Methods for Assuring Access to Covered Medicaid Services

Prepared for
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services

Mathematica provides support and technical assistance to the Centers for Medicare & Medicaid Services (CMS) and the states as they monitor access to care for beneficiaries in fee-for-service (FFS) Medicaid. Access encompasses examining, for example, whether beneficiaries’ needs are met, whether care and providers are available, how beneficiaries’ utilization of services may have changed, and how Medicaid payment rates compare with those of other public and private payers. Mathematica reviewed and assessed the 2016 Access Monitoring Review Plans (AMRPs) submitted by states (as required by 42 CFR 447.203 and 447.204), met with states to discuss their 2016 experiences, and worked with CMS to identify meaningful measures of access. We have created resources and tools to help states identify and report measures of access and compare Medicaid payment rates with those of other payers. We have also conducted webinars to let states know about the resources available to them.

Project Highlights

Resources to compare payment rates

Our team created an Excel-based Payment Rate Comparison Tool, which helps states compare Medicaid’s payment rates to those of Medicare and commercial payers. The Payment Rate Comparison Tool User Guide gives instructions for using the tool. We gave an overview of the Payment Rate Comparison Tool in a July 2017 webinar, available here.

We also developed a Payment Rate Resource Toolkit to help states identify and access data on Medicaid, Medicare, and commercial payment rates. The toolkit’s appendix provides a list of CPT codes for services, and states can use it to help compare payment rates. The Payment Resource Toolkit Appendix is also available in an Excel file that enables users to cut and paste the CPT codes into the Payment Rate Comparison Tool. We gave an overview of the Payment Resource Toolkit in a webinar in July 2017. The webinar is available on demand here.

Resources to monitor access to care

We created a draft Medicaid Access Tool in Microsoft Access. The tool allows states to report data related to monitoring access and potentially could be used to create an AMRP. The tool contains 10 templates that contain both core and additional measures. The completion of all core measures can be thought of as sufficiently monitoring access. The additional measures have more information so access can be monitored in more detail. The draft tool allows users to generate reports that track progress as they complete the templates, summarize the information they have entered, and generate a summary report of the data entered. States can generate reports, then export and print them. The Medicaid Access Tool User Guide has instructions on how to load and use the tool. The final version of tool is under development and will be published upon completion. 

The Resource Manual describes 32 measures and provides guidance on commonly used data elements, potential data sources (including standardized data sets), and—when applicable—alternative methods of calculating the measure. It also includes guidance on reporting beneficiary or provider feedback regarding access. The manual is organized to align with the templates of the Medicaid Access tool, but is a useful guide even if a state chooses not to use the tool.

We also developed a series of technical assistance briefs that give states options and strategies for monitoring access. The briefs, listed below, cover a range of topics relevant to monitoring access to care. We discussed the contents of the first three briefs in a webinar in September 2018. The webinar is available on demand here.

  • Leveraging Benchmarks, Advisory Groups, and Experts to Understand Access in Medicaid. This brief presents a process that staff in state Medicaid agencies can use to engage resources—such as benchmarks, subject matter experts, and advisory groups—in the development of their access monitoring measures. The brief describes what each resource is, discusses how and when states might use it, and includes links to supporting documents and more information.
  • Methods to Identify Changes in Access Among Medicaid Beneficiaries. This brief presents methods that state Medicaid agencies can use to assess changes in access. Some of the methods are derived from quality improvement, and others are more traditional statistical methods. The brief covers the advantages and challenges of these methods and gives examples of how they might be applied in the context of monitoring access for Medicaid beneficiaries.
  • Strategies to Compare Access to Care Among Medicaid Beneficiaries Versus Other Populations. Staff in state Medicaid agencies could use a variety of statistical methods to assess how well their Medicaid program is meeting the goal of giving Medicaid beneficiaries access to care that is comparable to that enjoyed by people with other sources of coverage. The advantages and challenges of different methods are discussed, along with examples of how the methods could potentially be applied within the context of monitoring access for Medicaid beneficiaries.
  • Monitoring Regional Access With Administrative Data. This brief covers two methods that state Medicaid agencies can use to assess regional differences in access. Both are derived from traditional statistical methods sometimes used in clinical research to compare test populations and control populations, but they are also useful in comparing populations whose different characteristics might affect their use of services independent of any regional differences in access. The brief discusses the advantages and challenges of these methods and gives examples of how they might be applied in the context of monitoring access for Medicaid beneficiaries.

For questions related to any of these resources, please contact the Mathematica Medicaid Access Team at