An Overview of Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) Grants
Given the high prevalence of chronic diseases and conditions in the United States, and the role that health risk behaviors play in contributing to chronic disease, policymakers have increasingly focused on the benefits of investing in preventive care and engaging Americans in their health behaviors. Several state Medicaid programs have implemented incentives for beneficiaries who demonstrate healthy choices, which are meant to empower individuals to change their lifestyle habits to achieve better health.
To promote and expand these incentives, the Affordable Care Act (ACA) established the Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) program.1 This program provides $85 million to ten states over five years to test the effectiveness of providing incentives directly to Medicaid beneficiaries who participate in prevention programs and change their health risks and outcomes by adopting healthy behaviors (Appendix). States must address either tobacco cessation, controlling weight, lowering cholesterol, lowering blood pressure, preventing or controlling diabetes, or a combination of these goals. In November 2013, an interim evaluation was conducted on MIPCD programs to date.2 This brief highlights key findings from the evaluation and puts them in context of past and proposed beneficiary incentive programs in Medicaid. A final evaluation of the MIPCD programs will be completed by July 2016.
States are taking various approaches to implementing MIPCD programs. Most states are targeting more than one health behavior or condition, offering money or money-equivalent (e.g. gift cards) as incentives, focusing on special populations (e.g. pregnant women or individuals with mental illness), and using randomized control trials to evaluate the programs. However, each initiative is designed differently and the range of interventions varies widely. States are using telephone helplines, counseling, educational and training programs, weight management classes, health coaches, and wellness plans combined with flexible spending accounts. Some states are offering incentives to providers to participate in the program as well. However, states faced challenges in implementing incentive programs, which led to delayed implementation in most states. As a result, data on program effectiveness is currently limited, but is expected to grow as programs expand.
In addition to the MIPCD program, other states are interested in including healthy behavior incentives in their Medicaid programs, for example, by incorporating the incentives into proposed or approved Section 1115 Medicaid expansion waivers. In general, however, pre-ACA beneficiary incentive programs and MIPCD programs tend to offer additional rewards that go beyond traditional Medicaid parameters, while states that are incorporating healthy behavior incentives into Medicaid expansion waivers are tying healthy behaviors to reduced or waived premiums and cost-sharing that are otherwise required. As states move forward, it is important to note that low-income individuals may face unique challenges that could limit their ability to participate in these programs or meet requirements to earn incentives. More evidence will be needed on the effect of beneficiary incentives in Medicaid on health care access and utilization, health outcomes, and costs.