The Tracking Medicaid Enrollment Growth During COVID-19 Databook, which includes Medicaid enrollment data from over 40 states, provides a comprehensive, detailed look at 2020 Medicaid enrollment trends to-date, with certain limitations. The Databook provides enrollment detail by state across four eligibility categories: expansion adults, children (including those enrolled in CHIP), non-expansion adults, and aged, blind, and disabled individuals. It also compares enrollment trends across expansion and non-expansion states.
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.
Analyzing the Fiscal Impact of COVID-19, the Economic Downturn, and Recent Policy Changes: 50-State Databook
As states and Medicaid programs face significant fiscal uncertainty as a result of the COVID-19 public health crisis, the Databook provides projected changes in federal and state Medicaid and CHIP expenditures during calendar years 2020 and 2021 across all fifty states and the District of Columbia for a given scenario and policy response. Taken together, the Databook provides estimates that span across a range of plausible scenarios reflecting increased enrollment and per enrollee spending growth and changes to the duration of the federal Public Health Emergency.
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.
On Wednesday, March 27, 2019, State Health and Value Strategies, in partnership with the Peterson Center on Healthcare, hosted a webinar on the ways in which several states and one community organization are using their multi-payer claims databases. More states are leveraging multi-payer claims databases to better understand how their health care systems are operating and implementing data-driven decision-making. States may not be aware, however, of the strategies other states and organizations are adopting to leverage claims databases to support health care transformation goals. During the webinar, presenters from the state of Vermont and Rhode Island, as well as the Washington Health Alliance, discussed how they are employing claims databases to enhance the value of care and will share lessons learned for those seeking to optimize their own databases.
All payer claims databases (APCDs) and multi-payer claims databases are a source of information that, when used effectively, can provide insight into how states’ health care systems are functioning and facilitate data-driven decision-making. This issue brief looks at the progress states and community organizations have made in using their APCDs and other multi-payer claims databases for various strategic purposes, and offers considerations for states that are seeking to optimize their own claims databases to achieve health care system performance improvement goals. The State Health Policy Highlight, Achieving Transparency and Value Using Multi-Payer Claims Databases, provides an overview of how states are leveraging their claims databases and reviews the lessons experienced states and community organizations have to offer other states seeking to optimize their own databases.
Using Hospital Admission, Discharge, and Transfer (ADT) Data to Coordinate Care: Lessons from Tennessee and Washington
On September 6, 2018, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar on effective use of admissions, discharge, and transfer (ADT) data. Considered to be the most relevant real-time electronic data for health care providers, ADT data, if used effectively, can help states improve overall health of their populations. This webinar featured the use of ADT data feeds to coordinate care for patients with behavioral health and other complex care issues by two states, Tennessee and Washington. Presenters provided an overview of their respective state programs, including operational and financing strategies, linkages to quality metrics and outcomes, and alignment with other statewide payment and delivery system efforts. Presenters also shared lessons learned and advice to states.
Data Points to Consider When Assessing Proposals to Cap Federal Medicaid Funding: A Toolkit for States
Key leaders in Congress and high-ranking members of the Trump Administration are proposing major changes to Medicaid financing through the adoption of a block grant or per capita caps. To assist states in assessing the potential implications of proposals to cap federal Medicaid funding, the State Network team at Manatt Health has developed a toolkit providing state-by-state data on Medicaid enrollment and expenditure trends—factors that are central to establishing the amount each state would be allocated under various capped funding proposals.
Recent proposals for the incoming Congress and presidential administration to repeal the Affordable Care Act (ACA) have also included calls for an overhaul of the current Medicaid program financing structure. Such a change, aimed at reducing federal Medicaid spending, would have significant implications for state Medicaid programs. A new webinar examined these proposals and the potential impact that they could have on states.
Section 1115 waivers allow states to waive certain Medicaid statutory requirements in order to advance state policy priorities and test innovations in their Medicaid programs, provided that they are budget neutral and “further the goals of the Medicaid program.” Since 2014, seven states have used 1115 waivers to implement alternative Medicaid expansions, and these waivers are likely to be leveraged by states in the next four years to advance changes to Medicaid. This issue brief, developed by Manatt Health, provides an overview of the features of these alternative Medicaid expansion waivers.