal survey, the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity. This brief also highlights relevant examples from states that use SDOH and health equity measures from the ACS, including which measures and what they are used for.
CMS Guidance Authorizes Medicaid Demonstration Applications That Cap Federal Funding: Implications for States
The Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter on January 30, 2020 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. Referred to as “Healthy Adult Opportunity” by CMS, these demonstrations would allow states to choose between two types of capped funding arrangements: a per capita cap or an aggregate cap (i.e., a block grant). In this SHVS issue brief, our colleagues at Manatt Health review the key features of the proposed capped funding demonstrations and highlight the considerations for states.
While Medicaid typically does not pay for housing (room and board), it does pay for some clinical and non-clinical services that can help people obtain and maintain their housing. New federal authorities to cover housing-related services have motivated states to think more broadly about the Medicaid populations who could benefit from access to housing-related services and the types of services that can promote housing stability. State Investments in Supportive Housing provides an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees. The issue brief also details how states are using these authorities to invest in supportive housing for diverse high-need Medicaid populations.
As the opioid epidemic continues, Medicaid programs are applying for SUD Section 1115 Demonstration waivers (SUD waiver) to expand Medicaid-funded treatment options. Some states with approved SUD waivers have formally implemented the American Society for Addiction Medicine (ASAM) Criteria to promote consistency in client placement for SUD treatment. The ASAM Criteria is a clinically driven multidimensional client assessment model that emphasizes treatment outcomes, client-specific lengths of service, and a team-based approach to care. This issue brief draws from the experiences of states that were among the first to implement their SUD waivers to profile how the ASAM Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.
How States Can Use Measurement as a Foundation for Tackling Health Disparities in Medicaid Managed Care
Many people in America face segregation, social exclusion, encounters with prejudice, and unequal access and treatment by the health care system, all of which can impact health. Medicaid programs serve a disproportionate share of populations that are negatively impacted by health disparities. This new State Health and Value Strategies (SHVS) issue brief provides examples from a handful of states that have begun the work of identifying, evaluating, and reducing health disparities within their Medicaid managed care programs. Additionally, it offers an approach for other states interested in measuring disparities in health care quality in Medicaid managed care as a step towards achieving health equity, such that all Medicaid managed care enrollees have a fair and just opportunity to be as healthy as possible.
Addressing Social Factors That Affect Health: Emerging Trends and Leading Edge Practices in Medicaid
Medicaid programs are increasingly considering how best to address social factors, such as housing, healthy food, and economic security, that can affect health and medical expenditures. Often referred to as social determinants of health (SDOH), these factors are significant drivers of population health outcomes. While states historically have had some experience tackling such issues for specialized, high-need populations, they are now confronting whether, and how, Medicaid should address SDOH for a broader population of Medicaid enrollees in order to achieve better health outcomes. This issue brief explores the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts, as well as the specific steps states can take to implement these practices.