Federal grants would pay Medicaid patients to get healthy

Amy Higgins

The U.S. Department of Health and Human Services wants to get America healthy. To do so, it has started a $100 million healthy behavior program to urge Medicaid members to ditch unhealthy habits through rewards.

How the program works

The program is called the Medicaid Incentives for Prevention of Chronic Diseases Program. Under the Patient Protection and Affordable Care Act (the federal health care reform law), any state Medicaid agency can apply for grants for prevention programs. According to the federal Centers for Medicare and Medicaid Services (CMS), each state Medicaid agency must address at least one of the following prevention goals to be given a grant:

  • Tobacco cessation.
  • Controlling or reducing weight.
  • Lowering cholesterol.
  • Lowering blood pressure.
  • Avoiding the onset of diabetes or in, the case of patients with diabetes, improving management of the disease.

Some healthy behavior programs will offer incentive programs and supplemental services to motivate program members to stick to their health goals. According to CMS, patients who get health coverage through Medicaid could be rewarded with any of the following:

  • Cash awards.
  • Preventive and support services not otherwise available through Medicaid.
  • Free goods.
  • Help with transportation.
  • Reduced Medicaid fees.

Patients even can choose to have their rewards transferred to friends, relatives and community organizations that helped them achieve their goals. According to CMS, states that qualify for grants must commit to operating their programs for at least three years and fulfill various requirements. States also must submit to mandatory CMS evaluations.

The money spent on these grants and incentives is money saved, according to Dr. Donald Berwick, administrator of CMS. By keeping people healthier and preventing them from developing serious health conditions, the program will reduce the nation's health care costs in the long run, Berwick says.

Prevalence (and cost) of unhealthy habits

The federal Centers for Disease Control and Prevention (CDC) reports some disturbing figures on unhealthy behavior in the United States:

  • About 46.6 million adults were smokers in 2009.
  • In 2009, only Colorado and the District of Columbia had a prevalence of obesity of less than 20 percent.
  • About 1.9 million people age 20 or older were newly diagnosed with diabetes in 2010.
  • An estimated 79 million adults 20 or older were at risk for diabetes in 2010.

The CDC says smoking costs the United States about $96 billion in health care expenditures each year, and the Weight-Control Information Network, an information service of the National Institute of Diabetes and Digestive and Kidney Diseases, says that for each obese beneficiary, Medicaid pays $1,021 more than it pays for normal-weight beneficiaries.

The CDC says state spending on smoking cessation does not meet its recommended levels. It reports that in 2011, states will collect $25.3 billion from tobacco taxes and legal settlements -- but that states are spending only 2 percent of that money on tobacco control programs. In other words, those who want to quit smoking may not be getting enough help to do so. The CDC says investing only about 15 percent of that money would finance every state tobacco control program at recommended levels.