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Medicaid Funds Will Reward Patients who Practice Good Health Habits

Thursday February 24, 2011
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The Centers for Medicare and Medicaid Services has announced $100 million in funding to states for rewarding Medicaid patients who make good health choices.

The grants, funded through the Affordable Care Act, aim to provide incentives to Medicaid beneficiaries of all ages who participate in prevention programs and demonstrate changes in health risk and outcomes.

According to CMS, the initiatives and programs must be “comprehensive, evidence-based, widely available and easily accessible.” The programs must use evidence-based research and resources such as the Guide to Community Preventive Services, the Guide to Clinical Preventive Services and the National Registry of Evidence-based Programs.

States that apply for a grant must address at least one of the following prevention goals: tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure and avoiding the onset of diabetes of improving the management of the condition.

Potential rewards for patients could include cash payments, reduced fees, premium services and possibly gift cards to use at supermarkets or retailers.

“Keeping people healthy is an important goal of the Affordable Care Act,” U.S. Health and Human Services Department Secretary Kathleen Sebelius said.

“One way to reach that goal is to encourage all Americans to make better choices about diet, exercise and smoking to avoid potentially disastrous outcomes down the road like heart disease, cancer or diabetes.”

Participating states must commit to operating their program for at least three years, conducting a state-level evaluation and fulfilling reporting requirements specified by the legislation and CMS. The reporting requirements include information technology system modification necessary to support the evaluation process.

Approved administrative and program expenditures will be reimbursed through grant funds from the $100 million appropriated for the program and evaluation. The program does not include a state cost-sharing requirement.

“With the right incentives, we believe that people can change their behaviors and stop smoking or lose weight,” Medicaid Administrator Donald Berwick said. “Not only can preventive programs help to improve individuals’ health, [but] by keeping people healthy we can also lower the nation’s overall healthcare costs.”

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