Medicaid

QualityTools

Predictive Modeling: A Guide for State Medicaid Purchasers 01/16/14

This guide for care managers and State Medicaid agencies provides information on how to use predictive modeling tools to identify patients who are good candidates for care management. A list of key considerations can help States prioritize and effectively target populations for care management, and help guide decisionmaking for patient care. The guide helps agencies do the following:

  • Understand which features of a predictive model are critical as well as how to enhance...
Medicaid and CHIP Learning Collaboratives Toolbox 08/27/13

This Medicaid and CHIP Learning Collaboratives (known as the MAC Collaboratives) online toolbox, for use by collaboratives, partners, and stakeholders, provides practical tools and resources to address common challenges and pursue innovations in Medicaid program design and operations. The toolbox, updated regularly, helps guide states through policy options, model business practices, sample contract language, requests for information draft language, and relevant background resources.
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Children's Electronic Health Record Format 03/06/13

The Children’s Electronic Health Record (EHR) Format, for EHR system developers, provides information about critical functionality, data elements, and other requirements needed in an EHR system to improve quality measurement and collection of clinical quality data. The information helps address health care needs specific to the care of children, especially those enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The tool includes a minimum set of data elements and...

Designing an Exchange: A Toolkit for State Policymakers 05/21/12

This legislative toolkit, from the National Academy of Social Insurance (NASI), can assist State policymakers with the design of health insurance exchanges, a key element of the Patient Protection and Affordable Care Act (ACA). It was developed by a panel of experts from a variety of disciplines and perspectives and builds on the model law released by the National Association of Insurance Commissioners (NAIC).

The toolkit includes legislative language with alternatives and...

Improving Outcomes for Children in Child Welfare: A Medicaid Managed Care Toolkit 04/25/12

This toolkit, developed by the Center for Health Care Strategies (CHCS), can help guide efforts to improve care for children in the child welfare system. The toolkit presents the work of 9 managed care organizations that participated in a 3-year CHCS quality improvement collaborative. It provides details about the pilot efforts of each plan, including identification, stratification and outreach strategies developed, as well as obstacles faced and preliminary outcomes achieved.

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Get Covered. Get in the Game. Campaign 02/15/12

The goal of the Get Covered. Get in the Game. campaign is to help uninsured children get health insurance so they can participate in sports programs. Eligible children and teens can get no-cost or low-cost health coverage through Medicaid and the Children's Health Insurance Program (CHIP).

The campaign materials include a guide that provides strategies and outreach materials that can help schools and communities link youth athletes—and all eligible children and teens—to...

Improving Asthma Care for Children Toolkit: Best Practices in Medicaid Managed Care 03/30/10

This toolkit provides strategies to improve asthma care tested by a diverse group of health plans serving Medicaid consumers. The inventive methods, targeted for children with asthma, can also be used for adults. The toolkit suggests the need for collaborative approaches and documentation to support further investments for the following techniques:

  • Developing and creatively using asthma registries
  • Using innovative methods to reach high-risk members
  • ...
Improving Medicaid Managed Care for Youth with Serious Behavioral Health Needs: A Quality Improvement Toolkit 03/04/10

This toolkit is designed primarily for managed care organizations that want to improve administrative and clinical practices that support the delivery of services to children and youth with serious behavioral health needs, as well as their families. In addition, purchasers of managed care services for this population can use the toolkit to identify promising approaches for their managed behavioral health care programs. Providers can also learn from the initiatives described, and implement...

Chronic Disease Cost Calculator 12/16/09

The Chronic Disease Cost Calculator is a downloadable tool that supports States in:

  • Estimating State Medicaid expenditures for six chronic diseases–congestive heart failure, heart disease, stroke, hypertension, cancer, and diabetes.
  • Generating estimates of the costs to Medicaid of selected chronic diseases using customized inputs (e.g., prevalence rates and treatment costs).
Developing and Implementing Self-Direction Programs and Policies: A Handbook 09/25/09

This handbook, from the national Cash & Counseling program, provides information for State staff, policymakers, service providers, program participants, and other stakeholders about self-direction programs and policies. It can be used to explain how States can increase program participants’ choice of and control over their services and supports. It also can help expand self-direction options in programs already providing home and community services and supports and develop new self-...

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