Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Adequate Insurance.

MCHbest Logo

Strategy. Medicaid Buy-In Program

Approach. Adopt a Medicaid Buy-In program for children with disabilities to ensure adequate insurance coverage

Return to main MCHbest page >>

Overview. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/for whose families incur high out-of-pocket costs for their care.[1] The Massachusetts Medicaid Buy-In program, called MassHealth CommonHealth, allows families of children with disabilities to buy into the state’s Medicaid program to cover more services and to defray costs that private insurance does not cover.[2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
  • Health Outcomes. This strategy helps contribute to reducing avoidable differences among socioeconomic and demographic groups or geographical areas in health status and health outcomes such as disease, disability, or mortality.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of state policies for legislative actions taken to establish a Medicaid Buy-In program for children with disabilities. (Measures the policy development process)
  • Number of enrollment assistance resources for events provided to help families navigate the Buy-In process. (Quantifies support for facilitating participation)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of eligible children with disabilities who enroll in the Medicaid Buy-In program. (Measures the uptake and participation rate among the focus population)
  • Percent of families reporting satisfaction with the Buy-In program enrollment process and benefits. (Evaluates the quality of the family experience)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships established with disability support organizations to promote the Medicaid Buy-In program. (Engages key community partners in outreach and enrollment)
  • Number of state agencies collaborating to streamline the Buy-In enrollment and renewal process. (Reflects efforts to create a family-friendly and efficient system)

OUTCOME MEASURES:

  • Number of hospital admissions for emergency department visits prevented among Buy-In enrollees due to comprehensive coverage and care coordination. (Demonstrates potential cost savings)
  • Number of parents of Buy-In enrollees who are able to maintain employment due to reduced caregiving burden and financial stress. (Measures the broader family economic impact)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of total eligible children with disabilities in the state who are enrolled in the Medicaid Buy-In program. (Assesses the reach and penetration of the program)
  • Percent of Buy-In program materials and communications that meet usability standards. (Reflects a commitment to outreach)

OUTCOME MEASURES:

  • Percent of children with disabilities in the Buy-In program who have access to all needed services and supports. (Demonstrates the adequacy and comprehensiveness of coverage)
  • Percent increase in the quality of life and community participation among children with disabilities enrolled in the Buy-In program. (Reflects the ultimate goal of supporting thriving)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 https://ciswh.org/project/the-catalyst-center/financing-strategy/medicaid-buy-ins/.

2 Hirschi M, Walter AW, Wilson K, Jankovsky K, Dworetzky B, Comeau M, Bachman SS. Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program. Journal of Child Health Care. 2019 Mar;23(1):6-19.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.