Health Center State Policy

Positive Outcomes for Medicaid Expansion Demonstration in Cleveland

By Kersten Lausch

Research demonstrating the value of Medicaid expansion continues to grow. The following is an overview of a recent study that examined how the MetroHealth Care Plus program in Cuyahoga County, Ohio impacted patient care. [Note: Unfortunately, access to the full text of Cebul et al.’s article in Health Affairs requires paid subscription or purchase.]

What is Care Plus?
In February 2013, prior to Ohio’s decision to expand Medicaid, CMS approved a Medicaid waiver that enabled a county-owned hospital (MetroHealth System) and two local FQHCs (Care Alliance and Neighborhood Family Practice) in Cuyahoga County to offer Medicaid-like coverage to residents (ages 18-64) with incomes at or below 133 percent of the federal poverty line. To finance Care Plus, the hospital used the $36 million annual subsidy it receives from Cuyahoga County taxpayers and drew down enhanced federal Medicaid matching dollars.

Over the next 11 months, Care Plus provided coverage to 28,294 patients who were able to receive benefits without co-pays through the program’s defined network, which included the three partner organizations and other community providers (e.g., community mental health centers). Care Plus patients formally transitioned to Ohio’s expanded Medicaid program on January 1, 2014.

What did the study find?
Between 2012 and 2013, Cebul and colleagues found that patients enrolled in Care Plus had better care and health outcomes than those who remained uninsured. For example, the researchers found that, compared to those who were continuously uninsured, Care Plus patients with diabetes improved over 13 percentage points on the diabetes composite standard (a combined metric for assessing quality of diabetes care).

The researchers also found that the total cost of care for patients enrolled in Care Plus was 28.7 percent below the budget cap set by CMS for the program to remain budget neutral.

What supported these outcomes?
In addition to giving patients access to care, Cebul et al. concluded that the program’s defined provider network and delivery system innovations helped to support the quality and cost outcomes. Specifically, all three partner organizations:

  • Used the same electronic health records platform;
  • Had patient-centered medical home-recognized primary care practices; and
  • Publicly reported performance in a regional health improvement collaborative.

The article by Cebul and colleagues was published in July’s Health Affairs issue, which was dedicated to the 50th anniversary of Medicaid. Several articles within the issue feature the substantial role played by health centers. For more information, read our post “Health Affairs’ July Issue Commemorating 50 Years of Medicaid Highlights Significant Role Played by Health Centers.”