This literature review explores the concept of Food Is Medicine (FIM)—a healthcare approach that integrates nutrition-based interventions to prevent, manage, and treat chronic diseases. The report emphasizes the role of produce prescriptions, medically tailored meals (MTMs) and groceries in improving health outcomes, especially among low-income populations.
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Los Angeles County Child Welfare-Involved Population Medi-Cal Analysis
Comparative Analysis of the Engagement in Care for Children in Medi-Cal Fee-for-Service vs. Managed Care and Learnings from Enhanced Care Management Early Implementation
In November 2023, the Los Angeles (LA) County Board of Supervisors passed a motion to address the implementation of new benefits for the child welfare-involved population launched through California’s Medicaid waiver, California Advancing and Innovating Medi-Cal, known as CalAIM. The CalAIM waiver expanded services to managed care beneficiaries, including enhanced care management (ECM) for coordinated case management, referrals, and community resource navigation and community supports, such as housing assistance, medically tailored meals, housing modifications, respite care for caregivers, and asthma management. These benefits are designed to better address health and social needs for the most vulnerable and at risk Medi-Cal beneficiaries, including children and youth involved in the child welfare system. The Board directed the Office of Child Protection (OCP), in collaboration with key county departments, to engage Health Management Associates, Inc. (HMA), as the technical assistance provider.
Recognizing that approximately two-thirds of child welfare-involved children and youth in LA County are enrolled in fee-for-service (FFS) Medi-Cal and ineligible for new CalAIM supports, HMA conducted a comparative analysis of the experience of children involved in the child welfare system in FFS versus managed care Medi-Cal through an analysis of federal T-MSIS data looking at a snapshot of data from December 2022. The analysis examined the experience of the child welfare-involved population in primary and preventive healthcare services (including well-child visits, dental visits, behavioral health) in Medi-Cal FFS versus managed care plan enrollment (MCPs) to inform decisions about existing practices for care management among the child welfare-involved population. The comparative analysis of the child welfare population in Los Angeles County, San Diego County, and Riverside County revealed children in managed care consistently showed higher rates of engagement in primary and preventative healthcare services.
Medicaid Expansion: Data-Driven Insights into Healthcare Needs and State 1115 Implementation Trends
This 10-slide presentation, Medicaid Expansion: Data-Driven Insights into Healthcare Needs, offers a focused analysis of the Medicaid Expansion population—non-disabled adults ages 19–64 with incomes up to 138% of the Federal Poverty Level—across more than 40 states. Using recent T-MSIS data, the deck highlights the high prevalence of chronic and behavioral health conditions within this group, while also detailing demographic trends among the approximately 16 million enrollees.
Developed by Matt Powers, Shreyas Ramani, Loren Anthes, and Lora Saunders, the presentation contextualizes health needs with Medicaid spending patterns, comparing the Expansion group to other eligibility categories, such as dual eligibles and children. It also breaks down pharmacy spending by therapeutic class, spotlighting common conditions like opioid use disorder. In light of recent federal legislative proposals such as H.R. 1, the deck explores how states are beginning to navigate policy changes through 1115 waiver activity—particularly around medically frail and good cause exemptions—offering early insight into likely implementation strategies.
Disaggregating Managed Care Payments Provides Opportunities for New Insights into Medicaid Spending for Critical Populations
HMA focused this paper on how states disperse Medicaid funds to certain subpopulations within the program’s categorical eligibility infrastructure. A previous companion paper centered on increasing our understanding of Medicaid managed care spending by provider, offering more detail on the relative order of magnitude of the amounts spent on inpatient and outpatient hospital care, professional services, long-term care, pharmacy, and other health services.
As the latest national Medicaid managed care enrollment data show 75% of Medicaid beneficiaries were enrolled in comprehensive managed care organizations (MCOs), these two foundational papers illustrate the importance of developing a sound methodology to reliably estimate costs associated with MCOS. These papers, which are the first to present findings related to the development of the MCO methodologies, help lay the foundation for further work that will enable us to answer relevant questions, including:
- How much do we spend on Medicaid patients with chronic conditions like asthma, diabetes, and hypertension?
- How much do we spend on Medicaid patients receiving long-term services and supports (LTSS) and what is the unmet need?
- How is Medicaid funding spent on childbirth and a child’s first year of life?
- What are the opportunities to be more efficient and effective with Medicaid resources?
Section 1115 Justice-Involved Reentry Demonstration Implementation Toolkit for Jail, Prison, and Juvenile Settings
This toolkit provides a set of implementation checklists for Section 1115 Justice-Involved Reentry Demonstrations tailored to three carceral settings: jails, prisons, and juvenile facilities. Each checklist outlines operational tasks across core domains to support effective planning, coordination, and continuity of care pre- and post-release.
This toolkit is intended to provide information for jails, prisons, and youth detention centers in states contemplating submitting a 1115 Justice-Involved Reentry Demonstration, as well as states that have an approved demonstration. All states with approved demonstrations must provide core services, including care management for physical and behavioral health, medication assisted treatment for individuals when clinically indicated before release, and medication in hand at release. It is important to note that states may vary in their populations of focus, care management models, and processes for submitting claims. It is essential to cross-reference your state’s demonstration when planning to operationalize this initiative.
What’s Really Causing the Rise in Insurance Premiums, and What Can States Do About It?
Healthcare cost increases are outpacing general inflation, which jeopardizes access to coverage and care, as well as investments in other priorities. As a result, states are looking for ways to reduce the cost burden for consumers, employers, and taxpayers. The State of Maine engaged Wakely Consulting Group, an HMA Company, to analyze historical medical trends and the associated impact on premiums in Maine’s health insurance market for the period of 2021 to 2025. The goal was to assess what factors are driving rising insurance costs. This project was supported by an HMA contract with Arnold Ventures, under which we provide technical assistance to states seeking to reduce healthcare cost growth.
Unlocking Solutions in Medicaid for Addressing the National Crisis and Improving Children’s Behavioral Health
Late 2024, HMA convened a panel of experts, including individuals with lived experience and state leaders, to spotlight the critical need for cross-system transformation. The discussion underscored the importance of centering youth and family voices, aligning placement and community-based services, and leveraging opportunities like the Family First Prevention Services Act, Medicaid waivers, and specialty managed care models. As states grapple with a behavioral health workforce crisis and insufficient foster care placements, the path forward requires bold, coordinated strategies grounded in flexibility, equity, and evidence. This brief includes key takeaways from the 2024 panel and outlines actionable insights to guide the transformation of the children’s behavioral health system.
State Medicaid Non-Emergency Medical Transportation Contracts: Key Provisions, Standards, and Considerations
Federal statute requires states to provide non-emergency medical transportation (NEMT) to Medicaid beneficiaries who have no other means of getting to medically necessary healthcare facilities. Though NEMT programs must meet certain federal requirements, states have considerable flexibility in the design and operation of their NEMT program. As a result, states vary widely in their NEMT procurement and contract standards, metrics, reporting, and enforcement of requirements for NEMT brokers, MCOs, and transportation providers. Health Management Associates, Inc. (HMA), examined NEMT-related requests for proposals (RFPs) and contracts for five states and interviewed state Medicaid officials, transportation brokers and providers, MCOs, advocates, and subject matter experts (SMEs). The goal was to synthesize the information gathered to help inform states and other stakeholders about key NEMT standards, challenges and successes, and considerations for developing RFPs and contracts.
Download the toolkit and the report.
Amber ground ambulance dataset reflects complexity and challenges of the industry, highlights the need to improve and continue cost data collection
The Centers for Medicare & Medicaid Services (CMS) is on the cusp of possessing the data needed to make long anticipated changes to the Medicare fee-for-service (FFS) ground ambulance payment system. It has been more than two decades since CMS revised these payment rates through a negotiated rulemaking process that was exclusive of actual cost data or inflationary considerations. Since then, the cost structure of ground ambulance entities has changed. CMS is now using the Ground Ambulance Data Collection System (GADCS) to gather ambulance cost data, as required by Congress, to offer an improved understanding of the costs of delivering ground ambulance services. Given the potential of GADCS data to improve the adequacy of Medicare FFS reimbursement rates, the American Ambulance Association developed a similar data collection device, referred to as Amber, to test these data with its membership of ground ambulance entities. Amber offers a glimpse into the current challenges of the ground ambulance industry.[i]
Health Management Associates, Inc. (HMA) assessed the Amber dataset for response rates and data quality, along with responses containing calendar year 2022 financial data. Amber response rates were low, but sample volumes were on par with prior industry surveys conducted in the past by federal agencies. The Amber sample is representative of the industry’s wide variation in entity size and geographic service area. Amber data are reliable for calculating margins, but some aspects of these data also signal that ground ambulance entities, particularly smaller entities, may have had difficulty with variable definitions or the submission process. We observe that Amber would be improved by including information on uncompensated care and more details on medication supply costs.
The 2022 financial data from Amber suggest that Medicare FFS margins, at -6 percent, had declined since GAO’s 2010 assessment and that the share of costs associated with labor has increased. Amber data also suggest that the cost structure of smaller ground ambulance entities and rural and super-rural entities differs from that of larger and more urban entities. Margins for small and rural entities are lower.
Based on our assessment of the Amber dataset and its 2022 financial, we offer several recommendations to policymakers and stakeholders. These recommendations are intended to improve future cost collection efforts that may inform payment reforms to enhance the payment accuracy of the Medicare FFS payment system for ground ambulance services.
- Provide additional educational support to respondents to improve consistency of data reporting
- Streamline and modify data collection devices to adhere to industry trends and challenges
- Develop a standardized method for assigning ground ambulance entities to geographic service area for research purposes
- Collect data on ground ambulance uncompensated care and bad debt
- Collect payer level data for cases involving treatment without transport
- Collect targeted data on top 10 medications by cost to accurately reflect costs in payment rates
- CMS should consider collecting ground ambulance cost data on a semi-regular basis
- CMS should consider phasing in the use of GADCS data to ensure that the data reflect the diversity of ambulance entities and consistent reporting of key financial variables
[i] American Ambulance Association. Ambulance Cost Collection. 2023. Available at: https://ambulance.org/advocacy/cost-reporting/.
Private Equity Investment in AI in the Healthcare Sector
HMA will be offering analyses on various investor related topics in the healthcare sector. Our first report examines the growth of Artificial intelligence (AI) in the US healthcare market. AI is expected to reach projected revenues of $102 billion by 2030. Learn more in this analysis.
New Insights on Medicaid Spending: An Analysis of Disaggregated Managed Care Spending
Medicaid is a federal/state health insurance program that served more than 86 million lower-income people in fiscal year (FY) 2021. The combined federal and state spending for Medicaid totaled $717 billion that year, $420 billion of which was spent on providing care to Medicaid managed care organization (MCO) members, and $297 billion on services provided to fee-for-service enrollees.
- While the role of managed care in Medicaid has grown tremendously over the past decade, with MCOs covering nearly three-quarters of Medicaid enrollees, detailed cost information has not been estimated for the people with MCO coverage. These data historically have been available only for fee-for-service (FFS) Medicaid because of limitations on federal data sources.
- This lack of data blocks our understanding of the relative magnitude of the cost drivers in the program and contributes to an uninformed debate about policy reforms to control the growth of spending and improve quality of care.
- Obtaining and using cost data by provider type for MCOs can help answer questions such as how much funding do MCO enrollees with diabetes, asthma, and/or hypertension consume? Of these patients, how many also have behavioral health conditions? How many MCO enrollees have six or more emergency department (ED) visits during a year and/or multiple inpatient hospital stays, and what does their resource consumption look like?
Health Management Associates (HMA) has developed a reliable methodology that can be applied to all 50 states, which approximates spending for the major categories of health services that MCOs cover, including: inpatient and outpatient hospital care, physician and other professional services, skilled nursing facilities, clinics, pharmaceuticals, and other services. HMA can determine prices for these services, which, combined with data on the number of encounters, yields reliable cost figures. These cost estimates will be useful in identifying unmet medical needs, gaps in our delivery systems, and areas of high spending where efficiencies and timely care management can be added to slow the growth in total health spending.
Workforce Solutions Partnerships: Call to Action to Build a Sustainable Behavioral Health Workforce
The Workforce Solutions Partnership, a collaboration of The National Council for Mental Wellbeing, The College for Behavioral Health Leadership, and Health Management Associates has worked since 2021 to create both short and long-term solutions addressing the behavioral health workforce crisis. In this whitepaper, we issue a Call to Action to partners across all sectors to join us in this effort to drive pervasive change and ensure the future of behavioral health care. We need you to help us create and define the future of the workforce and envision a new system of care. This paper outlines the problem and highlights the efforts developed by our partnership, and mechanisms that can help to address the problem.