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Medicaid and CHIP Topics

• Expanding Health Insurance for Children
• Keeping People with Long-Term Care Needs in the Community
• Improving Medicaid Managed Care
• Coordinating Care for Dual Eligibles
• Promoting Independence and Employment for People with Disabilities
• Analyzing Medicaid Prescription Drug Expenditures
• Using Medicaid Claims and Elibility Data
• Selected Publications

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Medicaid and the Children's Health Insurance Program

Mathematica works closely with states, federal agencies, and foundations to help design, evaluate, and improve Medicaid and state Children’s Health Insurance Programs (CHIP). The questions we address include:

• How are states using Medicaid and CHIP to insure and improve health care for children?
  
  
• How can Medicaid help keep people with long-term-care needs out of nursing facilities and living in the community?
  
  
• How can states and the federal government improve Medicaid managed care programs and make them more effective in providing care for people with chronic illnesses and disabilities?
  
  
• How can care for people who are dually eligible for Medicaid and Medicare be improved and better coordinated?
  
  
• How can Medicaid improve care for individuals with mental health and substance abuse needs?
  
  
• How can Medicaid promote independence and employment for people with potentially disabling conditions?
  
  
• How do Medicaid prescription drug expenditures vary among states and types of beneficiaries?
  
  
• How can Medicaid claims and eligibility data be used to analyze eligibility patterns, service use, costs, and quality?
  
  
• What are some of the important issues for Medicaid as health care reform is being implemented?

How are states using Medicaid and CHIP to insure and improve health care for children?

Mathematica has been at the forefront of evaluating how states have designed and implemented their CHIP programs, identifying lessons from that experience for both states and federal agencies. We have also worked with states and coalitions of public and private partners in a multi-year foundation-supported initiative to find effective ways of enrolling more children and their families in Medicaid and CHIP. As states and the federal government consider the future of Medicaid and CHIP in health care reform, these experiences with the design and implementation of coverage expansions can help inform future decision making.

Related publications:

• “SCHIP Children: How Long Do They Stay and Where Do They Go?” (January 2009)
• "Covering Kids & Families Evaluation: Synthesis of 10 Case Studies: Exploring Medicaid and SCHIP Enrollment Trends and Their Links to Policy and Practice”  (April 2009)
• “National Evaluation of the State Children’s Health Insurance Program:  A Decade of Expanding Coverage and Improving Access”  (September 2007)
• “Increasing Children’s Coverage and Access: A Decade of SCHIP Lessons” (September 2007)
• “SCHIP at 10: A Synthesis of the Evidence on Substitution of SCHIP for Other Coverage” (September 2007)
• “What Covering Kids & Families Tells Us About SCHIP” (February 2007)
• “SCHIP at 10: A Synthesis of the Evidence on Access to Care in SCHIP” (January 2007)
• “SCHIP at 10: A Synthesis of the Evidence on Retention” (January 2006)
• “Congressionally Mandated Evaluation of the State Children’s Health Insurance Program” (October 2005)
• “Congressionally Mandated Evaluation of the State Children’s Health Insurance Program: Final Cross-Cutting Report on the Findings from Ten State Site Visits” (December 2003, revised June 2004)

Related projects:

• CHIPRA 10-State Evaluation: Congressionally mandated evaluation to explore how the Children’s Health Insurance Program (CHIP) has evolved since its early years
• National Evaluation of the CHIPRA Quality Demonstration Grant Program: Evaluation of promising ideas for improving the quality of health care provided to children enrolled in Medicaid or CHIP
• Covering Kids & Families: Evaluation of a six-year Robert Wood Johnson Foundation initiative that supported state and local coalitions in 45 states in efforts to enroll eligible children and families in Medicaid and CHIP
  
• Children's Health Insurance Program (SCHIP) Evaluation: (CMS): Multi-faceted evaluation of the impact of CHIP, completed in 2007
  
• Children's Health Insurance Program (SCHIP) Evaluation: (ASPE): Congressionally mandated evaluation of the design and implementation of CHIP in 10 states, completed in 2005
  
• Santa Clara County Children's Health Initiative: Evaluation of a county-funded effort to expand health insurance coverage for children through an outreach campaign aimed at enrolling eligible children in Medicaid and CHIP and an insurance program for other children in families with incomes up to 300 percent of poverty

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How can Medicaid help keep people with long-term-care needs out of nursing facilities and living in the community?

Mathematica is working with the Centers for Medicare & Medicaid Services (CMS) to evaluate a major initiative―Money Follows the Person (MFP)―aimed at helping state Medicaid programs reduce their reliance on institutional care for people needing long-term care, and expand options for receiving care in the community. Also for CMS, we are identifying ways to improve the identification of Medicaid home- and community-based services in Medicaid Analytic eXtract (MAX) data files so that both states and the federal government can get a better understanding of the nature, scope, and cost of these services. MAX files can also be used for detailed studies of nursing facility residents and their care. 

Related publications:

• “Implications of State Program Features for Attaining MFP Transition Goals” (July 2009)
• “Transitioning Medicaid Enrollees from Institutions to the Community:  Number of People Eligible and Number of Transitions Targeted Under MFP” (January 2009)
• “A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002” (January 2008)
• “Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002” (January 2008)

Related projects:

• Money Follows the Person: Evaluation of the impact of CMS grants to states to support programs that enable Medicaid beneficiaries with long-term-care needs to live in the community rather than in institutions
• Measuring States’ Progress in Maintaining and Expanding Medicaid Home and Community-Based Services (HCBS): Analysis of the balance of Medicaid long-term care between institutional care and HCBS in all 50 states and the District of Columbia

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How can states and the federal government improve Medicaid managed care programs and make them more effective in providing care for people with chronic illnesses and disabilities?

For more than a decade, Mathematica has worked with the Center for Health Care Strategies (CHCS) and individual states to help design, implement, and improve Medicaid managed care programs, with a focus on programs aimed at people with chronic illnesses and disabilities. We have also recently started working with the Medicaid and CHIP Payment and Access Commission (MACPAC) to provide analysis and guidance on developing a research agenda on Medicaid managed care.

Related publications:

• “Enhanced Primary Care Case Management Programs in Medicaid:  Issues and Options for States”  (September 2009)
• “SoonerCare Managed Care History and Performance: 1115 Waiver Evaluation” (January 2009)
• “Quality-Related Provider and Member Incentives in Medicaid Managed Care Organizations” (July 2004)
• “State Medicaid Managed Care Evaluations and Reports: Themes, Variations, and Lessons” (May 2004)

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How can care for people who are dually eligible for Medicaid and Medicare be improved and better coordinated?

Over nine million people in the United States are dually eligible for Medicaid and Medicare. While they represent only a modest share of the enrollment in each program (18 percent of Medicaid enrollees and 16 percent of those in Medicare), they account for a disproportionately large share of expenditures in both programs (46 percent of Medicaid and 24 percent of Medicare). With care needs that are often complex and extensive, dual eligibles must navigate a system that divides responsibility for their care between the two programs in ways that are difficult to understand and coordinate. Mathematica is working with CHCS, states, federal agencies, the Medicare Payment Advisory Commission (MedPAC), and others to help find ways to better coordinate and integrate care for dual eligibles.

Related publications:

• “Coordinating and Improving Care for Dual Eligibles in Nursing Facilities: Current Obstacles and Pathways to Improvement” (March 2010)
• “Do We Know If Medicare Advantage Special Needs Plans Are Special?” (January 2008)
• “The Effect of the Program of All-Inclusive Care for the Elderly (PACE) on Quality” (February 2008)
• “Medicare Advantage Rate Setting and Risk Adjustment:  A Primer for States Considering Contracting with Medicare Advantage Special Needs Plans to Cover Medicaid Benefits” (October 2006)

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How can Medicaid improve care for individuals with mental health and substance abuse needs?

Mathematica is committed to conducting research that contributes to quality improvements in the care provided to those with mental health needs and substance abuse problems. We are working with the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services to analyze how to increase the implementation in Medicaid of evidence-based practices in treating schizophrenia and bipolar disorder. We worked with the Substance Abuse and Mental Health Services Administration to reduce recidivism of those with serious mental illnesses by facilitating maintenance of Medicaid eligibility upon release from institutions.  

Related publications:

• “Use of Out-of-Home Care Among a Statewide Population of Children and Youth Enrolled in Medicaid” (February 2011)
• "Effects of a Discharge Planning Program on Medicaid Coverage of State Prisoners with Serious Mental Illness” (January 2011)
• "Mental Disorders Among Non-Elderly Nursing Home Residents" (January 2011)
• "Medicaid Beneficiaries Using Mental Health or Substance Abuse Services in Fee-for-Service Plans in 13 States, 2003" (September 2010)
• "State Variation in Out-of-Home Medicaid Mental Health Services for Children and Youth: An Examination of Residential Treatment and Inpatient Hospital Services" (July 2010)
• “Establishing and Maintaining Medicaid Eligibility upon Release from Institutions" (June 2010)
• "Mental Disorders and Service Use Among Welfare and Disability Program Participants in Fee-for-Service Medicaid" (May 2010)
• "How Many Nursing Home Residents Live with a Mental Illness?" (July 2009)

Related projects:

• Enhancing the Adoption of Comparative Effectiveness Research in the Treatment of Serious Mental Illnesses in Medicaid: Determining the extent to which evidence-based practices are used in the treatment of schizophrenia and bipolar disorder have been adopted in state Medicaid programs.
• Developing Quality Measures for Medicaid Beneficiaries with Schizophrenia: Development, field-testing, and submittal for endorsement of at least three quality measures to assess the quality and appropriateness of outpatient care for Medicaid beneficiaries diagnosed with schizophrenia.
• Review of SoonerCare Behavioral Health Services: Review of the SoonerCare behavioral health system, Oklahoma’s Medicaid program, recent changes in the system to improve access to behavioral health services for children and youth under 21 years of age, costs to the state, current processes within the system, and gaps in services.
  

How can Medicaid promote independence and employment for people with potentially disabling conditions?

Mathematica is working with CMS and states to evaluate two major federal-state programs aimed at helping workers with disabilities obtain health benefits and supports they need to remain in the workforce and maintain their independence. 

The Demonstration to Maintain Independence and Employment (DMIE), authorized under the Ticket to Work and Work Incentives Improvement Act of 1999, awards funds to states to develop, implement, and evaluate initiatives for workers with potentially disabling health conditions. The Medicaid Buy-In Program allows adults with disabilities to earn more than would otherwise be possible and still have Medicaid coverage, which they can “buy into” by paying premiums based on income.

Related publications:

• “How Are the Experiences of Individuals with Severe Mental Illness Different from Those of Other Medicaid Buy-In Participants?” (August 2010)
• “Interim Report on the Demonstration to Maintain Independence and Employment” (April 2009)
• “Analysis of Medical Expenditures and Service Use of Medicaid Buy-In Participants, 2002-2005” (October 2009)
•  “What Happens to Medicaid Buy-In Participants After They Leave the Program?” (September 2009)
•  “The Three E’s:  Enrollment, Employment, and Earnings in the Medicaid Buy-In Program, 2006” (April 2008)

Related projects:

• Demonstration to Maintain Independence and Employment (DMIE): Evaluation of a four-state demonstration of the impact of providing health benefits and employment supports for workers with potentially disabling health conditions
• Medicaid Buy-In Program: Measurement of the effects of the Medicaid Buy-In program, which permits adults with disabilities whose incomes exceed Medicaid levels to purchase Medicaid coverage
• Accelerated Benefits Demonstration: Evaluation of the impact of providing medical benefits to those receiving Social Security Disability Insurance while they are in the 24-month waiting period for Medicare
• Center of Excellence in Research on Disability Services, Care Coordination, and Integration: One of the Center’s initial research studies will focus on individuals newly enrolled in the Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) programs. The study will examine the relationship between state policies for provision of home and community-based care under Medicaid and outcomes such as hospitalizations and long-term nursing home care use. 

To read more about Mathematica's broad range of disability policy studies, click here.

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How do Medicaid prescription drug expenditures vary among states and types of beneficiaries?

Mathematica researchers have been working with CMS since 2002 on state-by-state and national tables and chartbooks that show Medicaid drug use and expenditures by beneficiary characteristics (age, sex, and race), basis of eligibility (children, adults, disabled, aged), and type of drug (brand versus generic, top 10 drug groups, 17 therapeutic categories, and drugs excluded by statute from Medicare Part D). There are separate sets of tables for dual eligibles and nonduals. Tables and chartbooks for 1999 and 2001-2006 are on the CMS or Mathematica websites, and tables and a chartbook for 2007 are being prepared. 

Related publications:

• “Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2006” (May 2010)
• “Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2005” (June 2009)
• “New Medicaid Drug Use and Cost Data Highlight Issues for States after Medicare Part D” (June 2007)
• “Medicaid Beneficiaries with Congestive Health Failure:  Association of Medication Adherence with Healthcare Use and Costs” (July 2009)

Related project:

• Medicaid Prescription Drug Use and Expenditures by State, 1999-2006: Preparation of tables, chartbooks, issue briefs, and journal articles showing Medicaid prescription drug use and expenditures for all states

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How can Medicaid claims and eligibility data be used to analyze eligibility patterns, service use, costs, and quality?

For more than two decades, Mathematica researchers and analysts have worked with CMS and states to improve the value and usability of the Medicaid claims and eligibility data that all states are required to submit electronically to CMS through the Medicaid Statistical Information System (MSIS). We help CMS convert these data into MAX files that link demographic and eligibility information for all beneficiaries to summaries of their service use and costs by date of service. These person-level summary files can be linked to more detailed files on beneficiaries’ inpatient hospital, long-term-care, pharmacy, physician, and other service use. Mathematica has used these files in reports, chartbooks, issue briefs, and journal articles to analyze Medicaid enrollment, service use, and costs among Medicaid enrollees receiving prescription drugs, behavioral health services, and long-term care. Mathematica is currently helping CMS expand and enhance the Medicaid data infrastructure to support comparative effectiveness research (CER). Mathematica is also providing technical assistance to states to improve the reporting of states’ separate CHIP data and managed care encounter data.

Related publications:

• “Expanding Access to Medicaid Data for Research: Feasibility of a MAX Sample” (December 2010)
• “Development of the Medicaid Analytic Extract Provider Characteristics (MAXPC) File, Implementation Report, 2006” (September 2010)
• “Development of the Medicaid Analytic Extract Enrollee Master (MAXEM) File, 2005 and 2006” (September 2010)
• The Medicaid Analytic Extract Chartbook, 2004 (May 2008)
• The Medicaid Analytic eXtract (MAX) Chartbook (2007)
• “Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002" (January 2008)
• “A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002" (January 2008)
• “Prescription Drug Use and Expenditures Among Dually Eligible Beneficiaries” (Summer 2007)

For more information on Mathematica’s data development activities, click here.

For information on how to get access to MAX and MSIS data through the CMS Research Data Assistance Center (ResDAC), click here.

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What are some of the important issues for Medicaid as health care reform is being implemented?

Mathematica researchers and analysts work on the front lines of health care research, and the results of our work is frequently used to inform public policy decisions. The following reports represent Mathematica’s impact on the health care reform debate and implementation strategy as it relates to Medicaid and CHIP.

Related publications:

• "Covering Low-Income Childless Adults in Medicaid: Experiences from Selected States" (August 2010)
• "Enrolling the Eligible: Lessons for the Funders" (March 2010)
• "Encouraging Appropriate Use of Preventive Health Services" (May 2010)
• "Disease Management: Does It Work?" (May 2010)
• "Medical Homes: Will They Improve Primary Care?" (June 2010)
• "Financial Incentives for Health Care Providers and Consumers" (May 2010)
  

Related projects:

• Health Reform Dashboard: Development of performance measures for all provisions and goals of the Affordable Care Act
• White House Launch of healthcare.gov: Providing guidance to CMS on informing members of the public about potential Medicaid and CHIP eligibility
• Eligibility Determination and Modified Adjusted Gross Income: Implications for Enrollment Under Health Reform