SHADAC Expertise

Medicaid and CHIP Policy

Medicaid and CHIP Policy

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.

Related SHADAC work
Click on any title below to learn more about the project.

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.

Supporting BDT’s Stabilizing Medicaid Enrollment Learning Collaborative

SHADAC collaborated with a new partner, Benefits Data Trust (BDT), on a small project to design and lead a webinar for its Medicaid Churn Learning Collaborative participants on the topic of monitoring and evaluation. The webinar took place as state Medicaid agency participants were implementing activities to redetermine all individuals enrolled in Medicaid and were meeting federal reporting requirements to monitor the end of the continuous coverage provisions. 

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.

Past Work

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.