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Medicaid: Funders Support Research And Advocacy
According to the Medicaid and CHIP Payment and Access Commission (MACPAC), more than seventy-four million people were enrolled in Medicaid at a point in time in fiscal year 2018. However, “variability in Medicaid is the rule,” MACPAC’s online “Medicaid 101” notes. “States establish their own eligibility standards, benefit packages, provider payment policies, and administrative structures under broad federal guidelines, effectively creating” a different Medicaid program for each state and territory, as well as Washington, D.C. MACPAC also notes that “combined federal and state expenditures for Medicaid accounted for about 16 percent” of US health care spending in calendar year 2018.
As of July 1, 2021, thirty-eight states and Washington, D.C., had adopted Medicaid expansion, although two of those states (Missouri and Oklahoma) had ”adopted but not yet implemented expansion,” according to the Henry J. Kaiser Family Foundation. The American Rescue Plan Act (ARPA) of 2021, which was signed into law in March 2021, “offers states an additional incentive to expand [Medicaid] during the pandemic, with a temporary boost in the federal contribution” to this federal-state program, according to a May 25, 2021, Roll Call article. The article mentions expansion hurdles in Texas and Mississippi and notes that although Alabama, South Dakota, Wisconsin, and Wyoming are each “considering broader Medicaid eligibility” in its own way, “none is a sure bet for expansion.”
A May 2021 issue brief, “The Economic and Employment Effects of Medicaid Expansion under the American Rescue Plan,” cited in the Roll Call piece, was funded by the Commonwealth Fund. In the brief, two George Washington University researchers explain that ARPA incentives for expanding Medicaid to fourteen states (including Missouri and Oklahoma) “would yield economic benefits in addition to gains in health care access.” For example, Texas would gain 298,900 jobs.
Following are some examples of foundation funding related to Medicaid.
“In response to the pandemic,” states and the federal government have made numerous changes to Medicaid, says the Robert Wood Johnson Foundation’s (RWJF’s) 2021 Call for Proposals for its Research in Transforming Health and Health Care Systems national program. Some of those changes, originally considered temporary, may become permanent. Managed by AcademyHealth, the program will fund research “studies that examine the impact of Medicaid policies on communities of color and/or explore how current or proposed policies may alleviate or exacerbate racial inequity and structural racism” in Medicaid. The RWJF is interested in understanding how enrollees, states, and others have been affected by recent policy changes. The application period has concluded, but in March 2022 the RWJF will announce those selected for grants ranging from $150,000 to $350,000. The program says that rigorous evidence is necessary “to inform Medicaid policy” after the pandemic and to help policy makers “identify and eliminate policies that contribute to racial inequities.”
The Commonwealth Fund awarded a one-year, $778,250 grant to Harvard College to research the health and economic effects of COVID-19 on Arkansas, Kentucky, Louisiana, and Texas. The project also is examining “how Medicaid expansion has affected” responses to and the effects of the coronavirus in those states, says the Commonwealth Fund website. Texas is the only nonexpansion state in that group. “With the lag in federal surveys, private data collection such as this is essential for enabling federal and state governments to chart a path forward for their health systems and economies.”
The W. K. Kellogg Foundation (WKKF) awarded a $750,000 grant for 2020–22 to Mercy Health to increase access to health benefits for people of color in Mississippi “by providing Medicaid consumer assistance and education to communities and advocates,” according to the funder’s website. The grantee’s Mississippi Health Advocacy Program (MHAP) will use the money for its Strategic Health Assistance and Response Policy Initiative, according to a WKKF spokesperson. The funding will enhance MHAP’s role of helping lower-income families “navigate a complex enrollment and re-enrollment process” for Medicaid and the Children’s Health Insurance Program. This grant also supported “a statewide public education campaign” highlighting how health care coverage options for families in the state were being affected by the COVID-19 pandemic. In 2021 MHAP plans “to share stories of uninsured Mississippians in the ‘coverage gap’” because the state has not expanded Medicaid.
Community Health Workers Promotores in the Future of Medi-Cal is a fifteen-month California Health Care Foundation (CHCF) project. These workers are “trusted community members with lived experience” who can connect people “not well served by the traditional health care system with culturally competent health and social services.” The project aims to support Medi-Cal (California Medicaid) managed care plans with “tools to effectively integrate this highly effective workforce into their programs and services,” thus improving health outcomes for enrollees and advancing health equity for all state residents. Grantees include the Center for Health Care Strategies (CHCS), Health Management Associates, and others. As of June 2021, the project had released three “resource packages” on these workers’ care delivery role; training approaches; and data and evaluation (including “considerations for measuring the impact of programs” employing community health workers and promotores).
The pandemic showed the need to support family caregivers, says the National Academy for State Health Policy (NASHP), which presented a May 2021 webinar titled “Paying Family Caregivers through Medicaid Consumer-Directed Programs—State Opportunities and Innovations.” Such programs support enrollees cared for by family members and “individuals they are comfortable with.” Presenters included state officials from Connecticut and Virginia who described how those states “have expanded consumer direction to better serve older adults and people with disabilities and their family caregivers.” The John A. Hartford Foundation funded the webinar and the April 2021 NASHP report that was highlighted at the event.
The CHCS released an April 2021 technical assistance tool on “Building a Medicaid Strategy to Address Health-Related Social Needs.” Funded by the Episcopal Health Foundation, this tool can “guide state Medicaid agencies in developing a cohesive strategy” to address such needs “in the context of two dominant Medicaid trends: increases in Medicaid managed care enrollment and the proliferation of value-based payment models.” Using such a strategy can help states “advance health equity and improve community-level social determinants of health” (SDOH).
In 2018 California passed a law (SB 1004) that “requires Medi-Cal managed care plans to provide access to palliative care,” according to the CHCF website. The funder and the Coalition for Compassionate Care of California cohosted an April 2021 webinar, which discussed “progress and challenges” in “delivering SB 1004 palliative care services”; virtual visits; innovative practices used by providers and health plans to improve “access to, quality of, and impact of” their programs; and more.
Vanetta Abdellatif, Arcora Foundation president and CEO, mentioned the foundation’s DentistLink program in her broader presentation on oral health at Grantmakers In Health’s 2021 annual conference. The free DentistLink referral program helps Apple Health (Washington State Medicaid) enrollees find dentists who accept Medicaid and makes referrals for other state residents, including the uninsured. “Apple Health covers dental care for both children and adults,” according to DentistLink’s website. Abdellatif noted that when only emergency dental care was allowed during the pandemic, DentistLink stepped in to find providers with open offices.
In May 2021 NASHP published “Medicaid Strategies for Addressing Social Determinants of Health: Considerations from State Leaders for Improving Oral and Overall Health,” a blog post. Funded by the CareQuest Institute for Oral Health, the post notes that states are trying to improve the health of enrollees and reduce costs “by addressing [SDOH] in their managed care medical and dental contracts.” NASHP learned from discussions with state leaders that “integrating medical and dental systems to more effectively coordinate care and address patients’ social needs” is one key strategy. Many examples of states’ innovations are included.
In March 2021 the Blue Cross Blue Shield of Massachusetts Foundation released a primer on dual eligibles receiving health care coverage through both Medicare and MassHealth (Massachusetts Medicaid). The primer has four parts, including “a data chart pack” offering “a detailed analysis of enrollment, demographics, and spending trends” among dual eligibles in the Bay State.
In March 2021 the Milbank Memorial Fund released an issue brief titled “Medicaid Delivery System Reforms to Combat the Opioid Crisis.” Produced by AcademyHealth, the brief highlights two innovations, “health homes” and “warm handoffs and care transitions” (from inpatient or residential treatment to outpatient care, and from outpatient to a primary care doctor), which are being used in some states “to improve opioid use disorder outcomes.”
In addition, the Peter G. Peterson Foundation released a brief “explainer” titled “How Do States Pay for Medicaid?” in February 2021.The Montana Healthcare Foundation (MHCF) published a January 2021 report, produced by Manatt Health, titled Medicaid in Montana: How Medicaid Affects Montana’s State Budget, Economy, and Health. The MHCF and Headwaters Foundation cofunded the January 2021 report Economic Effects of Medicaid Expansion in Montana.
In a May 2021 statement, Missouri Foundation for Health (MFH) said, “There is no single issue more important [to its] work and mission than Medicaid expansion and achieving health equity in Missouri.” In August 2020 voters “approved an amendment to ingrain Medicaid expansion into Missouri’s constitution,” MFH explained. Expansion of MO HealthNet was to begin July 1, 2021. But because of “the state’s decision not to move forward [with expansion], uncertainty now clouds” the program’s future. A ruling by the Missouri Supreme Court was expected in late July 2021, MFH staff said.
Other foundations funding projects on Medicaid include the Kansas Health Foundation, which lists Medicaid expansion as one of its 2021 policy priorities. The Mt. Sinai Health Care, George Gund, and Woodruff Foundations fund the Center for Medicaid Policy (focused on Ohio Medicaid) at the Center for Community Solutions, in Cleveland.
Key Personnel Change
Elizabeth “Liz” Fowler is now a deputy administrator at the Centers for Medicare and Medicaid Services and director of its Center for Medicare and Medicaid Innovation, according to the agency’s website. She was previously executive vice president of programs at the Commonwealth Fund.
Compiled and written by Lee L. Prina, senior editor