An Overview of Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) Grants
Executive Summary
For more information on MIPCD grants, see http://innovation.cms.gov/initiatives/MIPCD/.
Kathleen Sebelius, Initial Report to Congress: Medicaid Incentives for Prevention of Chronic Diseases Evaluation (Washington, DC: U.S. Department of Health and Human Services, November 2013), http://innovation.cms.gov/Files/reports/MIPCD_RTC.pdf.
MIPCD Grants
“Chronic Disease Prevention and Health Promotion,” Centers for Disease Control and Prevention, accessed July 17, 2014, http://www.cdc.gov/chronicdisease/overview/index.htm?s_cid=ostltsdyk_govd_203.
Brian Ward, Jeannine Schiller, and Richard Goodman, “Multiple Chronic Conditions Among US Adults: A 2012 Update,” Preventing Chronic Disease 11, 130389 (April 2014), doi: http://dx.doi.org/10.5888/pcd11.130389.
“Chronic Disease Prevention and Health Promotion,” Centers for Disease Control and Prevention.
Elizabeth McGlynn, et al., “The Quality of Health Care Delivered to Adults in the United States,” New England Journal of Medicine 348 (June 2003): 2635-2645, http://www.nejm.org/doi/full/10.1056/NEJMsa022615.
Centers for Disease Control and Prevention, “CDC Health Disparities and Inequalities Report — United States, 2011,” Morbidity and Mortality Weekly Report Supplement 60 (January 2011): 1-113, http://www.cdc.gov/mmwr/pdf/other/su6001.pdf; Agency for Healthcare Research and Quality, 2010 National Healthcare Disparities Report (Washington, DC: AHRQ, 2010), http://www.ahrq.gov/qual/nhdr10/nhdr10.pdf.
Centers for Disease Control and Prevention, “CDC Health Disparities and Inequalities Report — United States, 2011,” Morbidity and Mortality Weekly Report Supplement 60 (January 2011): 1-113; Youfa Wang and May Beydoun, “The Obesity Epidemic in the United States – Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: A Systematic Review and Meta-Regression Analysis,” Epidemiologic Reviews 29, no. 1 (January 20017): 6-28, http://epirev.oxfordjournals.org/content/29/1/6.full; Ali Mokdad et al., “Actual Causes of Death in the United States, 2000,” Journal of the American Medical Association 291, no. 10 (2004): 1238-1245, http://jama.jamanetwork.com/article.aspx?articleid=198357.
See, for example: Center for Health Care Strategies, Inc., Examples of Consumer Incentives and Personal Responsibility Requirements in Medicaid (Hamilton, NJ: CHCS, May 2014), http://www.statecoverage.org/files/Consumer_Incentive_Matrix_060414.pdf.
“Preventive Health Assistance (PHA),” Idaho Department of Health and Welfare, accessed July 17, 2014, http://healthandwelfare.idaho.gov/Medical/Medicaid/PreventiveHealthAssistance/tabid/221/Default.aspx
See, for example: Pat Redmond, Judith Solomon, and Mark Lin, Can Incentives for Healthy Behavior Improve Health and Hold Down Medicaid Costs? (Washington, DC: Center on Budget and Policy Priorities, June 2007), http://www.cbpp.org/files/6-1-07health.pdf; Suzanne Felt-Lisk and Fabrice Smieliauskas, Evaluation of the Local Initiative Rewarding Results Collaborative Demonstrations: Interim Report (Washington, DC: Mathematica Policy Research, Inc., August 2005), http://www.mathematica-mpr.com/~/media/publications/PDFs/evaluationlocal.pdf; Joan Alker and Jack Hoadley, The Enhanced Benefits Rewards Program: Is it Changing the Way Medicaid Beneficiaries Approach their Health? (Washington, DC: Georgetown University Health Policy Institute, July 2008), https://georgetown.app.box.com/s/bahpaz41w5lkxxeey4p9; John Barth and Jessica Greene, Encouraging Healthy Behaviors in Medicaid: Early Lessons from Florida and Idaho (Hamilton, NJ: Center for Health Care Strategies, Inc., July 2007), http://www.chcs.org/media/Encouraging_Healthy_Behaviors_in_Medicaid.pdf; Jessica Greene, Medicaid Efforts to Incentivize Healthy Behaviors (Hamilton, NJ: Center for Health Care Strategies, Inc., July 2007), http://www.chcs.org/media/Medicaid_Efforts_to_Incentivize_Healthy_Behaviors.pdf; Aimee Miles, “Medicaid to Offer Rewards for Healthy Behavior,” Kaiser Health News (April 11, 2011), http://www.kffhealthnews.org/Stories/2011/April/08/Medicaid-incentives.aspx; Carol Irvin, Healthy Indiana Plan: The First Two Years (Indianapolis, IN: Mathematica Policy Research, Inc., July 15, 2010), http://www.mathematica-mpr.com/~/media/publications/PDFs/health/healthyIndiana_Irvin.pdf; Hilltop Institute, Evaluation of the HealthChoice Program (Baltimore, MD: Hilltop Institute, March 2012), http://www.hilltopinstitute.org/publications/EvaluationOfTheHealthChoiceProgram-March2012.pdf; Michael Hendryx et al., Evaluation of Mountain Health Choices: Implementation, Challenges, and Recommendations (Princeton, NJ: Robert Wood Johnson Foundation, August 2009), http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/08/evaluation-of-mountain-health-choices.html; Tami Gurley-Calvez et al., “Choice in Public Health Insurance: Evidence from West Virginia Medicaid Redesign,” Inquiry 48, no. 1 (February 2011): 15-33, http://inq.sagepub.com/content/48/1/15.full.pdf+html; January Angeles and Judith Solomon, Louisiana’s Medicaid Waiver Proposal: Is it the Right Fit for Louisiana? (Washington, DC: Center on Budget and Policy Priorities, December 2008), http://www.cbpp.org/cms/index.cfm?fa=view&id=2218#_ftn20; Jim Saunders, “Florida Legislature Passes Massive Medicaid Overhaul,” Kaiser Health News (May 8, 2011), http://www.kffhealthnews.org/Stories/2011/May/08/Florida-Legislature-Passes-Massive-Medicaid-Overhaul.aspx; Judith Solomon, West Virginia’s Medicaid Changes Unlikely to Reduce State Costs or Improve Beneficiaries’ Health (Washington, DC: Center on Budget and Policy Priorities, May 2006), http://www.cbpp.org/cms/?fa=view&id=336; Families USA, Mountain Health Choices: An Unhealthy Choice for West Virginians (Washington, DC: Families USA, August 2008).
“Preventive Health Assistance (PHA),” Idaho Department of Health and Welfare.
“Mountain Health Choices,” Mountain Health Trust, accessed August 11, 2014, http://www.mountainhealthtrust.com/mountainhealthchoices.aspx.
Indiana’s Healthy Indiana Plan (HIP) is a pre-ACA Medicaid expansion program for uninsured adults ages 19-64 earning less than 100% of the federal poverty level (FPL) ($11,670 for an individual and $19,790 for a family of three in 2014). Individuals receive a $1,100 health savings account, to which the state and individual contribute. If beneficiaries complete all age and gender appropriate preventive services, all remaining account funds (both state and individual) are rolled over to the next year; however, if preventive services are not completed, only the individual’s prorated contribution (not the state’s) rolls over. Indiana has submitted a waiver to implement HIP 2.0, which builds on the original HIP program. HIP 2.0 will be an option for adults ages 19 to 64 with incomes up to 138% FPL. However, if the waiver is not approved, the state has submitted a contingency waiver to renew the current HIP program for another three years. See: “Healthy Indiana Plan,” Healthy Indiana Plan, accessed July 17, 2014, http://www.in.gov/fssa/hip/index.htm; “Governor Pence Unveils HIP 2.0 Plan to Provide Consumer-Driven Health Care Coverage for Uninsured Hoosiers,” Healthy Indiana Plan, accessed July 17, 2014, http://www.in.gov/fssa/hip/files/HIP_2.0_release_5.15.pdf; “HIP 2.0 Proposal,” Healthy Indiana Plan, accessed July 17, 2014, http://www.in.gov/fssa/hip/2442.htm.
See, for example: Florida’s Section 1115 demonstration waiver, Managed Medical Assistance (formerly titled Medicaid Reform): http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/fl/fl-medicaid-reform-ca.pdf; Indiana’s Section 1115 demonstration waiver, Healthy Indiana Plan (HIP): http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/in/in-healthy-indiana-plan-fs.pdf and HIP 2.0 waiver application: http://www.in.gov/fssa/hip/files/HIP_2_0_Waiver_(Final).pdf.
See, for example: Indiana’s Hoosier Healthwise program: http://provider.indianamedicaid.com/provider-specific-information/managed-care.aspx.
See, for example: Genevieve Kenney and Jennifer Pelletier, Medicaid Policy Changes in Idaho under the Deficit Reduction Act of 2005: Implementation Issues and Remaining Challenges (Washington, DC: State Health Access Reform Evaluation, June 2010), http://www.shadac.org/files/shadac/publications/IdahoMedicaidDRACaseStudy.pdf; Michael Hendryx et al., Evaluation of Mountain Health Choices: Implementation, Challenges, and Recommendations (Princeton, NJ: Robert Wood Johnson Foundation, August 2009), http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/08/evaluation-of-mountain-health-choices.html.
See, for example: Suzanne Felt-Lisk and Fabrice Smieliauskas, Evaluation of the Local Initiative Rewarding Results Collaborative Demonstrations: Interim Report; The Commonwealth Fund, Feature: Public Programs are Using Incentives to Promote Healthy Behavior, October 2007, http://www.commonwealthfund.org/publications/newsletters/states-in-action/2007/oct/september-october-2007/feature/public-programs-are-using-incentives-to-promote-healthy-behavior; The Commonwealth Fund, Wisconsin: BadgerCare Plus Healthy Living Update, April 2008, http://www.commonwealthfund.org/publications/newsletters/states-in-action/2008/apr/april-may-2008/snapshots--short-takes-on-promising-programs/wisconsin--badgercare-plus-healthy-living-update.
As of July 1, 2014, Enhanced Benefits Reward$ Program participants are no longer be able to earn new credits for participating in healthy behaviors, however participants may redeem their credits until June 30, 2015. See: Florida Agency for Health Care Administration, Letter to Enhanced Benefits Reward$ Program Participants, July 31, 2013, http://www.fdhc.state.fl.us/medicaid/Enhanced_Benefits/EB_Program_Phase_Out_1st_Notice_07-31-2013.pdf. The MMA program was rolled out between May-August 2014. See: “Managed Medical Assistance,” Agency for Health Care Administration, accessed August 11, 2014, http://www.fdhc.state.fl.us/medicaid/statewide_mc/mmahome.shtml. In the renewed MMA Section 1115 waiver, the state will require managed care plans operating in MMA program counties to establish programs to encourage and reward healthy behaviors. These programs will be administered by the plans, and each plan must have, at a minimum, a medically approved smoking cessation program, a medically directed weight loss program, and a substance abuse treatment plan that meet all state requirements. See: Centers for Medicare and Medicaid Services, Letter from Cindy Mann to Justin Senior, July 31, 2014, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/fl/fl-medicaid-reform-ca.pdf. For more information, see: Centers for Medicare and Medicaid Services, Medicaid Waivers: Florida Managed Medical Assistance (MMA), accessed August 11, 2014, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers_faceted.html.
The enhanced benefit plan was comparable to the traditional Medicaid plan, but covered additional benefits such as weight management and nutritional education services. The basic benefit plan covered fewer services than the traditional Medicaid plan by limiting prescription drugs and not covering benefits such as tobacco cessation, diabetes education, and chiropractic and podiatry services. The Mountain Health Choices program operated under state plan amendments under the Deficit Reduction Act.
Associated Press, “New Rule to End West Virginia’s Medicaid Redesign,” The Register-Herald (May 19, 2010), http://www.register-herald.com/news/state_and__region/article_70fe5794-4176-50f7-a5c8-1d018f6503cc.html; Eric Eyre, “West Virginia Medicaid Redesign Cost State Money,” Charleston Gazette (December 23, 2012), http://www.wvgazette.com/News/201212230095; Doug Trapp, “Federal Rule Drastically Cuts Wellness Program in West Virginia,” American Medical News (November 12, 2010), http://www.amednews.com/article/20101112/government/311129997/8/.
Robert Kane et al., Economic Incentives for Preventive Care (Rockville, MD: Agency for Healthcare Research and Quality, August 2004), http://www.ahrq.gov/downloads/pub/evidence/pdf/ecinc/ecinc.pdf.
See, for example: Pat Redmond, Judith Solomon, and Mark Lin, Can Incentives for Healthy Behavior Improve Health and Hold Down Medicaid Costs?; Jessica Greene, Medicaid Efforts to Incentivize Healthy Behaviors.
See Endnote 11.
Ibid.
See, for example: Kevin Volpp et al., “A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation,” special article, New England Journal of Medicine 360, no. 7 (February 2009): 699-709, http://www.nejm.org/doi/pdf/10.1056/NEJMsa0806819; Kevin Volpp et al., “Financial Incentive-Based Approaches for Weight Loss: A Randomized Trial,” Journal of the American Medical Association 300, no. 22 (December 2008): 2631-2637, http://jama.ama-assn.org/content/300/22/2631.full.pdf+html; Centers for Medicare and Medicaid Services, Medicaid Incentives for Prevention of Chronic Diseases Funding Opportunity Announcement (Washington, DC: CMS, February 2011), http://innovation.cms.gov/Files/fact-sheet/MIPCD-Funding-Opportunity-Announcement.pdf; Robert Kane et al., “A Structured Review of the Effect of Economic Incentives on Consumers’ Preventive Behavior,” American Journal of Preventive Medicine 27, no. 4 (November 2004): 327-352, doi: http://dx.doi.org/10.1016/j.amepre.2004.07.002; Ron Goetsel and Nicolaas Pronk, “Worksite Health Promotion: How Much do we Really Know About What Works?,” American Journal of Preventive Medicine 38, no. 2, supplement (February 2010): S223-S225, http://www.ajpm-online.net/article/S0749-3797(09)00754-5/abstract.
Texas received the largest first-year grant award ($2,753,130), while Montana received the smallest first-year grant award ($111,788). At the time of the interim evaluation, RTI did not have the data required to complete an analysis of states’ associated administrative costs, but plans to do so in future analyses.
Kathleen Sebelius, Initial Report to Congress: Medicaid Incentives for Prevention of Chronic Diseases Evaluation.
Ibid.
States are taking different approaches to defining their target populations of Medicaid beneficiaries with or at risk of chronic diseases. For example, some states are focusing on specific age groups, locations, or beneficiaries with particular health characteristics, diagnoses, or risk factors. Some states are focusing on, or running separate programs for, beneficiaries enrolled in managed care organizations (MCOs) and fee-for-service (FFS) Medicaid. Other states are focusing on beneficiaries who receive care at specified providers, such as participating community mental health centers.
Kathleen Sebelius, Initial Report to Congress: Medicaid Incentives for Prevention of Chronic Diseases Evaluation.
Ibid.
Ibid.
Ibid.
Wisconsin changed its initiative from a clinical trial to a quality improvement project; however, it is maintaining its randomized two-group design.
Kathleen Sebelius, Initial Report to Congress: Medicaid Incentives for Prevention of Chronic Diseases Evaluation.
U.S. Department of Health and Human Services, MIPCD Funding Opportunity Announcement (Washington, DC: U.S. Department of Health and Human Services, February 23, 2011), http://innovation.cms.gov/Files/fact-sheet/MIPCD-Funding-Opportunity-Announcement.pdf.
Status of MIPCD Programs to Date
Kathleen Sebelius, Initial Report to Congress: Medicaid Incentives for Prevention of Chronic Diseases Evaluation.
Ibid.
Public Law 111-148, 111th Congress, Sec. 4108 (Patient Protection and Affordable Care Act): http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf.
For more information on these waivers, see: Kaiser Commission on Medicaid and the Uninsured, Medicaid Expansion Through Premium Assistance: Arkansas, Iowa, and Pennsylvania’s Proposals Compared (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2014), https://www.kff.org/health-reform/fact-sheet/medicaid-expansion-through-premium-assistance-arkansas-and-iowas-section-1115-demonstration-waiver-applications-compared/; Robin Rudowitz, Samantha Artiga, and MaryBeth Musumeci, The ACA and Recent Section 1115 Medicaid Demonstration Waivers (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, February 2014), https://www.kff.org/medicaid/issue-brief/the-aca-and-recent-section-1115-medicaid-demonstration-waivers/; Alexandra Gates, Robin Rudowitz, and MaryBeth Musumeci, Medicaid Expansion in Michigan (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2014), https://www.kff.org/medicaid/fact-sheet/medicaid-expansion-in-michigan/.
See Endnote 15.
