The Medicaid Incentives for the Prevention of Chronic Disease grant program, which provided a total of $85 million over five years, tested the effectiveness of providing incentives directly to Medicaid beneficiaries of all ages who participated in MIPCD prevention programs, and changed their health risks and outcomes by adopting healthy behaviors.
Awards were for a 5-year period, but are subject to annual renewal of funding. Grants must have 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 in the case of a diabetic, improving the management of the condition.
Key features of the programs that received grant awards are detailed below.
The Medicaid Incentives for Prevention of Chronic Diseases: Increasing Quitting among Medi-Cal Smokers was expected to engage 20,497 Medi-Cal (Medicaid) beneficiaries in quitting smoking and managing diabetes through a new service: telephone counseling. The state also expected outreach efforts to bring in as many as 100,000 callers to the state telephone helpline.
Medi-Cal members would be offered a $20 incentive to call the helpline, complete the intake protocol, and participate in counseling sessions. Beneficiaries were also able to obtain nicotine replacement therapy by calling the helpline. To encourage callers to maintain their efforts to quit smoking, eligible beneficiaries also received $10 for every relapse-prevention call they complete. Both the helpline and the California Diabetes Program planned to conduct rigorous evaluations which would allow them to tailor their interventions throughout the grant period.
The California Department of Health Care Services oversaw the program; partner organizations include the California Medicaid Research Institute, a University of California multi-campus research program; the University of California; the San Diego Smoker’s Helpline, the California Diabetes Program, and the University of California San Francisco.
CA Detailed Summary (PDF) | First Year Grant Award: $1,541,583
The Incentives to Quit Smoking for Connecticut Medicaid Program (iQUIT) was a tobacco cessation program that focused on pregnant women and mothers of newborns, and people with serious mental illness. Led by the Connecticut Department of Social Services, partners include the state Department of Public Health, the Department of Mental Health and Addiction Services, adult and pediatric medical homes, obstetrics providers, local mental health authorities, the Connecticut Hispanic Health Council (HHC) and a Yale University research team.
Envisioned as part of the person-centered medical home program Connecticut developed to provide primary care to Medicaid beneficiaries, the iQuit program targeted Medicaid recipients over 18 who smoke and provided counseling, access to a Quitline, nicotine-replacement therapy (NRT), other medications, and peer coaches. Incentives for counseling and using the Quitline range from $5 to smokers for each counseling visit or call to the Quitline, to $15 for a negative CO breathalyzer test and for attending five counseling sessions.
The iQuit program expanded an existing Department of Health tobacco cessation program, which enrolled 1,600 prenatal care patients in six Federal Qualified Health Centers.
CT Detailed Summary (PDF) | First Year Grant Award: $703,578
The Hawaii Patient Rewards and Incentive for Supporting Empowerment Project (HI-PRAISE) aimed to improve early detection and diabetes self-management for 4,521 patients during the recruitment period.
HI-PRAISE was a collaboration of the state Medicaid office; the University of Hawaii (UH) John A. Burns School of Medicine; the UH Center for Disability Studies, private providers, and 14 community health centers (CHCs) across the state. The state estimated that there were over 11,000 Medicaid insured adults with diabetes in Hawaii. Initially, approximately 3,731 patients ages 18 or older were recruited from the CHCs.
CHCs and providers determined the amount, frequency, and type of incentives, which could include a $20 gift card for compliance with ADA-recommended strategies such as blood tests, eye exams and cholesterol tests, to prevent, treat, and manage diabetes or a $25 coupon for patients who go to the first session of smoking cessation, behavioral health counseling and diabetes education as appropriate. The program paid CHCs and private providers $150 per patient for diabetes education during clinical visits and for referrals to services that will help break down barriers to improving their health.
HI Detailed Summary (PDF) | First Year Grant Award: $1,265,988
The primary prevention goal of the Minnesota Medicaid Incentives for Prevention of Diabetes targeted weight loss as the gateway to long-term reductions in diabetes, improved cardiovascular health, and reduced health care expenditures.
Working with the state health department and the local and national YMCAs, the state Medicaid program enrolled Medicaid beneficiaries between the ages of 18 and 75 who live in the Twin Cities metro area, and who have been diagnosed with pre-diabetes or who have a significant risk of developing type 2 diabetes. The program, taught by certified YMCA coaches, worked with the State’s 36 certified health care homes to identify participants and offered them the opportunity to participate at no cost.
In addition to meals, transportation, childcare, and other support, participants received health-related incentives, such as vouchers for use at farmers’ markets, exercise equipment, or healthy foods cookbooks. The incentives were valued between $10 and $50 for participation, goal attainment, and goal maintenance.
MN Detailed Summary (PDF) | First Year Grant Award: $1,015,076
The Montana Medicaid Incentives to Prevent Chronic Diseases Program promoted diabetes prevention and reduction of cardiovascular disease in high-risk adults with Medicaid through weight loss promoted by healthy diet choices and regular physical activity. Led by the state Department of Public Health and Human Services’ Diabetes Prevention and Control Program and Medicaid Program, this intervention used the evidence-based diabetes prevention program model. The program enrolled a minimum of 726 adult Medicaid beneficiaries who are at risk for developing cardiovascular disease and type 2 diabetes. It built on the Montana Cardiovascular Disease and Diabetes Prevention Program, which has been operating in 14 health care facilities since 2008. These sites include diabetes self-management programs, cardiac rehabilitation programs, a local health department, and a rural health center. Participants were assisted in achieving a seven percent weight loss in 10 months and maintaining it over time, and used coaches who are certified diabetes educators, along with registered dieticians, registered nurses, exercise physiologists, and physical therapists. The maximum total cash incentive per participant was $320 provided through debit cards, which could be drawn down over an extended period of time.
MT Detailed Summary (PDF) | First Year Grant Award: $111,791
The Nevada Medicaid Incentives for Prevention of Chronic Diseases gave out points, redeemable for rewards, for participating in programs to control weight, lower cholesterol and blood pressure, and avoid the onset of diabetes. Medicaid and Nevada Check Up beneficiaries who were at risk of or diagnosed with diabetes were rewarded for participating in diabetes self-management programs conducted by Nevada’s Medicaid Managed Care Organizations, the University Medical Center or the YMCA. A third program, Healthy Hearts, targeted 950 children at risk of heart disease in fee-for-service Medicaid.
NV Detailed Summary (PDF) | First Year Grant Award: $415,606
The New Hampshire Wellness Incentive Program sought to help approximately 4,500 Medicaid beneficiaries with mental illness lose weight and stop smoking. Roughly half of these beneficiaries participated in a Supported Fitness and Weight Management program which could include a health club membership; participation in In SHAPE, a motivational health promotion program; participation in Weight Watchers, or a combination of In SHAPE and Weight Watchers.
Participants who express interest in quitting smoking following a smoking cessation decision support session could participate in smoking cessation programs that could include referral to a primary care physician, with or without additional phone or computer-based therapy. Participants would receive vouchers for memberships to community fitness centers and formal weight loss programs. Beneficiaries who received help quitting smoking would receive incentives for participation and positive outcomes. Half of participants in both the weight loss and anti-smoking programs would get monetary incentives to participate; the other half would be assigned to a control group that does not receive incentives.
NH Detailed Summary (PDF) | First Year Grant Award: $1,669,800
The New York State Medicaid Incentives Plan, which began piloting interventions in New York City and western New York, focus on quitting smoking, lowering high blood pressure, and managing diabetes or preventing its onset. New York hoped to enroll more than 18,000 adult Medicaid beneficiaries; its program would provide direct cash payments or lottery tickets as incentives. Participants would be assigned to one of four treatment arms for each prevention goal, to test how well different incentive approaches work.
Participants in one treatment arm would receive incentives for process activities, such as participating in smoking cessation counseling or attending primary care appointments. A second treatment arm would test whether outcome incentives—for example, quitting smoking or maintaining a reduced weight—are more effective. Participants in the third treatment arm would receive incentives for both process activities and outcomes. The final arm would serve as a control, with no incentives.
NY Detailed Summary (PDF) | First Year Grant Award: $2,000,000
Texas’s Wellness Action Planning and Navigation for Adults with Multiple Chronic Conditions targeted 1,250 participants with severe mental illness and individuals with other disabilities that co-occur with mental illness or substance use disorders, ages 21-55. Under this program, volunteer participants would be randomly placed into intervention and control groups. Intervention group participants would develop an individual wellness plan and would be able to draw on a $1150 per year flexible wellness account to help finance specific health goals that the participant defines. Health system navigators trained in motivational interviewing, person-centered planning, illness self-management, and flexible fund administration would also support these participants.
TX Detailed Summary (PDF) | First Year Grant Award: $2,753,130
In the Striving to Quit program, the Wisconsin Department of Health Services’ Tobacco Quit Line would connect adults who have Badger Care (Medicaid) coverage, with evidence-based tobacco cessation treatment services at primary care clinics. It would also link high-risk pregnant Badger Care members with trained smoking cessation counselors, in a new tobacco cessation program called “First Breath.”
The state expected to reach an estimated 8,000 adults with QuitLine counseling and hoped to achieve an anticipated quit rate of 25 percent. It hoped to provide face-to-face counseling to as many as 3,000 pregnant women, with special emphasis on reaching African American women, and aims for 36 percent to stop smoking. Each treatment option would have participants who get services and cash incentives, and a control group who would receive treatment services only.
WI Detailed Summary (PDF) | First Year Grant Award: $2,298,906