As states prepare to provide coverage for 15-20 million more Medicaid beneficiaries due to health reform, the imperative is even greater to find ways to address rising costs and extend high-quality and cost-effective care to existing Medicaid beneficiaries as well as the expansion population.

This CHCS policy brief outlines promising state approaches to improve care and curb spending for Medicaid’s highest-cost patient subsets, including opportunities to:

  1. Enhance fee-for-service primary care case management programs;
  2. Integrate physical and behavioral health services; and
  3. Integrate care for adults who are dually eligible for Medicare and Medicaid.

The brief highlights innovative state initiatives in each of these areas and outlines the critical program elements necessary to enhance care for beneficiaries with complex needs. It offers tangible opportunities for states to rethink care delivery for their highest-need, highest-cost populations.

Roughly five percent of Medicaid beneficiaries account for nearly 60 percent of total program spending. Improving the quality of care for these and other high-need, high-cost beneficiaries is among the few viable options to curb rising costs over the long-term.

This brief is part of CHCS’ Medicaid Best Buys series developed to help states, health plans, and policymakers identify programs that have the greatest potential to improve health care quality and control costs for beneficiaries with complex needs. The series synthesizes CHCS’ work supported by multiple funding partners, including the California HealthCare Foundation, The Colorado Health Foundation, The Commonwealth Fund, Kaiser Permanente, the New York State Health Foundation, the Robert Wood Johnson Foundation, The SCAN Foundation, and the United Hospital Fund.