Funder: Milbank Memorial Fund

Author: Greg Howe, Anne Smithey, Rob Houston, Center for Health Care Strategies

May 2021 | Brief


Over the last 20 years, the Centers for Medicare & Medicaid Services (CMS) has launched three primary care models designed to align multiple payers with Medicare: Comprehensive Primary Care, Comprehensive Primary Care Plus, and Primary Care First. State Medicaid agencies can be valuable participants in these models given that they are among the largest health care payers in a market and are a driver of a state’s health policy. This brief, authored by the Center for Health Care Strategies for the Milbank Memorial Fund, examines state Medicaid agencies’ decision-making around participating in federal models.

The authors interviewed Medicaid leadership in nine states that considered participation in one or more of these CMS primary care models. They found that the federal primary care model’s alignment with existing state primary care programs and goals was important to Medicaid agencies that decided to participate. Leadership from state agencies that chose not to participate expressed concerns related to the lack of alignment with their existing efforts, budgetary and staffing constraints, and minimal stakeholder interest. If multipayer alignment is necessary for primary care transformation, both Medicaid agencies and CMS may need to be more flexible.

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