Learning Collaboratives to Support the Development of High-Performing State Health Coverage Programs

Prepared For

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services

Since 2011, Mathematica has partnered with the Centers for Medicare & Medicaid Services (CMS) on the Medicaid and CHIP Learning Collaboratives project.

The Learning Collaboratives (LCs)—which are work groups of state and federal officials meeting on a regular basis for a defined period of time—have been a valuable means of (1) identifying states’ needs for policy development and clarification, (2) encouraging peer-to-peer learning between states about promising practices, and (3) developing tools for all states to support high-performing health programs.

We worked closely with CMS and state officials to develop solutions to emerging issues and to convey essential information effectively to states. During this project, states have used virtual LC meetings and interviews to share ideas with CMS and other states, give feedback on proposed policies and tools, and learn about new approaches from their peers. The products that the LCs have made available to states include information and materials that directly support policy implementation. This information includes strategies to increase coverage and care coordination among Medicaid-eligible, justice-involved populations and former foster care youth, as well as tools to help states and CMS measure the accuracy of determinations based on modified adjusted gross income in their new eligibility systems.

Mathematica has produced analyses, briefings, and tools to help CMS meet its legislative requirements and develop program regulations. We also helped develop the Medicaid and CHIP performance indicators, and we provided technical assistance to states on reporting the indicators and to CMS on using the indicators for public reporting.

Two LCs are currently active:

  • The Coverage LC plays a critical role in (1) addressing foundational and emerging issues associated with eligibility determination and renewal policies and (2) identifying and disseminating states’ best practices for covering important subpopulations. Most recently, this LC has developed technical assistance tools and products such as model eligibility notices and a disaster recovery toolkit. We also produced tools to help CMS meet its legislative requirements, such as programs for calculating the quarterly Basic Health Program reconciliation payments that are due to states and a method for measuring the accuracy of Medicaid and CHIP determinations made through the Express Lane Eligibility program.
  • At its inception, the Federally Facilitated Exchange (FFE) LC was intended to (1) address emerging policy, operational, and systems issues for states that relied on the FFE platform and (2) inform and refine CMS’s implementation guidance. In recent years, the FFE LC has broadened its focus to also support all states as they upgrade their eligibility and enrollment systems for the modern Medicaid program. The LC now also provides technical assistance and analysis to help CMS and states increase the automation, efficiency, and accuracy of their eligibility and enrollment systems.

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