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Medicaid/CHIP: Selected Publications

Expanding Health Insurance for Children

"SCHIP Children: How Long Do They Stay and Where Do They Go?" Christopher Trenholm, James Mabli, and Ander Wilson, January 2009. This brief highlights findings from a seven-state study examining retention of children in the State Children's Health Insurance Program (SCHIP) and coverage after they leave the program. Once children enrolled in SCHIP leave public insurance, they are far more likely to become uninsured—and remain uninsured for some time—than they are to obtain private coverage. The findings suggest that the extent to which SCHIP has substituted for private insurance may be well below the rates estimated in some studies.

"Synthesis of 10 Case Studies: Exploring Medicaid and SCHIP Enrollment Trends and Their Links to Policy and Practice." Covering Kids & Families Evaluation. Judith Wooldridge, Christopher Trenholm, and Angela Gerolamo, April 2009.

"National Evaluation of the State Children's Health Insurance Program: A Decade of Expanding Coverage and Improving Access." Margo Rosenbach, Carol Irvin, Angela Merrill, Shanna Shulman, John Czajka, Christopher Trenholm, Susan Williams, So Sasigant Limpa-Amara, and Anna Katz, January 2007. Expanding health coverage for children is at the center of policy debates as reauthorization of the 10-year-old State Children’s Health Insurance Program (SCHIP) continues. This report presents findings from Mathematica’s comprehensive seven-year evaluation of SCHIP for the Centers for Medicare & Medicaid Services. The report highlights states’ progress in conducting outreach, averting substitution, improving access, and reducing the number of uninsured low-income children. The study found that SCHIP reduced both the number and rate of uninsured children and improved children’s access to health care. From 1997 to 2003, the percentage of uninsured low-income children fell from 25 percent to 20 percent. Enrollment climbed to 6 million children in 2003 and reached 6.6 million in 2006. In addition, access to care improved, although some gaps remain for children with special health care needs and children of minority race/ethnicity.

"Increasing Children's Coverage and Access: A Decade of SCHIP Lessons."Trends in Insurance Coverage, Issue Brief #4. Margo Rosenbach, September 2007.

"SCHIP at 10: A Synthesis of the Evidence on Substitution of SCHIP for Other Coverage." So Limpa-Amara, Angela Merrill, and Margo Rosenbach, September 2007. When SCHIP was enacted in 1997, policymakers sought to safeguard against the substitution of SCHIP for other insurance coverage. This report synthesizes and assesses evidence from published and unpublished literature and state SCHIP annual reports on the magnitude of substitution in SCHIP. Wide-ranging estimates across studies are explained as a function of differences in purposes, methods, and analytic perspectives.

"What Covering Kids & Families Tells Us About SCHIP." Judith Wooldridge, Presentation, Alliance for Health Reform Briefing, February 2007.

"SCHIP at 10: A Synthesis of the Evidence on Access to Care in SCHIP." Shanna Shulman and Margo Rosenbach, January 2007. SCHIP has made substantial gains in providing affordable health coverage to children. However, health insurance alone does not ensure access to needed health services. This paper presents recent evidence about changes in access to care associated with enrollment in SCHIP.

"SCHIP at 10: A Synthesis of the Evidence on Retention." Shanna Shulman, Margo Rosenbach, and Sylvia Kuo, November 2006. Retention is key in achieving SCHIP’s mission to reduce the number of uninsured children. This paper synthesizes the available evidence on disenrollment rates and reasons for disenrollment to produce estimates of SCHIP retention rates. The paper also summarizes the evidence on state SCHIP policies that influence retention.

"Congressionally Mandated Evaluation of the State Children's Health Insurance Program." Final Report to Congress. Judith Wooldridge, Genevieve Kenney, Christopher Trenholm, Lisa Dubay, Ian Hill, Myoung Kim, Lorenzo Moreno, Anna Sommers, and Stephen Zuckerman, October 2005. Across the country, children without health insurance are a cause for concern. This report examines the design and implementation of State Children's Health Insurance Programs, noting that they were succeeding in almost all areas examined. The study focused on 10 states with a large proportion of eligible and enrolled children nationwide, developing findings from surveys of enrolled and recently disenrolled children in those states. The study incorporated a national perspective, drawing on a national survey of state program administrators, and from a national survey of low-income uninsured children.

"Congressionally Mandated Evaluation of the State Children's Health Insurance Program: Final Cross-Cutting Report on the Findings from Ten State Site Visits." Ian Hill, Corinna Hawkes, Mary Harrington, Ruchika Bajaj, William Black, Nancy Fasciano, Embry Howell, Heidi Kapustka, and Amy Westpfahl Lutzky, December 2003, rev. June 2004.

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Keeping People with Long-Term Care Needs in the Community

"Implications of State Program Features for Attaining MFP Transition Goals." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #2. Debra J. Lipson and Susan R. Williams, June 2009. In 2007, the federal government funded programs in 30 states and the District of Columbia under the Money Follows the Person demonstration to support the transition of Medicaid beneficiaries in long-term institutional care to home and community-based settings. This report describes variation in the design of state transition programs and discusses how differences in key features affect the pace and degree of implementation, as well as the likelihood of meeting transition goals. While some states are on track to meet their goals, others have been slow to start programs because of delays in finalizing operational plans or Medicaid home and community-based program changes, problems finding or contracting with transition agencies, and other setbacks.

"Transitioning Medicaid Enrollees from Institutions to the Community: Number of People Eligible and Number of Transitions Targeted Under Money Follows the Person (MFP)." The National Evaluation of the Money Follows the Person Demonstration Grant Program, Reports from the Field #1. Audra T. Wenzlow and Debra J. Lipson, January 2009. The MFP demonstration is the most ambitious program to date aimed at helping Medicaid enrollees transition from long-term care institutions to the community. This report, the first in a new series, assesses the scope of the program—profiling the Medicaid population in long-term institutional care eligible for MFP, rates of transition to the community before MFP began, and potential change in transition rates if states reach their program goals. State MFP programs seek to transition about 36,000 individuals over the course of the demonstration, or less than 1 percent of the approximately one million people who could be eligible annually.

"A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002." Audra T. Wenzlow, Robert Schmitz, and Kathy Shepperson, January 2008. This report examines how person-level data in the Medicaid Analytic eXtract (MAX) data system can be used to better understand long-term care service use and expenditures, and to evaluate the utility of MAX data for further study of long-term care. The authors compare expenditure and utilization-based measures of the balance of institutional and community-based long-term care services. They also examine long-term care expenditures and utilization for two key groups of enrollees—young disabled enrollees and enrollees ages 65 and older. The article decomposes community-based long-term care expenditures by type of service and summarizes other Medicaid services used and costs incurred in 2002.

"Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002." Audra T. Wenzlow, Robert Schmitz, and Jill Gurvey, January 2008. This report describes patterns of Medicaid nursing home utilization for each state and nationally. The authors address the following questions: (1) What are the characteristics of people who use Medicaid nursing home services? (2) How do these people become eligible for Medicaid? (3) How long do Medicaid-covered nursing home spells last and how often do individuals return to nursing homes? They also examine how state policies are associated with nursing home utilization.

Improving Medicaid Managed Care

"Enhanced Primary Care Case Management Programs in Medicaid: Issues and Options for States." James M. Verdier, Vivian Byrd, and Christal Stone, September 2009.This report examines how five states—Oklahoma, North Carolina, Pennsylvania, Indiana, and Arkansas—have enhanced their Medicaid primary care case management (PCCM) programs to provide more intensive care management and care coordination for high-need beneficiaries, improve financial and performance incentives for primary care providers, and increase use of performance and quality measures. The report is aimed at states that may not have the option of contracting with fully capitated at-risk managed care organizations (MCOs), or that may want to use PCCM programs as an option for beneficiaries and as a source of competition and comparison for MCOs.

"SoonerCare Managed Care History and Performance: 1115 Waiver Evaluation." James Verdier, Margaret Colby, Debra Lipson, Samuel Simon, Christal Stone, Thomas Bell, Vivian Byrd, Mindy Lipson, and Victoria Pérez, January 2009. Oklahoma’s Medicaid managed care 1115 waiver program, SoonerCare, has been through many changes in the last 15 years, including the end of fully capitated managed care in 2003 and expansion statewide of the SoonerCare Choice enhanced primary care case management program. Mathematica’s evaluation found that SoonerCare managed care has contributed to improvements in access to care from 1995 through 2008, especially for children, although some aspects of access still lag behind national averages or could be significantly improved. Physician participation has improved substantially in recent years, and preventable hospitalizations among adults have declined. In addition, Medicaid costs per member in Oklahoma were substantially below the national average between 1996 and 2005.

"Quality-Related Provider and Member Incentives in Medicaid Managed Care Organizations." James Verdier, Suzanne Felt-Lisk, Fabrice Smieliauskas, Jaclyn Wong, and Laurie Felland, July 2004.This issue brief describes the demographic characteristics of vulnerable adults—those at significant risk of needing long-term care services in the near future. In addition, it reports on their knowledge of long-term care coverage and service availability in their areas, as well as their sources of information regarding long-term care. The brief notes that many vulnerable adults do not know what services are available in their communities and also lack information about the costs involved. This brief is based on a survey of adults age 50 and older in 13 communities participating in the Robert Wood Johnson Foundation’s Community Partnerships for Older Adults Program.

"State Medicaid Managed Care Evaluations and Reports: Themes, Variations, and Lessons." James M. Verdier and Robert E. Hurley, May 2004. States have undertaken a wide range of efforts to evaluate and report on their Medicaid managed care programs to help ensure that public dollars are being put to good use and that Medicaid beneficiaries are receiving high-quality, efficiently administered care. The report looks at how four states—Arizona, Maryland, Rhode Island, and Virginia—have carried out this responsibility, and draws lessons for other states from their experiences. It highlights lessons that focus on identifying audiences and tailoring evaluations and reports to these audiences' interests and needs.

Coordinating Care for Dual Eligibles

"Coordinating and Improving Care for Dual Eligibles in Nursing Facilities: Current Obstacles and Pathways to Improvement." James M. Verdier, March 2010. More than half of all nursing facility residents are dually eligible for both Medicare and Medicaid, enmeshing them in a system of care and coverage that is complex, fragmented, uncoordinated, and inefficient. This policy brief suggests that coordination of care for these dual eligibles could be improved by shifting responsibility for long-term nursing facility services from Medicaid to Medicare. Some incremental steps could also increase accountability for prescription drug use, reduce avoidable hospitalizations, cut costs, and improve overall care. It is important to ensure that Medicaid home- and community-based service programs and nursing facility care remain coordinated for those who can be cared for in the community.

"Do We Know If Medicare Advantage Special Needs Plans Are Special?" James Verdier, Marsha Gold, and Sarah Davis, January 2008. Special needs plans (SNPs) are a type of Medicare Advantage managed care plan that serves individuals who have chronic or disabling conditions, are covered under both Medicare and Medicaid, or are institutionalized. Enrollment in SNPs has nearly doubled in the past year to almost 1.1 million, and many expect continued enrollment growth in both existing plans and in the nearly 300 new plans approved for 2008. This report describes the history of these plans, how they fit into the larger Medicare Advantage marketplace, and how to assess whether SNPs are performing differently from other Medicare Advantage plans.

"The Effect of the Program of All-Inclusive Care for the Elderly (PACE) on Quality." Jody Beauchamp, Valerie Cheh, Robert Schmitz, Peter Kemper, and John Hall, February 2008. PACE is a Medicare managed care benefit intended to prolong the independence and enhance the quality of life of frail beneficiaries by providing solutions to the service delivery problems encountered by those who remain living in the community. This report estimated the effect of PACE on indicators of quality of care such as health management, health care utilization, health status, and participant satisfaction by comparing survey responses of PACE participants to a matched sample of individuals who were eligible for PACE but did not participate in the program. Overall, PACE improved health management outcomes, increased preventive care, and reduced hospital use, though the program did not show significant improvements in participant health status or satisfaction.

"Medicare Advantage Rate Setting and Risk Adjustment: A Primer for States Considering Contracting with Medicare Advantage Special Needs Plans to Cover Medicaid Benefits." James M. Verdier, September 2006. The Center for Health Care Strategies is working with states to integrate the financing, delivery, and administration of primary, acute, behavioral health, and long-term care services and supports for adults with disabling chronic conditions who are dually eligible or covered solely by Medicaid. The initiative is also helping states develop the infrastructure for integrating health care services and contracting with Special Needs Plans. This primer outlines the bidding process for Medicare Advantage Special Needs Plans and highlights the opportunity for a coordinated bidding and contracting process that will allow states to benefit from savings resulting from better integrated Medicare-Medicaid coverage.

Improving Care for Individuals with Mental Health and Substance Abuse

"Use of Out-of-Home Care Among a Statewide Population of Children and Youth Enrolled in Medicaid." Jonathan D. Brown, Morris Hamilton, Brenda Natzke, Henry T. Ireys, and Mathew Gillingham, Journal of Child and Family Studies, February 2011 (subscription required). This study used Medicaid claims to examine patterns of out-of-home care—residential treatment, psychiatric hospitals, and general hospitals—and identify demographic and diagnostic characteristics associated with the sector of care used. The study also looked at whether youth had more than one out-of-home stay during the year. Nearly 40 percent of children in out-of-home care had more than one out-of-home stay during the year, and 40 percent of these youth received services from more than one sector of out-of-home care. The findings underscore the need for a systemwide approach to reducing use of out-of-home care.

"Effects of a Discharge Planning Program on Medicaid Coverage of State Prisoners with Serious Mental Illness." Audra T. Wenzlow, Henry T. Ireys, Bob Mann, Carol Irvin, and Judith L. Teich. Psychiatric Services, January 2011 (subscription required.). This study assessed the effectiveness of a discharge planning program implemented in three Oklahoma state prisons to assist inmates with serious mental illness to enroll in Medicaid on the day of release or soon thereafter. The program had significant positive effects. On the day of release, 25 percent of inmates who received program services were enrolled in Medicaid, compared with 8 percent of inmates at the same facilities in the two years before the new program was implemented and 3 percent for inmates in comparison facilities. The effect was even greater three months after release.

"Mental Disorders Among Non-Elderly Nursing Home Residents." Samuel E. Simon, Debra J. Lipson, and Christal M. Stone. Journal of Aging & Social Policy, January 2011 (subscription required). Despite federal nursing home policies designed to prevent inappropriate institutionalization, many Medicaid beneficiaries under age 65 with serious mental illness may be inappropriately admitted to nursing facilities. A combination of the Medicaid policy requiring coverage for nursing home care and a lack of appropriate community-based care options may be the cause.

"Medicaid Beneficiaries Using Mental Health or Substance Abuse Services in Fee-for-Service Plans in 13 States, 2003." Henry T. Ireys, Allison L. Barrett, Jeffrey A. Buck, Thomas W. Croghan, Melanie Au, and Judith L. Teich. Psychiatric Services, September 2010 (subscription required). This study examined Medicaid beneficiaries using mental health or substance abuse services in fee-for-service plans in 13 states in 2003, concluding that they entered general hospitals and visited emergency rooms far more frequently than other beneficiaries.

"State Variation in Out-of-Home Medicaid Mental Health Services for Children and Youth: An Examination of Residential Treatment and Inpatient Hospital Services." Jonathan Brown, Brenda Natzke, Henry Ireys, Mathew Gillingham, and Morris Hamilton, Administration and Policy in Mental Health and Mental Health Services Research, August 2009 (online), July 2010 (print), (subscription required). Using Medicaid data from 2003, this article describes the demographics and diagnoses of youth under 22 receiving mental health services in general and psychiatric hospitals, psychiatric residential treatment facilities, and other residential treatment settings. The research found that treatment stays and costs in these facilities varied considerably from state to state, findings which may call for more research on state service systems and Medicaid policies.

"Establishing and Maintaining Medicaid Eligibility Upon Release from Public Institutions." Audra Wenzlow, Henry T. Ireys, Carol Irvin, and Matthew Hodges. June 2010. This report describes an evaluation of Oklahoma’s efforts to develop and implement a model program to ensure that eligible individuals with mental illness were enrolled in Medicaid at discharge from state prisons and institutions for mental diseases.

"Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid." LaDonna Pavetti, Michelle K. Derr, Jacqueline F. Kauff, and Allison Barrett. Psychiatric Services, May 2010 (subscription required).

"How Many Nursing Home Residents Live with a Mental Illness?" Ann D. Bagchi, James M. Verdier, and Samuel E. Simon. Psychiatric Services, July 2009 (subscription required). A number of data sets can be used to estimate the size of the nursing home population with mental illness; however, estimates vary because of differences in data collection. The 2004 National Nursing Home Survey (NNHS) estimates that 6.8 percent of nursing home residents had a primary diagnosis of mental illness in that year (6.0 percent of those 65 and older, and 12.9 percent of those under 65). Comparable populations in the Medicaid Analytic eXtract (MAX) data set had fewer mental illness diagnoses, and those in the nursing facility Minimum Data Set (MDS) had more. The authors conclude that the estimates from the NNHS are more reliable, but they are available only at the national level. State- and facility-level estimates would have to be generated with the MDS or MAX data sets, with users being aware of differences in recorded diagnoses among the three, especially the relatively limited diagnoses in the MAX and imprecise diagnoses in the MDS.

Promoting Independence and Employment for People with Disabilities

"How Are the Experiences of Individuals with Severe Mental Illness Different from Those of Other Medicaid Buy-In Participants?" Working with Disability Work and Insurance in Brief #11. Su Liu and Sarah Croake, August 2010. This issue brief profiles Medicaid Buy-In participants with severe mental illness and compares their characteristics, employment experiences, and medical expenditures with those of other program participants. These individuals have better employment outcomes than participants with other disabling conditions, at least in the short to medium term.

"Interim Report on the Demonstration to Maintain Independence and Employment." Gilbert Gimm, Noelle Denny-Brown, Boyd Gilman, Henry T. Ireys, and Tara Anderson, April 2009. With better access to health care and employment supports, individuals with physical and mental impairments can stay employed, maintain health, and avoid becoming dependent on federal disability benefits. To help American workers with potentially disabling conditions achieve these goals, Congress authorized the Demonstration to Maintain Independence and Employment (DMIE) under the Ticket to Work and Work Incentives Improvement Act of 1999. This report is an interim assessment of the national DMIE program. Early findings from four states using random assignment show that DMIE programs can be implemented in a wide range of settings and can be customized to meet the needs of different target populations. A total of 4,099 baseline DMIE participants were enrolled as of September 2008.

"Analysis of Medical Expenditures and Service use of Medicaid Buy-In Participants, 2002-2005." Gilbert Gimm, Kristin L. Andrews, Jody Schimmel, Henry T. Ireys, and Su Liu, October 2009. When workers with disabilities “buy into” Medicaid by paying monthly premiums, states can offer them Medicaid coverage when their income and assets would otherwise make them ineligible. Using MAX data and Medicare claims files, this report provides the most comprehensive information to date on patterns of Medicaid and Medicare spending and service use among Medicaid Buy-In participants. Researchers found that combined inflation-adjusted Medicaid and Medicare expenditures for Buy-In participants more than doubled from $887 million to $1.9 billion between 2002 and 2005, as did program enrollment. However, they also found that, when compared with other working-age disabled Medicaid enrollees, Buy-In participants in 2005 incurred lower annual Medicaid expenditures. This difference suggests that Buy-In participants who are working may require fewer services or a less expensive mix of services than other adult disabled Medicaid enrollees.

"What Happens to Medicaid Buy-In Participants After They Leave the Program?" Working with Disability, Work, and Insurance In Brief #9. Su Liu and Silvie Colman, September 2009. This brief explores the paths of people with disabilities who leave the Medicaid Buy-In program, finding that their earnings and employment rates decline after disenrollment. The program helps adults with disabilities work while still retaining Medicaid coverage. At the end of 2008, 37 states reported covering 92,446 people in the program.

"The Three E's: Enrollment, Employment, and Earnings in the Medicaid Buy-In Program, 2006." Gilbert Gimm, Sarah R. Davis, Kristin L. Andrews, Henry T. Ireys, and Su Liu, April 2008. The Medicaid Buy-In program is part of a broader federal effort to improve employment outcomes for people with disabilities by allowing states to expand Medicaid coverage to workers with disabilities whose income and assets would ordinarily make them ineligible for Medicaid. This report presents a national profile of the enrollment, employment, and earnings of Buy-In participants in 2006 and investigates the association between participant characteristics, state program features, and employment outcomes. The report notes that the Buy-In program continues to be a popular coverage option for states and enrollment is growing nationwide from 29,398 to 97,491 participants between 2001 and 2006. About 69 percent of participants nationwide were employed with average annual earnings of $8,237 in 2006.

Analyzing Medicaid Prescription Drug Expenditures

“Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2006.” Ann Bagchi, James Verdier, and Dominick Esposito, May 2010. This chartbook highlights national and state-by-state data on Medicaid prescription drug use and expenditures for 2006 by beneficiary characteristics (age, sex, and race), basis of eligibility (children, adults, disabled, and aged), and type of drug (brand vs. generic, top 10 drug groups, top 7 therapeutic categories, and drugs excluded by statute from Medicare Part D).

"Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2005." Ann Bagchi, James Verdier, and Dominick Esposito, June 2009. This chartbook highlights national and state-by-state data on Medicaid prescription drug use and expenditures for 2005 by beneficiary characteristics (age, sex, and race), basis of eligibility (children, adults, disabled, and aged), and type of drug (brand vs. generic, top 10 drug groups, top 7 therapeutic categories, and drugs excluded by statute from Medicare Part D). Separate graphs highlight Medicare-Medicaid dual eligibles, whose drug coverage shifted to Medicare in 2006, and nondual beneficiaries, who continue to receive their drug coverage from Medicaid.

"New Medicaid Drug Use and Cost Data Highlight Issues for States After Medicare Part D." James Verdier, Ann Bagchi, and Dominick Esposito, Trends in Health Care Financing, Issue Brief #7, June 2007. This issue brief highlights a number of Medicaid prescription drug issues that remain for states after the movement of dual eligibles into the Medicare Part D drug benefit. The brief describes new data, prepared by Mathematica and available on the Centers for Medicare & Medicaid Services website, that provide detailed information on prescription drug cost and utilization for both nondual and dual eligible Medicaid beneficiaries for 2001 and 2002. The brief also notes that states can use this information as a starting point to highlight ways in which they may differ from other states or national averages, triggering more careful and thorough analysis.

"Medicaid Beneficiaries with Congestive Heart Failure: Association of Medication Adherence with Healthcare Use and Costs." Dominick Espositio, Ann D. Bagchi, James M. Verdier, Deo S. Bencio, and Myoung S. Kim, The American Journal of Managed Care, July 2009. Congestive heart failure (CHF) is a leading cause of hospitalization and mortality in the United States, affecting more than 5 million people at an expected cost of $34.8 billion in 2008. This article examines the association of medication adherence via the medication possession ratio with health care use and costs among Medicaid beneficiaries with CHF to estimate potential savings resulting from improved adherence. Using Medicare and Medicaid data for four states, researchers found that total health care costs were $5,910 (23 percent) less per year for adherent beneficiaries compared with nonadherent beneficiaries. Beneficiaries with adherence rates of 95 percent or higher had about 15 percent lower health care costs than those with adherence rates between 80 percent and less than 95 percent ($17,665 vs. $20,747), suggesting that the relationship between adherence and costs is graded. This study is the first to look beyond the 80 percent medication possession ratio threshold used in the relevant literature.

Using Medicaid Claims and Eligibility Data

“Expanding Access to Medicaid Data for Research: Feasibility of a MAX Sample.” Audra Wenzlow , Ellen Bouchery , and John Czajka, December 2010.

“Development of the Medicaid Analytic eXtract Provider Characteristics (MAXPC) File.” Deo Bencio, Julie Sykes, and Mei-Ling Mason, September 2010.

“Development of the Medicaid Analytic Extract Enrollee Master (MAXEM) File, 2005 and 2006.” John Czajka, Audra Wenzlow, and Julie Sykes, September 2010.

The Medicaid Analytic eXtract 2004 Chartbook. Victoria Perez, Bob Schmitz, Audra T. Wenzlow, Kathy Shepperson, David Baugh, and Susan Radke, 2008.

The Medicaid Analytic eXtract (MAX) Chartbook. Audra T. Wenzlow, Dan Finkelstein, Ben Le Cook, Kathy Shepperson, Christine Yip, and David Baugh, 2007. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experience in 2002. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollee demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2002. Appendix tables

"Prescription Drug Use and Expenditures Among Dually Eligible Beneficiaries." Ann D. Bagchi, Dominick Esposito, and James M. Verdier, Health Care Financing Review, summer 2007. Using Medicaid Analytic eXtract (MAX) claims files for 1999 and 2001, the authors describe patterns of prescription drug use and expenditures among dually eligible Medicare and Medicaid beneficiaries for all Medicaid full dually eligible beneficiaries and three important subgroups: the aged, disabled, and full-year nursing home residents. The analyses indicate great variation in use and expenditures across states that cannot be explained through differences in use of cost containment strategies. The findings suggest that Medicare Part D plans may achieve significant savings by providing incentives for greater use of generic drugs.

Issues for Medicaid as Health Reform Is Implemented

"Covering Low-Income Childless Adults in Medicaid: Experiences from Selected States." Stephen A. Somers, Allison Hamblin, James M. Verdier, and Vivian L.H. Byrd, August 2010. This Center for Health Care Strategies policy brief draws insights from 10 states with programs for low-income childless adults to shed light on the likely care needs and costs of the 16 to 20 million new Medicaid beneficiaries who will be brought into the program in 2014. A significant subset of the expansion population will have a complex range of health needs, including high rates of mental illness and substance abuse, and higher average costs than parents currently enrolled in Medicaid.

"Encouraging Appropriate Use of Preventive Health Services." Reforming Health Care Issue Brief #2. Jill Bernstein, Deborah Chollet, and G. Gregory Peterson, May 2010. This brief summarizes evidence on the benefits and cost-effectiveness of preventive health services, noting that health reform brings significant new opportunities to improve access to preventive care.

"Disease Management: Does It Work?" Reforming Health Care Issue Brief #4. Jill Bernstein, Deborah Chollet, and G. Gregory Peterson, May 2010. Disease management programs seek to control health care costs by focusing on two major drivers: high-cost chronic illness and inpatient hospitalizations for acute conditions. The fourth brief in a new series from Mathematica looks at the research evidence on the effectiveness of disease management programs and the role of disease management in health care reform.

"Financial Incentives for Health Care Providers and Consumers." Reforming Health Care Issue Brief #5. Jill Bernstein, Deborah Chollet, and Stephanie Peterson, May 2010. Health reform will emphasize financial incentives for providers and consumers to promote the use of effective health services and discourage use of marginally effective or inappropriate services. The fifth brief in a new series from Mathematica looks at evidence on the impacts of these financial incentives and draws lessons for policymakers.

"Medical Homes: Will They Improve Primary Care?" Reforming Health Care Issue Brief #6. Jill Bernstein, Deborah Chollet, Deborah Peikes, and G. Gregory Peterson, June 2010. Medical homes are part of our nation’s overall efforts to reform the health care system. For decades, medical homes have been a model for coordinating health care for children, particularly those with special health care needs. The sixth brief in a new series from Mathematica looks at federal and state efforts to establish medical homes and notes considerations for policymakers seeking to improve access to services and the quality of care.

"Enrolling the Eligible: Lessons for the Funders." Beth Stevens, Sheila Hoag, and Judith Wooldridge. The Foundation Review, March 2010 (subscription required). This article describes lessons from Covering Kids & Families® (CKF) and covers topics such as how outreach, simplification, and coordination increase enrollment of low-income children and their families in Medicaid and SCHIP. The authors suggest that funders should consider the program’s life cycle—start-up, maturity, or perpetuation/death—both for what is funded and how it is evaluated.