Restrictive Medicaid Policies Will Impede Innovation to Improve Care and Reduce Costs
End Notes
[1] For another discussion of the issues addressed in this paper, see Cindy Mann, “Are New Medicaid Waivers on a Collision Course with State Delivery System Reform?” Commonwealth Fund, September 26, 2018, https://www.commonwealthfund.org/blog/2018/are-new-medicaid-waivers-collision-course-state-delivery-system-reform.
[2] Jennifer Wagner, “Medicaid Coverage Losses Mounting in Arkansas From Work Requirement,” Center on Budget and Policy Priorities, January 17, 2019, https://www.cbpp.org/blog/medicaid-coverage-losses-mounting-in-arkansas-from-work-requirement.
[3] CMS approved waivers that include work requirements in Arizona, Arkansas, Indiana, Kentucky, Michigan, New Hampshire, and Wisconsin. CMS also approved a Maine waiver that included a work requirement, but Governor Janet Mills did not accept the terms of the waiver, so it did not go into effect.
[4] Aviva Aron-Dine, Raheem Chaudhry, and Matt Broaddus, “Many Working People Could Lose Health Coverage Due to Medicaid Work Requirements,” Center on Budget and Policy Priorities, April 11, 2018, https://www.cbpp.org/research/health/many-working-people-could-lose-health-coverage-due-to-medicaid-work-requirements.
[5] Samantha Artiga, Petry Ubri, and Julia Zur, “The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings,” Kaiser Family Foundation, June 01, 2017, https://www.kff.org/medicaid/issue-brief/the-effects-of-premiums-and-cost-sharing-on-low-income-populations-updated-review-of-research-findings/.
[6] Laura Dague, “The effect of Medicaid premiums on enrollment: A regression discontinuity approach,” Journal of Health Economics, September 2014, https://www.sciencedirect.com/science/article/abs/pii/S0167629614000642.
[7] The Lewin Group, “Healthy Indiana Plan 2.0: POWER Account Contribution Assessment,” March 31, 2017, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/Healthy-Indiana-Plan-2/in-healthy-indiana-plan-support-20-POWER-acct-cont-assesmnt-03312017.pdf.
[8] Judith Solomon, “Locking People Out of Medicaid Coverage Will Increase Uninsured, Harm Beneficiaries’ Health,” Center on Budget and Policy Priorities, February 22, 2018, https://www.cbpp.org/research/health/locking-people-out-of-medicaid-coverage-will-increase-uninsured-harm-beneficiaries.
[9] Department of Health and Human Services, “Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value,” January 26, 2015, http://wayback.archive-it.org/3926/20170127185400/https://www.hhs.gov/about/news/2015/01/26/better-smarter-healthier-in-historic-announcement-hhs-sets-clear-goals-and-timeline-for-shifting-medicare-reimbursements-from-volume-to-value.html.
[10] Alex M. Azar II, “Remarks on Value-Based Transformation to the Federation of American Hospitals,” Department of Health and Human Services, March 5, 2018, https://www.hhs.gov/about/leadership/secretary/speeches/2018-speeches/remarks-on-value-based-transformation-to-the-federation-of-american-hospitals.html.
[11] Centers for Medicare & Medicaid Services, “Participation Criteria for the Quality Payment Program,” May 22, 2017, https://www.youtube.com/watch?v=Fw8d3Sg6qP0&feature=youtu.be.
[12] Colorado Department of Health Care Policy and Financing, 1915(b) waiver, approved August 28, 2018, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Downloads/CO_ACC-PCCM-PIHP-Program_CO-04.pdf.
[13] Martha Hostetter, Sarah Klein, and Douglas McCarthy, “Hennepin Health: A Care Delivery Paradigm for New Medicaid Beneficiaries,” Commonwealth Fund, October 7, 2016, https://www.commonwealthfund.org/publications/case-study/2016/oct/hennepin-health-care-delivery-paradigm-new-medicaid-beneficiaries.
[14] State of Oregon, 1115 Waiver Demonstration Renewal, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/or/or-health-plan2-ca.pdf.
[15] Jim Lloyd, Rob Houston, and Tricia McGinnis, “Medicaid Accountable Care Organization Programs: State Profiles,” Center for Health Care Strategies, October 2015, http://www.chcs.org/resource/medicaid-accountable-care-organization-programs-state-profiles/.
[16] Arkansas 1915(i) State Plan Amendment, https://medicaid.mmis.arkansas.gov/general/comment/comment.aspx.
[17] Deloitte, “Alternative Payment Models in Medicaid: Could MACRA Be a Catalyst for States’ Value-Based Care Efforts?” October 2017, https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-alternative-payment-models-in-Medicaid-MACRA.pdf.
[18] Center for Health Care Strategies, “Medicaid Accountable Care Organizations: State Update,” February 2018, https://www.chcs.org/media/ACO-Fact-Sheet-02-27-2018-1.pdf.
[19] Robert Mechanic and Clifton Gaus, “Medicare Shared Savings Program Produces Substantial Savings: New Policies Should Promote ACO Growth,” Health Affairs Blog, September 11, 2018, https://www.healthaffairs.org/do/10.1377/hblog20180906.711463/full/.
[20] David B. Muhlstein et al., “Medicare Accountable Care Spending Patterns: Shifting Expenditures Associated with Savings,” American Journal of Accountable Care, February 2018, https://www.ajmc.com/journals/ajac/2018/2018-vol6-n1/medicare-accountable-care-spending-patterns-shifting-expenditures-associated-with-savings.
[21] Kristen A. Peck, “How ACOs Are Caring for People with Complex Needs,” Commonwealth Fund, December 2018, https://www.commonwealthfund.org/publications/fund-reports/2018/dec/how-acos-are-caring-people-complex-needs.
[22] Medicare Payment Advisory Commission, “Report to the Congress: Medicare and the Health Care System,” June 2018, http://medpac.gov/docs/default-source/reports/jun18_medpacreporttocongress_sec.pdf?sfvrsn=0; see also National Academies Press, “Variation in Health Care Spending: Target Decision Making, Not Geography,” October 2013, https://www.ncbi.nlm.nih.gov/books/NBK201647/.
[23] J. Michael McWilliams et al., “Changes in Post-Acute Care in the Medicare Shared Savings Program, JAMA Internal Medicine, April 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415671/.
[24] Ibid.
[25] J. Michael McWilliams et al., “Changes in Patients’ Experiences in Medicare Accountable Care Organizations,” New England Journal of Medicine, October 30, 2014, https://www.nejm.org/doi/full/10.1056/NEJMsa1406552.
[26] Hostetter 2016.
[27] Oregon Health Authority, “Health system transformation in Oregon: lessons from the first five years,” March 2018, https://stateofreform.com/wp-content/uploads/2018/03/Lessons-from-the-first-five-years.pdf.
[28] Oregon Health Authority, “Oregon Health System Transformation: CCO Metrics 2016 Final Report,” June 27, 2017, http://www.oregon.gov/oha/HPA/ANALYTICS-MTX/Documents/CCO-Metrics-2016-Final-Report.pdf.
[29] Aaron J. Dawe et al., “The Impact of Continuous Medicaid Enrollment on Diagnosis, Treatment, and Survival in Six Surgical Cancers,” Health Services Research, September 26, 2014, https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.12237.
[30] Leighton Ku and Erika Steinmetz, “Bridging the Gap: Continuity and Quality of Coverage in Medicaid,” Association for Community Affiliated Plans, September 10, 2013, http://www.communityplans.net/Portals/0/Policy/Medicaid/GW%20Continuity%20Report%20%209-10-13.pdf.
[31] Institute of Medicine, “Care Without Coverage: Too Little, Too Late,” 2002, https://www.ncbi.nlm.nih.gov/pubmed/25057604.
[32] Dawe 2014, op cit.
[33] Lars Osterberg and Terrence Blaschke, “Adherence to Medication,” New England Journal of Medicine, August 4, 2005, https://www.nejm.org/doi/full/10.1056/nejmra050100; Michael C. Sokol et al., “Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost,” Medical Care, June 2005, https://journals.lww.com/lww-medicalcare/Abstract/2005/06000/Impact_of_Medication_Adherence_on_Hospitalization.2.aspx; Gordon D. Schiff et al., “Decompensated Heart Failure: Symptoms, Patterns of Onset, and Contributing Factors,” American Journal of Medicine, June 2003, https://www.amjmed.com/article/S0002-9343(03)00132-3/pdf.
[34] Artiga 2017; Ramin Mojtabai and Mark Olfson, “Medication Costs, Adherence, and Health Outcomes Among Medicare Beneficiaries,” Health Affairs, July 2003, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.4.220.
[35] Hannah Katch and Judith Solomon, “Restrictions on Access to Care Don’t Improve Medicaid Beneficiaries’ Health,” Center on Budget and Policy Priorities, December 11, 2018, https://www.cbpp.org/research/health/are-medicaid-incentives-an-effective-way-to-improve-health-outcomes.
[36] Ritesh Banerjee, Jeanette Y. Ziegenfuss, and Nilay D. Shah, “Impact of discontinuity in health insurance on resource utilization,” BMC Health Services Research, 2010, https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/1472-6963-10-195.
[37] Peter S. Hussey et al., “Continuity and the Costs of Care for Chronic Disease,” JAMA Internal Medicine, May 2014, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1835350.
[38] In Minnesota’s Integrated Health Partnerships, for example, patients must have six months of continuous enrollment (or nine months of total enrollment) in qualifying programs during the “performance period” during which the contract is in place to give providers sufficient time to provide care management. See https://mn.gov/dhs/assets/2017-ihp-rfp-appendix-d_tcm1053-294444.pdf.
[39] Centers for Medicare & Medicaid Services 2017, op cit. Medicaid beneficiaries can count toward participating providers’ minimum percentage for the purpose of earning a Quality Payment Program payment bonus beginning in 2021.
[40] Centers for Medicare & Medicaid Services, “Core Set of Adult Health Care Quality Measures for Medicaid: Technical Specifications and Resource Manual for Federal Fiscal Year 2018 Reporting,” May 2018, https://www.medicaid.gov/medicaid/quality-of-care/downloads/medicaid-adult-core-set-manual.pdf; Centers for Medicare & Medicaid Services, “Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP: Technical Specifications and Resource Manual for Federal Fiscal Year 2018 Reporting,” February 2018, https://www.medicaid.gov/medicaid/quality-of-care/downloads/medicaid-and-chip-child-core-set-manual.pdf.
[41] National Committee for Quality Assurance, “NCQA Endorses Medicaid and CHIP Quality Improvement Act,” February 4, 2015, https://www.ncqa.org/comment-letter/ncqa-endorses-medicaid-and-chip-quality-improvement-act/.
[42] Artiga 2017.