Incentivizing Healthy Behaviors in Medicaid is Hard To Do

A new report from researchers from Duke University sparked my interest as I have not delved into the recent research on this issue for some time. Some years ago, I looked closely at Florida’s efforts in this regard which were ineffective and administratively costly. 

Duke’s new comprehensive study concluded that “We do not have enough information to conclude whether incentive programs are effective in longer-term health outcomes and costs in Medicaid” (P. 5) The report also cited “multiple operational challenges in implementing … incentive programs” and that states reported that “administrative challenges were greater than expected.”

States continue to try different approaches to encouraging (or in some cases punishing) Medicaid beneficiaries to behave differently. Employers do too as the report points out. The researchers found that a consistent challenge is informing beneficiaries about the incentive programs – a problem we certainly identified in our Florida work.

One of the more successful programs it appears has been Idaho’s premium reduction approach for families in CHIP who have their premiums waived if a child has their well-child visit (66% had their premiums reduced). I like this approach though I suspect that many of these families would have completed their well child visits anyway – of course they are generally required for school attendance as well.

The researchers cite smoking cessation as an area where some evidence of success exists (p. 5) and note that in contrast programs targeting weight loss, diabetes and blood pressure management had “inconsistent results” (p. 5).

I am glad this report is out because I am sure that we will hear more about this subject – its political appeal is enduring. Let’s hope that policymakers try to look at the available facts – though I won’t hold my breath!


Joan Alker
Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy