Ideas for Managing Costs and Improving Care Delivery for High-Cost Medicaid Beneficiaries

Chronic care is driving the cost of the Medicaid program, and the future of insurance coverage for low-income families and children depends upon success in meeting the needs of those with chronic conditions at a cost society can afford. This paper tallies the suggestions made by a group of informants who have given substantial thought to how Medicaid can achieve this goal.
National Academy for State Health Policy (NASHP) staff conducted 28 one-hour semi-structured telephone interviews with key informants representing state agencies, researchers, providers, and consumers during August, September, and October 2006. Informants were asked to describe innovations in Medicaid policy that would improve services to high-cost Medicaid beneficiaries and/or improve the cost effectiveness of the Medicaid program. They were also asked to describe the most effective levers for improving efficiency and quality and innovations that have been successful.
This paper is organized around four major categories of responses:
 1) remove the institutional bias in Medicaid;
2) improve coordination of care for dual eligibles;
3) improve chronic care management; and
4) reduce demand for the Medicaid program.

High Cost Medicaid Beneficiaries

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