Evaluating Medicaid: Moving Beyond Coverage to Understanding Program Design

Medicaid is perhaps the most under-researched insurance program in the nation, even though it provides coverage for more than 70 million low-income individuals who have relatively little other recourse for insurance or medical care. Evaluations of the Medicaid program face several challenges: Data are difficult to obtain, pricing and expenditure measures are complex, churn on and off the program can introduce noise in quality measurement, and with widespread experimentation across the nation, comparison groups that allow for the study of interventions or natural experiments can be elusive. Research surrounding behavioral health, oral health, the social determinants of health, and racial and ethnic disparities is particularly sparse and deserves additional attention. The call for policymakers and researchers is to develop and evaluate Medicaid payment and delivery system models that can prove (and improve) the value of the program.