SHADAC has worked both independently and under contract to the Robert Wood Johnson Foundation (RWJF) and the Medicaid and CHIP Payment Access Commission (MACPAC) to monitor and analyze changes in the Medicaid and CHIP policy landscape such as Medicaid expansion, eligibility, enrollment, and renewal, quality measurement, as well as states’ waiver application, implementation, and evaluation. SHADAC faculty and staff have exceptional knowledge of Medicaid and CHIP, including knowledge from the perspective of state policymakers and program administrators, as well as operational issues at the federal and state levels.
Below, you'll find examples of SHADAC projects and blogs in this area of expertise.
Related SHADAC Products
Medicaid Equity Monitoring Tool Project
With support from the Robert Wood Johnson Foundation (RWJF), SHADAC led a project designed to assess whether a comparative data tool would be useful to state Medicaid programs, policymakers, advocates, and others by providing information and opportunities for structural change to improve health equity for people enrolled in Medicaid.
Our goal was to identify a set of key equity-related indicators and understand whether populating them into a centralized “Medicaid Equity Monitoring Tool” could be a helpful, feasible, and reliable way of tracking and advancing health equity in Medicaid.
In the first of five originally planned project phases, SHADAC researchers and our partner, RACE for Equity, worked concurrently to: conduct environmental scans; engage stakeholders; develop a measurement framework for advancing health equity in the Medicaid program; and draft a tool wireframe.
In Phase 2, SHADAC conducted several planning activities to inform discussions of tool feasibility and decision making regarding next steps in tool development. This included performing data scans to understand what available data measures currently exist to populate a tool. From this work, we produced a pair of related resources: the “State Medicaid Member Experience Quantitative Data Scan” and the companion “State Medicaid Member Experience Qualitative Data Scan” for understanding the opportunities and gaps for the “Medicaid Member Experience” section of the tool wireframe. We also created a similar resource summarizing findings from our data scans for the “Program Actions” section of the tool, which would display measures describing the actions state Medicaid programs are taking to address health equity.
This project also involved:
- Collaborating with partner organization, Health Leads, to engage directly with Medicaid member communities
- Creating an “Annotated Bibliography” of academic research and grey literature sources on underlying factors and root causes that may contribute to inequities in Medicaid
- Consulting with a professor and doctoral student in the University of Minnesota School of Public Health regarding underlying structural and contextual factors in understanding inequity in Medicaid
Learn more about the additional publications that came from this project as well as our key takeaways and future considerations on the SHADAC webpage detailing this work at the intersection of Medicaid and health equity.
Project Assessing SNAP and Medicaid Coordination in State Agencies
This project, conducted with MEF Associates, aimed to examine state-level opportunities for coordination between the Supplemental Nutrition Assistance Program (SNAP) and Medicaid. Because of the overlap in participation in both of these programs, this project sought to understand how states are developing approaches to coordinate the two programs in order to improve efficiency, accuracy, access, and experiences. We also sought to understand challenges that states might face when developing and implementing coordination efforts.
This study included case studies in five states, each of which involved document and policy review, process mapping, and semi-structured interviews with SNAP and Medicaid staff and other groups.
Data Sources to Research Integrated Care for Dual Eligibles Project
Numerous studies have shown that dually eligible individuals (i.e., those who are eligible for both Medicaid and Medicare) account for a disproportionate share of spending within both Medicaid and Medicare. Not only that, but research has also shown that the lack of integration between these two programs also contributes to excess costs and lower quality care.
In this project, conducted with support from the Arnold Ventures Foundation, SHADAC sought to understand and describe the strengths and limitations of existing data sources that could be used to study the broad topic of dual eligible care integration. A primary focus of this project was whether these data can address research questions aimed at improving care for dual eligibles, focusing particularly on:
- Enrollment in integrated care models
- Analysis of priority subpopulations
- LTSS; and
- Enrollee social needs.
The final report provides a systematic review of 34 data sources that can produce nationally representative estimates for dual eligible individuals and have the potential to inform research on integrated care models. The report also provides an overview of important gaps within the data, concluding with a set of recommendations to address these gaps. The full report and further details on this project can be found here.
Insurance Coverage Transitions After Medicaid Unwinding
In April 2023, the continuous coverage requirement implemented during the COVID-19 public health emergency ended. As a result, states restarted their Medicaid eligibility redetermination procedures for nearly 95 million Medicaid enrollees. This process of redeterminations for enrollees post continuous coverage requirement is commonly known as the Medicaid “unwinding.”
This brief aimed to provide information on those who, during the resumed redetermination process, were not re-enrolled in Medicaid and instead transitioned off of Medicaid. SHADAC researchers sought to understand:
- The share of those who transitioned off of Medicaid to other sources of coverage or became uninsured, and
- The factors (e.g., age, income, employment, race/ethnicity, etc.) associated with various transition types (e.g., transition off of Medicaid, off to other source of coverage, off to uninsurance, etc.).
Using data from the 2024 Current Population Survey Annual Social and Economic Supplement (CPS ASEC), some key findings of this study include:
- Of those with Medicaid in 2023, 5.8% transitioned off Medicaid
- Of those who transitioned off Medicaid, 55.8% transitioned to other coverage; 44.2% became uninsured
Find details on this study’s methods and a discussion of results in the final report here.
Past Work
Tracking Health Insurance Coverage During the Unwinding: Monthly Data from the Household Pulse Survey
The unwinding of the Medicaid continuous coverage requirement ("Medicaid Unwinding") represents the largest nationwide coverage transition since the Affordable Care Act. Since February 2020, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) has increased by 23 million enrollees. Not only that, but analysis also indicates that as many as 15 million individuals will exit Medicaid to other coverage or become uninsured. Lack of publicly available data on Medicaid enrollment, renewal, and disenrollment makes it difficult to track the phenomenon of the 'Medicaid Unwinding'. As states “unwind” the Medicaid continuous coverage requirement and restart standard redetermination procedures, SHADAC researchers are using data from the U.S. Census Bureau’s Household Pulse Survey (HPS) to track trends in health insurance coverage rates. See our findings and frequent updates here.
Tracking the Data on Medicaid’s Continuous Coverage Unwinding (State Health & Value Strategies)
A lack of publicly available data on Medicaid enrollment, renewal, and disenrollment makes it difficult to understand exactly who is losing Medicaid coverage and for what reasons. This issue brief lays out a phased set of priority measures and provides a model enrollment and retention dashboard template that states can use to monitor both the short-term impacts of phasing out public health emergency (PHE) protections and continuous coverage requirements, as well as longer-term enrollment and retention trends. Through its work with SHVS, SHADAC also published a series of issue briefs that tracked through an interactive map the format of state reporting of unwinding data, state-based marketplace transition data (i.e. people who no longer qualify for Medicaid but might be eligible for a qualified health plan offered through the marketplace), and Medicaid unwinding reinstatement data.
Assessment and Synthesis of Selected Medicaid Eligibility, Enrollment, and Renewal Processes and Systems in Six States
SHADAC worked as a contractor for the Medicaid and CHIP Payment Access Commission (MACPAC) to conduct an assessment of Medicaid eligibility, enrollment, and renewal processes and systems in six study states—Arizona, Colorado, Florida, Idaho, New York, and North Carolina. Utilizing a multi-case study methodology as well as key informant interviews with state and local agency staff and advocacy organizations, SHADAC collected and synthesized data on Medicaid enrollment processes and systems for individuals whose income eligibility is based on Modified Adjusted Gross Income (MAGI) in order to assess the extent to which states were achieving desired goals such as program efficiency and a simplified beneficiary experience. As a follow up, SHADAC identified the risks that remain for both individuals and state agencies that cause eligible individuals to remain uninsured or lose Medicaid coverage and conducted interviews with key stakeholders nationally and in four states to obtain additional input on potential risk points and strategies to improve eligibility determination and renewal accuracy.
SHADAC Advocates a Data-Based Approach to Advancing Medicaid and CHIP Access Monitoring Plan
On February 17, 2022, the Centers for Medicare & Medicaid Services (CMS) released a request for information (RFI) regarding access to coverage and care in Medicaid and the Children’s Health Insurance Program (CHIP). SHADAC researchers focused our response on Objective 4: Question 1, which asked researchers to consider how CMS might develop a stronger Medicaid and CHIP access monitoring approach through data reporting and analysis. These comments are based on SHADAC’s experience providing data and evaluation technical assistance (TA) to states, and mirror recent testimony to the Medicaid and CHIP Payment Access Commission (MACPAC) provided by SHADAC’s Deputy Director.
Addressing Social Determinants of Health through Behavioral Health-focused 1115 Waivers: Implementation Lessons from Three States
Through the Robert Wood Johnson Foundation’s (RWJF) “Research in Transforming Health” program, SHADAC researchers conducted a study to understand how three states—Illinois, Texas, and Washington—were addressing the needs of justice-involved populations through implementation of Section 1115 Medicaid waiver programs. The specific aim of the study was to identify promising practices and lessons learned related to the development, implementation, and management of these innovative behavioral health policies with the purpose of informing policy development in states considering similar 1115 waivers.