Medicaid Incentives for the Prevention of Chronic Diseases Model

Section 4108 of the Affordable Care Act authorizes grants to States to provide incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors.

The initiatives or programs are to be “comprehensive, evidence-based, widely available, and easily accessible.” The programs must use relevant evidence-based research and resources. An application by a State for a grant under the program must address one or more of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition.

The Participating States

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There are 10 states participating in the Medicaid Incentives for the Prevention of Chronic Diseases Model. (List)
To view an interactive map of this Model, visit the Where Innovation is Happening page.

The following States were awarded grants based upon their proposal. They include statewide and non-statewide program areas in urban and rural locations:

CaliforniaMontanaNew York
ConnecticutNevadaTexas
HawaiiNew HampshireWisconsin
Minnesota  

See the details of these state efforts.

Background

Interventions that address the behavioral or social circumstances that influence participation in preventive health services and/or otherwise have a positive impact on outcomes of preventive health services may contribute to improving health and decreasing growth in health care expenditures.

Improving participation in preventive activities will require finding methods to encourage Medicaid consumers to engage in and remain in such efforts. A significant review of the effects of economic incentives on consumers’ preventive health behaviors, primarily in commercial insurance program was published in 2004 in the American Journal of Preventive Medicine. A systematic literature review identified 111 randomized controlled trials, of which 47 (published between 1966 and 2002) were reviewed. These studies showed that financial incentives worked about 73 percent of the time. Incentives that increased the ability to purchase a preventive service worked better than more diffuse incentives, but the type matters less than the nature of the incentive. Economic incentives were assessed to be effective in the short run for simple preventive care and distinct, well-defined behavioral goals.

Read more background related to this effort.

Initiative Details

These initiatives or programs are "comprehensive, evidence-based, widely available, and easily accessible." The programs must use relevant evidence-based research and resources, including: the Guide to Community Preventive Services; the Guide to Clinical Preventive Services; and the National Registry of Evidence-based Programs.

An application by a State for a grant under the program must address at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or improving the management of the condition.

Participating States must commit to operating their program for at least 3 years, conducting a State-level evaluation, and fulfilling reporting requirements specified by the legislation and CMS, including information technology system modification necessary to support the evaluation and reporting requirements. Approved administrative and program expenditures will be reimbursed through grant funds from the $100 million dollars appropriated for this program and evaluation. There is no State cost sharing requirement in this program.

Additional Information



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