Improving Lives and Reducing Cost of Care for High-Need, High-Cost Medicaid Enrollees with Mental Illness and Substance Abuse


The substantial proportion of high-need, high-cost adults insured fully or partly by Medicaid means that strategies to improve outcomes and lower costs for these patients, many of whom contend with mental illness and substance use, must involve the states. State governments are well positioned to implement strategies that shift care away from expensive emergency departments and hospitals and toward less-expensive community-based care and other cost-effective interventions. While many states are interested in transforming care delivery this way, it is not clear what concrete steps states, providers, and payers must take. Under the direction of the National Governors Association (NGA), five competitively selected states will participate in a learning laboratory to advance policy, practice, and financing strategies for improving outcomes and lowering costs for the high-need, high-cost Medicaid population. Activities will kick off with a visit to a state considered a pioneer in this area. This "model state" will have implemented programs for individuals with moderate-to-severe mental illness or substance-use disorders and will have created conditions for scaling and spreading those solutions statewide. The NGA team will then provide the five state teams with individual and group technical assistance. At the project's midpoint, participants will convene to exchange ideas and experiences. At the conclusion, NGA will evaluate states' success in implementing their customized action plans. The action plans that the five states develop and execute could lead to improved outcomes and reduced costs for high-need, high-cost Medicaid enrollees. Other states will also benefit from this work: the NGA team will produce an online roadmap for care delivery transformation, along with other tools and resources.

Grant Details

Grantee Organization:
National Governors Association Center for Best Practices
Principal Investigator:
Hemi Tewarson and Sandra Wilkniss
Award Amount:
Approval Date:
July 11, 2017

Forgot Password

An email has been sent to {{email}} with your reset password.

Account was not found. Please go to the login page and enter a new password.

Account was not found. Please try again with a different email address.

There was an error when attempting to send to {{email}}. Please contact an administrator.