5-Slide Series
This edition provides excerpts of opioid-related questions that have appeared in Medicaid MCO procurements. These slides demonstrate some of the ways in which states are using their request for proposal (RFP) process to promote innovation and elevate the MCOs’ mechanisms to effectively serve enrollees who have opioid use disorder.
Publication
This report was enlisted by the Pennsylvania Homecare Association to evaluate the need for enhancing Pennsylvania’s Medicaid Private Duty Nursing (PDN) payment rates. Through a mixture of quantitative analyses and real-life patient examples, this report highlights the anticipated benefits this PDN rate increase is projected to yield.
5-Slide Series
This edition looks at various state-level policy changes seeking to restrict inappropriate use of opioids, conducting a pre-versus-post comparison of prescription opioid usage related to the dates of these policy changes.
Publication
This report was commissioned by the Home Care and Hospice Association of Colorado. The report derives the Medicaid payment rate increase needed to attract adequate private duty nursing (PDN) service capacity in Colorado. We’ve estimated the cost to the Medicaid agency these rate increases will create — including the rate increase and the enhanced PDN capacity the higher payments can be expected to yield. The report also estimates the offsetting Medicaid savings that the increased PDN support can be expected to create via shortening and preventing hospitalizations.
5-Slide Series
This edition focuses on the trends in Medicaid prescription opioid and MAT use. An example of our findings is that opioid prescriptions per Medicaid enrollee decreased 54% from 2013-2022.
Publication
This report describes trends in opioid and medication-assisted treatment (MAT) prescription drug usage in Medicaid, put together for a presentation at a recent opioid conference.
Publication
Building upon our 2014 report titled Prescription Drug Adherence in Medicaid Managed Care, this report provides updated analyses performed on medication adherence, assesses the impacts of Medicaid expansion and the COVID-19 pandemic on medication adherence, and offers recommendations for further improvement to Medicaid medication access and adherence.
5-Slide Series
This edition summarizes our tabulations of several key Medicaid prescription drug cost and usage trends across the 2018-2022 timeframe. Our findings include:
• Pre-rebate costs per Medicaid prescription grew sharply, at an average annual rate of 9.7% from 2018-2022.
• Prescriptions per Medicaid enrollee have trended steadily downward since the onset of the COVID-19 pandemic.
• Pre-rebate MCO costs per prescription were 38.2% below the corresponding fee-for-service (FFS) figure in 2018 but this differential was less than half as wide (16.6%) during 2022.
• Managed care organizations (MCOs) paid for 74.3% of Medicaid prescriptions during Q4 2021. This proportion dropped to 62.5% in Q4 2022, with the decrease largely attributable to California implementing a carve-out model in January 2022.
5-Slide Series
This edition conveys some of our perspectives related to the current reinstatement of Medicaid redeterminations. This is an important time period to capture (and share) detailed information on how Medicaid enrollees can best be successfully reached, as well as the dynamics of continuous enrollment, coverage retention and loss. We delineate several specific data points that will be valuable to collect.
5-Slide Series
This edition focuses on the share of the overall population that receives Medicaid, and how this percentage has trended throughout the past decade nationally and state by state. Between Medicaid expansion, COVID dynamics, and some shifts in the economy’s performance, the past ten years have created several interesting Medicaid enrollment trends and large-scale shifts. Altogether, Medicaid enrollment jumped up 57% from 2013-2022, an increase of 36.2 million persons. Kentucky has experienced the largest rate of growth, ranking 42nd during 2013 in terms of the proportion of its overall population receiving Medicaid coverage and moving all the way to 8th as of 2022.
