Genevieve Kenney: The Sport of Medicaid Reform

Genevieve Kenney, Ph.D., is a Senior Fellow at the Urban Institute and has over 20 years experience conducting health policy research. Jenny has worked extensively on coverage and access issues facing low-income families and children. She has evaluated various Medicaid and State Children’s Health Insurance Programs. Her SHARE project evaluates Medicaid reform initiatives in Kentucky and Idaho. Collaborators on the project include Julia Costich and Jeff Talbert from the University of Kentucky, Jim Marton from Georgia State University, Ed Baker from Boise State University and Jennifer Pelletier from The Urban Institute.

We talked to Jenny about digging into data, following in her mother's footsteps, and sports writing.

Kentucky and Idaho are both experimenting with Medicaid reforms to reduce costs while maintaining access and quality. How do they plan on doing that?

Both states planned to implement a combination of strategies that included cost sharing, tailored benefit packages, personal health benefits, disease management programs, and reimbursement changes aimed at promoting greater receipt of preventive care. Both states acted quickly after the passage of the Deficit Reduction Act in 2005 and were early adopters of these types of policy changes.

Do states benefit from enacting reforms under the Deficit Reduction Act as opposed to applying for Medicaid waivers?

The Deficit Reduction Act made it easier for states to make changes to benefit packages and cost sharing requirements in Medicaid. Changes could be made through State Plan Amendments as opposed to through Waivers which need to be regularly renewed and meet certain budget neutrality conditions and which have stricter reporting requirements.

Does your study employ a quantitative, a qualitative or a mixed-methods approach?

We use a mixed-methods approach. I’m an economist and one of the nerdiest researchers you are ever going to meet. I love data. I love digging into data and using number-driven analyses to answer interesting questions. But over the years I have come to see how helpful qualitative data is to understanding implementation issues associated with policy changes and for identifying factors that may confound impact analyses. Using a mixed-methods approach, this study will identify challenges to reforming Medicaid that operate on a variety of levels: political, operational, and service delivery and quantify the impacts of particular policy changes, where possible to do so.

Other states will certainly be interested in those results – will they be able to see how their programs stack up?

There is great diversity with respect to state Medicaid programs, but we haven’t figured out a way to reap maximum benefit when it comes to evaluating the implications of that diversity. Researchers interested in studying Medicaid and CHIP have very limited comparable information across states. This is a source of frustration because despite the potential benefits of state experimentation, we have not learned nearly as much from it as is desirable from a public policy standpoint.

When did you become interested in these issues?

My junior year of college I had the opportunity to study abroad in Paris and Geneva, where I took a number of international classes that focused on the developing world. I became interested in issues around poverty, and I started seeing economics as a useful framework for devising policy solutions. During that time my mother was working on her Ph.D. in agricultural economics and I was fortunate enough to assist her with collecting some of her dissertation data, so I knew exactly what a doctorate in economics entailed. Thanks to this experience and many conversations with my mom, I started graduate school with open eyes.

When did you start working on health care topics?

When I first came to the Urban Institute I did some international work, particularly on health and family planning issues in Africa and Asia. I worked on a variety of interesting policy questions around low income populations – from homelessness in the United States and family planning in Indonesia to health programs in Senegal. But for much of the past 20 years, my work has focused on how public policy shapes coverage, access, and health outcomes for low income kids, pregnant women, and families in the United States.

If you had rebelled against your mom’s academic path, what would you have done instead?

I wanted to be a sports writer. I wrote for the sports section of my high school paper and played tennis. I also loved football and basketball. I loved sports, even though I am probably a better spectator than active participant!