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Milbank Memorial Fund

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Medicaid: Lots of responsibility but little power


This piece discusses how Medicaid has great responsibility but surprisingly little power.

The  article notes:

For “all of its growth, Medicaid hasn’t really improved its governance or increased its power. State Medicaid leaders have seen their responsibilities and influence grow exponentially, but extra resources — like more administrative positions, pay raises and better technical assistance — haven’t followed, according to a recent report by the Milbank Memorial Fund. “The Role of State Medicaid Directors: A Leadership Imperative” calls for states to re-evaluate how their programs are run and how their directors are compensated.”


“For all their responsibility…{state} Medicaid directors often don’t have much control over services like substance abuse, mental health and long-term care. This fragmentation of responsibility was especially frustrating for Deborah Bachrach, the former Medicaid director of New York.

“Eligibility and enrollment went through county offices, and those people didn’t even report to me. States need to rethink where Medicaid falls on the totem pole of government.”




Population health in Medicaid delivery systems


A Milbank Memorial Fund report’s  writers conclude that ”Medicaid ACOs have the potential not only to align payment and care delivery incentives to promote high-quality, well-coordinated care, but also to improve population health within their enrolled population and beyond. States, in conjunction with county governments and commercial payers, can help ensure that Medicaid ACOs play an important role in improving health outcomes across the life course by (1) requiring ACOs to incorporate population health–focused design and governance structures, patient services, metrics, and information-sharing systems; and (2) focusing on building strategic partnerships between ACOs and other population health–oriented entities. States that incorporate population health components in Medicaid delivery system reforms will experience health improvements and cost reductions—but these improvements will only reach the height of their potential if states coordinate these initiatives with other agencies, insurers, and providers.”

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