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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 improve their 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 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?

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.

Recent 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)
• “Congressionally Mandated Evaluation of the State Children’s Health Insurance Program” (October 2005)

Related projects:

• 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. 

Recent 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 project:

• 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

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How can states improve their 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.

Recent 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?

Nearly 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.

Recent publications:

• “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 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.

Recent publications:

• “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

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 2001-2005 are on the CMS or Mathematica websites, and tables and a chartbook for 2006—the year in which Medicare Part D took over drug coverage for dual eligibles—are being prepared. 

Recent publications:

• “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 Medicaid Analytic eXtract (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, and journal articles to analyze Medicaid service use and costs for prescription drugs, behavioral health services, and long-term care. 

Recent publications:

• “The Medicaid Analytic Extract Chartbook, 2002” (May 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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