Medicaid Transformation in an Era of National Health Reform


By 2026, an estimated 71 million adults and children will have coverage through Medicaid, now the nation’s largest public insurer. Federal spending on the program is estimated at $3.79 trillion. Since 2014, Commonwealth Fund–supported work by Sara Rosenbaum and her colleagues has informed policymakers about Medicaid’s transformation under the Affordable Care Act, differences in states’ implementation of the eligibility expansion, and the varying effects on low-income people. The Rosenbaum team’s first set of activities will involve continued tracking and analysis of differences in states’ implementation of the expansion and the implications of this variation for low-income people. The focus will be on approaches to enrollment and renewal; 1115 waivers and state expansion efforts; and new state requirements for improving access to care. The team will also analyze emerging proposals to reform Medicaid and the Children’s Health Insurance Program. The project team will also undertake an analytic study of Medicaid managed care’s efforts to promote value in the Medicaid program. After first reviewing the evolution and growth of Medicaid managed care, the researchers will look at how states currently partner with plans to promote delivery system reform. The team will examine 10 top-performing states to assess best practices of Medicaid agencies and managed care plans in such areas as design and adequacy of provider networks, alternative models for provider compensation, and performance measurement. The work will be conducted with a particular focus on best practices that can be adopted in low-performing states. These analyses will produce important insights for federal and state policy leaders into Medicaid’s continuing transformation and its effects on both current and potentially eligible enrollees. The work will inform assessments of policy proposals during this election season as well as future legislative and regulatory activities.

Grant Details

Grantee Organization:
George Washington University
Principal Investigator:
Sara Rosenbaum, J.D.
Award Amount:
Approval Date:
July 13, 2016

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