State Medicaid Initiatives to Improve Access and Contain Costs
Facing a potential influx of new Medicaid enrollees under health care reform, state policymakers will confront new pressures to contain Medicaid costs while simultaneously improving enrollment, access, and quality. The first two papers in this session address two cost-saving strategies being explored by state Medicaid programs. The first paper uses a quasi-experimental design to evaluate the early impacts of a recent statewide implementation of risk-based Medicaid managed care in Kentucky. The authors examine changes in inpatient hospital utilization following implementation to provide new evidence on health and expenditures for Medicaid enrollees. In addition to relying on managed care, Medicaid programs also attempt to control costs by targeting intensive case management to subgroups of high-need enrollees. In looking toward the upcoming Medicaid expansions for low-income adults, states will have limited access to information for this population that may be used to identify enrollees most likely to benefit from intervention. The second paper in this session tests the ability of different self-reported health measures, which could be collected by state programs at the time of enrollment, to prospectively identify individuals with high future health expenditures. Finally, in addition to cost considerations, the Medicaid expansions will lead to important questions regarding the coordination of coverage within families. In particular, for adults joining their children on the Medicaid program, there may be important consequences for the health of the family and children. The third paper examines the interconnections between parental and child Medicaid coverage in Wisconsin on utilization and health outcomes.