10 State Strategies for Improving Medicaid


As Medicaid consumes a larger share of state budgets, policymakers seek ways to improve outcomes, reduce costs and make sure their state’s program is managed as efficiently and effectively as possible.

Report coverWhile there is no silver bullet, states are adopting a wide array of strategies to reduce spending, improve care outcomes and quality, and provide states with a return on their health investments.

Over its 50-year history, Medicaid has represented an important and evolving issue for state policymakers. Approximately one in five, or 68 million, Americans received coverage through Medicaid in 2017, making it the largest source of coverage for low-income children, pregnant women, adults, seniors and people with disabilities. Although federal law sets Medicaid minimum standards related to eligible groups, required benefits and provider payments, it offers states latitude in decisions about program eligibility, optional benefits, premiums and cost-sharing, delivery system and provider payments.

As a result, each state Medicaid program is unique, reflecting that states have options through their state plan amendments or by using Section 1115 waivers to design programs that better meet their needs and priorities. A state plan is an agreement between a state and the federal government describing how that state administers its Medicaid program; waivers give states latitude to deviate from those agreements.

States have adopted a wide range of innovations to improve Medicaid quality and results. States enacted more than 100 Medicaid laws in 2017 aimed at reducing costs and improving outcomes through a variety of delivery and payment reforms, eligibility expansions and Medicaid waivers. The following 10 questions highlight state strategies to address pressing health care challenges and deliver high-quality, cost-effective services to the millions of adults and children who rely on Medicaid for their coverage.

  1. What are states doing to introduce new Medicaid payment models?
  2. What can states do to improve Medicaid performance and quality?
  3. What are state Medicaid programs doing to address the opioid crisis?
  4. What are states doing to focus on high-needs, high-cost patients?
  5. What are best practices for promoting healthy births?
  6. How are Medicaid programs encouraging personal responsibility through incentives and work requirements?
  7. What are states doing related to enrollment, eligibility and cost-sharing?
  8. What are states doing to integrate behavioral health and primary care?
  9. How can Medicaid programs decrease fraud, abuse and waste?
  10. How are states improving and managing long-term services and supports (LTSS)?



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