The Centers for Medicare and Medicaid Services (CMS) announced on February 24 the availability of $100 million that it will award to state Medicaid agencies to design and implement incentives for Medicaid recipients to participate in programs to prevent smoking, obesity, high blood pressure, high cholesterol, and diabetes under the Medicaid Incentives for the Prevention of Chronic Diseases (MIPCD) program.   CMS expects to award grants competitively to ten or more states. Incentives and administrative activities for the MIPCD program will qualify for 100 percent Federal financial participation (FFP). The new program reflects findings that carefully designed incentives for participation in prevention programs are effective in the short term and could be effective over the long term, helping to reduce the overwhelming human costs (e.g., 430,000 deaths in the United States annually attributable to smoking) and financial costs (e.g., $147 billion annually in US health costs attributable to obesity) of preventable diseases. The new program is authorized by section 4108 of the Affordable Care Act (ACA) and builds on the experience of West Virginia, Idaho and Florida in Medicaid recipient incentive programs under the Deficit Reduction Act (DRA) of 2005.  Incentives in the new program may include direct cash payments, extra services, and/or reduced co-payments. Cash payments will not adversely affect financial eligibility for Medicaid or any other federally funded programs. CMS will give preference in scoring MIPCD applications to states that demonstrate their ability to implement an effective program, including state legislative support, endorsements from consumer and advocacy groups, and program evaluation expertise. States must use widely respected evidence-based research and resources, such as the National Registry of Evidence-Based Programs, in designing new state programs.  States will be required to track Medicaid recipients’ participation and outcomes, perform evaluation activities, produce reports to CMS on state processes utilized and lessons learned, and report data to CMS on measures of service utilization and quality. CMS expects that state Medicaid agencies will partner with other state agencies, local governments, and service providers, including managed care organizations, that agree to meet MIPCD reporting requirements. Applications are due May 2, 2011.  CMS will announce grant awards by August 1, 2011 for the period August 1, 2011 through December 31, 2015.

About Tom Entrikin

A former policy specialist with the U.S. Health Care Financing Administration (now Centers for Medicare & Medicaid Services (CMS)), Tom Entrikin has vast experience providing technical assistance to states on Medicaid eligibility, coverage, and reimbursement; provider certification and enrollment; program integrity; recovery of third party liabilities; Medicaid Management Information System (MMIS) performance specifications and operations; interagency agreements; contracts with managed care organizations; and Medicaid waiver programs.

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