The NCSL Blog


By Emily Blanford

With Medicaid accounting for nearly 30% of total state spending on average and significant enrollment increases over the course of the COVID-19 pandemic, policymakers seek options to manage state spending on Medicaid programs.

group of people standing arm in armNCSL’s latest health policy report, "Improving Health and Controlling Costs in Medicaidthe 6|18 initiative," highlights options to improve health outcomes and help control costs using evidence-based interventions identified by the Centers for Disease Control and Prevention’s (CDC) 6|18 Initiative.

The 6|18 Initiative was developed to better connect the health care sector, particularly payers like Medicaid, and the public health sector. The name “6|18” comes from the focus on six common, preventable health conditions and 18 evidence-based interventions to prevent and manage these conditions.

These chronic conditions include tobacco use, high blood pressure, inappropriate antibiotic use, asthma, unintended pregnancies and Type 2 diabetes. The conditions were selected for the initiative because they affect large numbers of people and significantly impact individual health and drive high health care spending. In addition, there are proven and practical evidence-based strategies to prevent or control these conditions.

For example, did you know that in the U.S. approximately 34 million people have diabetes and 84 million people have prediabetes? Fortunately, Type 2 diabetes can be prevented or delayed using evidence-based interventions that can help people make lifestyle changes necessary to manage diabetes.

Medicaid clients are more likely than privately insured individuals to have chronic conditions. With chronic conditions being among the costliest to treat and manage, both Medicaid beneficiaries and state budgets may benefit from the 6|18 evidence-based approaches to services.

People with certain chronic conditions also have a significantly higher risk of severe complications and death due to COVID-19, underscoring the value of projects like the 6|18 Initiative that connect public health and health care systems.

Check out "Improving Health and Controlling Costs in Medicaidthe 6|18 Initiative" for more information about the impacts of these chronic conditions and proven strategies, including state examples, to improve health and control Medicaid expenditures.

Emily Blanford is a program principal in NCSL’s Health Program. 

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This blog was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award (cooperative agreement OT18-1802) totaling $280,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CDC/HHS or the U.S. government.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.