With the 50th anniversary of Medicaid this month, Health Affairs used the opportunity to showcase how Medicaid is changing health care for millions of Americans. One of the ways it does this is through innovative waivers that support states in transforming delivery systems to improve access and quality of care. Another avenue for change is by focusing Medicaid coverage on areas of crucial need, such as mental health care.
Medicaid’s Improvements to Access and Quality
An Examination of Medicaid Delivery System Reform Incentive Payment [DSRIP] Initiatives Under Way in Six States Health Affairs (subscription required)
DSRIP waivers play a critical role in essential hospitals’ ability to improve access, care coordination, and quality. This study offers a comparison of DSRIP waivers in six states: California, Kansas, Massachusetts, New Jersey, New York, and Texas. Members of America’s Essential Hospitals play a vital role in securing and carrying out these demonstrations.
In California, Primary Care Continuity Was Associated With Reduced Emergency Department (ED) Use And Fewer Hospitalizations Health Affairs (subscription required)
Prior to California’s Medi-Cal expansion, the state received a Section 1115 Medicaid waiver to test the impacts of improved access to primary care for a Medi-Cal ineligible population. In the first two years of the Health Care Coverage Initiative, patients were allowed to switch primary care providers within a safety net provider network. In the third year, patients had to adhere to one primary care provider. Results show that implementing a policy to encourage adherence to a designated primary care provider improved adherence, and a higher levels of adherence were associated with fewer emergency department visits and hospitalizations.
MetroHealth Care Plus: Effects Of A Prepared Safety Net On Quality Of Care On A Medicaid Expansion Population Health Affairs (subscription required)
Essential hospital MetroHealth System participated in a waiver demonstration in Ohio to explore the potential impact of expanding coverage on physical health measures for a closed panel of patients ineligible for Medicaid prior to expansion. The study found that enrollees had greater improvement in the composite standard of care for diabetes (considered the gold standard for diabetes care) and significant improvement in rates of good blood pressure control for hypertension.
Lessons From Medicaid’s Divergent Paths On Mental Health And Addiction Services
Health Affairs (subscription required)
Medicaid’s coverage of mental health and addiction disorders over the past 50 years has differed dramatically. Medicaid is now the largest payer for mental health services at more than a quarter of all mental health spending (both public and private insurance combined), though state and local government funds have remained the foundation of addiction services spending, which increased by $15 billion between 1986 and 2009. The Affordable Care Act mandates Medicaid coverage of addiction services, and experts expect a doubling in Medicaid spending in this area by 2020. The article, referencing the journey of mental health services, recommends Medicaid agencies remain flexible over coverage to best meet diverse addiction needs. Additionally, seeking community-based alternative treatment to inpatient admission is critical for transforming addiction care delivery to more patient-centered care. Lastly, increased Medicaid coverage will result in an expanded supply of addiction services providers and will increase the quality of mental health care.
