The United States has a much higher rate of chronic disease compared to other developed countries, according to The Commonwealth Fund. In fact, the US Centers for Disease Control and Prevention reports that 6 in 10 Americans have a chronic disease, and those conditions are the primary contributor to the nation’s $3.5 trillion in annual health care costs. A high percentage of people with chronic disease receive their health care coverage through Medicaid.
Nearly 20 percent of Americans have their health care covered by Medicaid – the nation’s health care program for the low-income population. In 2014, Medicaid’s role in taking care of the poorest and sickest Americans grew when The Affordable Care Act empowered states to expand Medicaid to people with an income at or below 138 percent of the federal poverty level. Currently, 38 states and the District of Columbia have expanded their Medicaid coverage. That expansion of eligibility includes many who are sick and who have not previously had access to health care. And that includes many who have chronic medical conditions.
Can Medicaid Make a Difference?
In 2012, The Kaiser Family Foundation conduced an analysis, reporting, “The relatively comprehensive Medicaid benefits package and improved care management could also foster more appropriate care patterns for the uninsured at a greatly reduced out-of-pocket cost, potentially improving both their health and personal economic security, as these individuals have quite limited incomes. For these reasons, Medicaid eligibility may have a substantial, positive impact on the quality of life for poor, uninsured adults with chronic conditions, especially those without children—a vulnerable population that has historically been excluded from health coverage.”
The same report also concluded, “If states can meet the challenges of effectively implementing the ACA Medicaid expansion, the results of this analysis suggest that enrollment in Medicaid may provide greater access to important services that would enable newly eligible adults with chronic conditions to better manage their conditions.”
Medicaid Managed Care brings with it the promise of member outreach and case management to improve care for members with chronic conditions. Here are two examples of how that has played out.
· The report, Changes in Ambulatory Utilization After Switching from Medicaid Fee-for-Service to Managed Care, looked at Medicaid members in New York state. The researchers found that the transition from fee-for-service Medicaid to Medicaid Managed Care was associated with a significant decrease in ambulatory utilization, especially among beneficiaries with five or more chronic conditions.
· Molina Healthcare published a study on the outcomes from their Care Management programs, analyzing data on claims prior to enrollment in Care Management and 24 months of data post-enrollment in Care Management. The results show that Molina’s Care Management Programs successfully reduced all-cause inpatient admissions, emergency department visits, inpatient costs, emergency department costs, and total costs. Additionally, they saw improved adherence to medication regimens and the utilization of preventive care services.
As Medicaid continues to expand to cover more people, there is hope that a higher number of low-income individuals will get the care they need to prevent or manage chronic conditions.