Medicaid's Evolving Delivery Systems

The July Health Affairs focuses on how Medicaid has reshaped care delivery and how it can leverage its influence as a dominant player to push additional reforms.

July 2015
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The July 2015 issue of the journal Health Affairs, supported by the California Health Care Foundation, explores the evolution of Medicaid from a program for vulnerable and underserved patients to the insurer for many middle-class workers and their families. As the program has changed, so too have the benefits and populations it covers.

Five articles that examine issues pertinent to California are available with a subscription through the links below to the Health Affairs site:

  • "Lessons from Medicaid's Divergent Paths on Mental Health and Addiction Services," by Christina Andrews et al., chronicles how Medicaid programs used their influence as the dominant payers for mental health treatment to expand the range of services covered, incentivize alternatives to inpatient treatment, and enforce quality standards through licensure. As Medicaid programs are poised to become the largest payer for addiction treatment in the US, the authors highlight how these reforms could similarly improve addiction treatment services.
  • "Deficiencies in Care at Nursing Homes and Racial/Ethnic Disparities Across Homes Fell, 2006-11," by Yue Li et al., finds improvements in the quality of care and diversity of residents in nursing homes over five years. The authors note that increasing the Medicaid payment rate had a positive influence on quality and equity, and caution that state case-mix payment approaches, which had a negative effect on both, may need to be reevaluated.
  • "Federally Qualified Health Center Use Among Dual Eligibles: Rates of Hospitalizations and Emergency Department Visits," by Brad Wright, Andrew J. Potter, and Amal Trivedi, found that the rate of emergency room (ER) use by dual-eligible populations previously seen at a Federally Qualified Health Center (FQHC) increased, contrary to indications from earlier, broader research. Furthermore, while hospitalizations among dual eligibles who were also seen at an FQHC went down overall, this was not the case among dual eligibles of Asian descent, who had more hospitalizations despite also receiving care at an FQHC.
  • "The Supreme Court Ruling That Blocked Providers from Seeking Higher Medicaid Payments Also Undercut the Entire Program," by Nicole Huberfeld, comments on the implications of the Armstrong v. Exceptional Child Center decision that concluded that Medicaid providers cannot ask federal courts to force states to pay fair rates for medical services. Will this "win" for states weaken Medicaid operations and jeopardize care for beneficiaries in states with low payment rates?
  • "An Examination of Medicaid Delivery System Reform Incentive Payment (DSRIP) Initiatives Under Way in Six States," by Michael K. Gusmano and Frank J. Thompson, looks at how Medicaid DSRIP waivers hold hospitals and other providers accountable for measureable improvements in health care delivery. California, Kansas, Massachusetts, New Jersey, New York, and Texas set the context for this review.

Health Affairs' July 8 release in Washington, DC, featured some of the authors and panels covering primary care, complex populations, and payment and coverage. See a recap of the briefing.