8:00am | January 26, 2017


Jill Braunstein at (202) 452-8097

WASHINGTON, D.C.In a new report, panel members reflecting a diverse range of skills and knowledge announced a series of steps that would enable Medicaid to build on its essential role as an insurer of more than 70 million people and increase its capacity to address the underlying social determinants of health.

The report, Strengthening Medicaid as a Critical Lever in Building a Culture of Health, is the result of a study panel that included state Medicaid program directors, public health and health policy experts, health researchers, medical and health professionals, and health plans, and was convened by the nonprofit, nonpartisan National Academy of Social Insurance.

As the nation’s largest public insurer of low-income and medically vulnerable individuals and families, Medicaid has the potential to play a more prominent role in improving patient and population health by integrating coverage of clinical care needs with other programs that focus on critical health determinants such as programs that fund housing, nutrition, education, and community development. Medicaid’s potential to partner in health improvement stems from its role as the front-line health care responder for the country’s most vulnerable populations and health problems.

“The panel approached this project with several key goals in mind,” said Trish Riley, co-chair of the study panel and Executive Director at the National Academy for State Health Policy. “We aimed to discuss strategies that could increase Medicaid’s potential to help move the dial on individual and population health, while improving health care quality and program efficiency.”

To balance the differences in views between panel members and to assist stakeholders from a variety of backgrounds in benefitting from the report, the panel divided their findings by those that can be accomplished administratively (without any further legislative action) and those that would require legislative change. These opportunities include:

  • Develop health improvement demonstrations that employ a longer-term savings time frame, focus on the social determinants of health, recognize health-related expenditures as qualified for federal funding, and count a broader range of estimated cost offsets when calculating budget neutrality.
  • Develop a fast-track approval process for demonstrations introducing innovations in Medicaid’s role as an insurer, including a clear implementation roadmap and definable outcome measures for promising service delivery transformation models.
  • Disseminate social determinants screening tools for use in managed care and integrated delivery systems, and adopt payment methods that foster comprehensive care and the integration of health and social services.
  • Improve data sharing between physical health, mental health, and substance use disorder services and providers to enhance care coordination.
  • Create a state option to enable stabilization of Medicaid enrollment over time for adults.

The report also recognized several key challenges that Medicaid faces in strengthening this its role, including the high cost states already bear for insuring vulnerable populations as well as the complexities of implementing innovative care delivery models.  An additional critical issue faced by states is the chronic insufficiency of funding for the very types of health, nutrition, housing, community development, and other programs with which Medicaid needs to partner to improve health. In addition, complexities of the health care system – such as a generally fragmented infrastructure that drives health care providers to operate in silos and the administrative burdens of state-based transformation efforts – have limited growth towards a Culture of Health.

The study panel findings note that along with continued exploration of ways Medicaid can be further strengthened as a tool for improving health, attention must focus on ways to ensure the preservation of the Medicaid program’s core mission as the largest source of public health insurance, in a manner that respects the need for budgetary limits and efficient program management.

“Medicaid’s resilience and flexibility position the program to assume roles that no other insurer can undertake,” said Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy at The George Washington University’s Milken Institute School of Public Health and co-chair of the study panel. “Its place in the American health care system is simply foundational.”

The Academy study panel and the final report were funded by the Robert Wood Johnson Foundation.

The National Academy of Social Insurance is a nonprofit, nonpartisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solutions to challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.

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