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Determinación de la Elegibilidad , Medicaid , Medicare , Mejoramiento de la Calidad , Humanos , Determinación de la Elegibilidad/organización & administración , Determinación de la Elegibilidad/normas , Medicaid/organización & administración , Medicaid/normas , Medicare/organización & administración , Medicare/normas , Estados Unidos , Calidad de la Atención de Salud/organización & administración , Beneficios del SeguroRESUMEN
Importance: Medicaid is the largest health insurance program by enrollment in the US and has an important role in financing care for eligible low-income adults, children, pregnant persons, older adults, people with disabilities, and people from racial and ethnic minority groups. Medicaid has evolved with policy reform and expansion under the Affordable Care Act and is at a crossroads in balancing its role in addressing health disparities and health inequities against fiscal and political pressures to limit spending. Objective: To describe Medicaid eligibility, enrollment, and spending and to examine areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. Evidence Review: Analyses of publicly available data reported from 2010 to 2022 on Medicaid enrollment and program expenditures were performed to describe the structure and financing of Medicaid and characteristics of Medicaid enrollees. A search of PubMed for peer-reviewed literature and online reports from nonprofit and government organizations was conducted between August 1, 2021, and February 1, 2022, to review evidence on Medicaid managed care, delivery system reforms, expansion, and health disparities. Peer-reviewed articles and reports published between January 2003 and February 2022 were included. Findings: Medicaid covered approximately 80.6 million people (mean per month) in 2022 (24.2% of the US population) and accounted for an estimated $671.2 billion in health spending in 2020, representing 16.3% of US health spending. Medicaid accounted for an estimated 27.2% of total state spending and 7.6% of total federal expenditures in 2021. States enrolled 69.5% of Medicaid beneficiaries in managed care plans in 2019 and adopted 139 delivery system reforms from 2003 to 2019. The 38 states (and Washington, DC) that expanded Medicaid under the Affordable Care Act experienced gains in coverage, increased federal revenues, and improvements in health care access and some health outcomes. Approximately 56.4% of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. Expanding Medicaid, addressing disparities within Medicaid, and having an explicit focus on equity in managed care and delivery system reforms may represent opportunities for Medicaid to advance health equity. Conclusions and Relevance: Medicaid insures a substantial portion of the US population, accounts for a significant amount of total health spending and state expenditures, and has evolved with delivery system reforms, increased managed care enrollment, and state expansions. Additional Medicaid policy reforms are needed to reduce health disparities by race and ethnicity and to help achieve equity in access, quality, and outcomes.
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Reforma de la Atención de Salud , Equidad en Salud , Medicaid , Anciano , Niño , Etnicidad , Femenino , Reforma de la Atención de Salud/economía , Equidad en Salud/normas , Humanos , Cobertura del Seguro/economía , Medicaid/economía , Medicaid/organización & administración , Medicaid/normas , Grupos Minoritarios/estadística & datos numéricos , Patient Protection and Affordable Care Act/economía , Embarazo , Estados Unidos/epidemiologíaAsunto(s)
Equidad en Salud , Medicaid , Equidad en Salud/normas , Humanos , Medicaid/normas , Estados UnidosAsunto(s)
Centers for Medicare and Medicaid Services, U.S. , Innovación Organizacional , Mejoramiento de la Calidad , Centers for Medicare and Medicaid Services, U.S./organización & administración , Centers for Medicare and Medicaid Services, U.S./normas , Medicaid/normas , Medicare/normas , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/normas , Estados UnidosRESUMEN
Importance: Unreliable performance measures can mask poor-quality care and distort financial incentives in value-based purchasing. Objective: To examine the association between test-retest reliability and the reproducibility of hospital rankings. Design, Setting, and Participants: In a cross-sectional design, Centers for Medicare & Medicaid Services Hospital Compare data were analyzed for the 2017 (based on 2014-2017 data) and 2018 (based on 2015-2018 data) reporting periods. The study was conducted from December 13, 2020, to September 30, 2021. This analysis was based on 28 measures, including mortality (acute myocardial infarction, congestive heart failure, pneumonia, and coronary artery bypass grafting), readmissions (acute myocardial infarction, congestive heart failure, pneumonia, and coronary artery bypass grafting), and surgical complications (postoperative acute kidney failure, postoperative respiratory failure, postoperative sepsis, and failure to rescue). Exposures: Measure reliability based on test-retest reliability testing. Main Outcomes and Measures: The reproducibility of hospital rankings was quantified by calculating the reclassification rate across the 2017 and 2018 reporting periods after categorizing the hospitals into terciles, quartiles, deciles, and statistical outliers. Linear regression analysis was used to examine the association between the reclassification rate and the intraclass correlation coefficient for each of the classification systems. Results: The analytic cohort consisted of 28 measures from 4452 hospitals with a median of 2927 (IQR, 2378-3160) hospitals contributing data for each measure. The hospitals participating in the Inpatient Prospective Payment System (n = 3195) had a median bed size of 141 (IQR, 69-261), average daily census of 70 (IQR, 24-155) patients, and a median disproportionate share hospital percentage of 38.2% (IQR, 18.7%-36.6%). The median intraclass correlation coefficient was 0.78 (IQR, 0.72-0.81), ranging between 0.50 and 0.85. The median reclassification rate was 70% (IQR, 62%-71%) when hospitals were ranked by deciles, 43% (IQR, 39%-45%) when ranked by quartiles, 34% (IQR, 31%-36%) when ranked by terciles, and 3.8% (IQR, 2.0%-6.2%) when ranked by outlier status. Increases in measure reliability were not associated with decreases in the reclassification rate. Each 0.1-point increase in the intraclass correlation coefficient was associated with a 6.80 (95% CI, 2.28-11.30; P = .005) percentage-point increase in the reclassification rate when hospitals were ranked into performance deciles, 4.15 (95% CI, 1.16-7.14; P = .008) when ranked into performance quartiles, 1.47 (95% CI, 1.84, 4.77; P = .37) when ranked into performance terciles, and 3.70 (95% CI, 1.30-6.09; P = .004) when ranked by outlier status. Conclusions and Relevance: In this study, more reliable measures were not associated with lower rates of reclassifying hospitals using test-retest reliability testing. These findings suggest that measure reliability should not be assessed with test-retest reliability testing.
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Hospitales/estadística & datos numéricos , Hospitales/normas , Medicaid/estadística & datos numéricos , Medicaid/normas , Medicare/estadística & datos numéricos , Medicare/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Estudios Transversales , Humanos , Reproducibilidad de los Resultados , Estados UnidosRESUMEN
SUMMARY The 1-month drug-dispensing limit is a common drug utilization tool used by state Medicaid agencies to control spending. Since the beginning of the COVID-19 pandemic, many states relaxed the 1-month dispensing limit restriction in order to align with social distancing recommendations. Yet, some states have not relaxed this limit and have differed substantially regarding the policies that have been implemented. Among states that relaxed the 1-month supply limit, determining which chronic disease drugs qualified for this extension can be challenging for patients and clinicians. As more commercial and Medicare insurance beneficiaries are offered 90-day drug supplies, the 30-day drug supply limit with Medicaid has become a health equity issue, since many individuals insured by Medicaid have already experienced a disproportionate impact from and remain at high risk for severe COVID-19 disease. Thus, we propose policy solutions to ensure that Medicaid beneficiaries have safe and uninterrupted access to chronic disease medications during and beyond the COVID-19 pandemic. DISCLOSURES: No funding was received for this work. Alpern has received funding from Arnold Ventures for research related to the use and spending of off-patent drugs, unrelated to this work, and is a member of the Pharmacy and Therapeutics Committee at Regions Hospital, St. Paul, MN. DeSilva has received CDC support for work on Vaccine Safety Datalink, VISION network, and Center of Excellence for Newcomer Health, unrelated to this work. Chomilo is Medicaid Medical Director for the State of Minnesota's Department of Human Services.
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COVID-19/epidemiología , Medicaid/normas , Distanciamiento Físico , Enfermedad Crónica , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/normas , Medicaid/economía , Pandemias , Políticas , SARS-CoV-2 , Estados Unidos/epidemiologíaAsunto(s)
Educación de Postgrado en Medicina/organización & administración , Internado y Residencia/organización & administración , Medicaid/organización & administración , Gobierno Estatal , Apoyo a la Formación Profesional/organización & administración , Educación de Postgrado en Medicina/economía , Educación de Postgrado en Medicina/métodos , Educación de Postgrado en Medicina/normas , Financiación Gubernamental/normas , Humanos , Internado y Residencia/economía , Internado y Residencia/normas , Medicaid/economía , Medicaid/normas , Apoyo a la Formación Profesional/economía , Apoyo a la Formación Profesional/normas , Estados UnidosRESUMEN
Maternal mortality has been increasing in the United States over the past 3 decades, while decreasing in all other high-income countries during the same period. Cardiovascular conditions account for over one fourth of maternal deaths, with two thirds of deaths occurring in the postpartum period. There are also significant healthcare disparities that have been identified in women experiencing maternal morbidity and mortality, with Black women at 3 to 4 times the risk of death as their White counterparts and women in rural areas at heightened risk for cardiovascular morbidity and maternal morbidity. However, many maternal deaths have been shown to be preventable, and improving access to care may be a key solution to addressing maternal cardiovascular mortality. Medicaid currently finances almost half of all births in the United States and is mandated to provide coverage for women with incomes up to 138% of the federal poverty level, for up to 60 days postpartum. In states that have not expanded coverage, new mothers become uninsured after 60 days. Medicaid expansion has been shown to reduce maternal mortality, particularly benefiting racial and ethnic minorities, likely through reduced insurance churn, improved postpartum access to care, and improved interpregnancy care. However, even among states with Medicaid expansion, significant care gaps exist. An additional proposed intervention to improve access to care in these high-risk populations is extension of Medicaid coverage for 1 year after delivery, which would provide the most benefit to women in Medicaid nonexpanded states, but also improve care to women in Medicaid expanded states.
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Accesibilidad a los Servicios de Salud , Mortalidad Materna , Medicaid , Complicaciones Cardiovasculares del Embarazo , Adulto , Etnicidad , Femenino , Política de Salud/tendencias , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Mortalidad Materna/etnología , Mortalidad Materna/tendencias , Medicaid/economía , Medicaid/normas , Formulación de Políticas , Periodo Posparto , Embarazo , Complicaciones Cardiovasculares del Embarazo/economía , Complicaciones Cardiovasculares del Embarazo/mortalidad , Estados Unidos/epidemiologíaAsunto(s)
Gastos en Salud/estadística & datos numéricos , Gastos en Salud/normas , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Precios de Hospital/estadística & datos numéricos , Precios de Hospital/normas , Estudios Transversales , Adhesión a Directriz/normas , Adhesión a Directriz/estadística & datos numéricos , Humanos , Medicaid/normas , Medicaid/estadística & datos numéricos , Medicare/normas , Medicare/estadística & datos numéricos , Estados UnidosRESUMEN
Importance: Safety-net hospitals (SNHs) operate under limited financial resources and have had challenges providing high-quality care. Medicaid expansion under the Affordable Care Act led to improvements in hospital finances, but whether this was associated with better hospital quality, particularly among SNHs given their baseline financial constraints, remains unknown. Objective: To compare changes in quality from 2012 to 2018 between SNHs in states that expanded Medicaid vs those in states that did not. Design, Setting, and Participants: Using a difference-in-differences analysis in a cohort study, performance on quality measures was compared between SNHs, defined as those in the highest quartile of uncompensated care in the pre-Medicaid expansion period, in expansion vs nonexpansion states, before and after the implementation of Medicaid expansion. A total of 811 SNHs were included in the analysis, with 316 in nonexpansion states and 495 in expansion states. The study was conducted from January to November 2020. Exposures: Time-varying indicators for Medicaid expansion status. Main Outcomes and Measures: The primary outcome was hospital quality measured by patient-reported experience (Hospital Consumer Assessment of Healthcare Providers and Systems Survey), health care-associated infections (central line-associated bloodstream infections, catheter-associated urinary tract infections, and surgical site infections following colon surgery) and patient outcomes (30-day mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia). Secondary outcomes included hospital financial measures (uncompensated care and operating margins), adoption of electronic health records, provision of safety-net services (enabling, linguistic/translation, and transportation services), or safety-net service lines (trauma, burn, obstetrics, neonatal intensive, and psychiatric care). Results: In this difference-in-differences analysis of a cohort of 811 SNHs, no differential changes in patient-reported experience, health care-associated infections, readmissions, or mortality were noted, regardless of Medicaid expansion status after the Affordable Care Act. There were modest differential increases between 2012 and 2016 in the adoption of electronic health records (mean [SD]: nonexpansion states, 99.4 [7.4] vs 99.9 [3.8]; expansion states, 94.6 [22.6] vs 100.0 [2.2]; 1.7 percentage points; P = .02) and between 2012 and 2018 in the number of inpatient psychiatric beds (mean [SD]: nonexpansion states, 24.7 [36.0] vs 23.6 [39.0]; expansion states: 29.3 [42.8] vs 31.4 [44.3]; 1.4 beds; P = .02) among SNHs in expansion states, although they were not statistically significant at a threshold adjusted for multiple comparisons. In subgroup analyses comparing SNHs with higher vs lower baseline operating margins, an isolated differential improvement was noted in heart failure readmissions among SNHs with lower baseline operating margins in expansion states (mean [SD], 22.8 [2.1]; -0.53 percentage points; P = .001). Conclusions and Relevance: This difference-in-differences cohort study found that despite reductions in uncompensated care and improvements in operating margins, there appears to be little evidence of quality improvement among SNHs in states that expanded Medicaid compared with those in states that did not.
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Medicaid/normas , Proveedores de Redes de Seguridad/normas , Estudios de Cohortes , Humanos , Medicaid/tendencias , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Patient Protection and Affordable Care Act/normas , Patient Protection and Affordable Care Act/tendencias , Satisfacción del Paciente , Proveedores de Redes de Seguridad/tendencias , Estados UnidosRESUMEN
Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.
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Certificación/legislación & jurisprudencia , Certificación/normas , Hogares para Ancianos/legislación & jurisprudencia , Hogares para Ancianos/normas , Asistentes de Enfermería/legislación & jurisprudencia , Asistentes de Enfermería/normas , Casas de Salud/legislación & jurisprudencia , Casas de Salud/normas , Adulto , Anciano , Anciano de 80 o más Años , Gobierno Federal , Femenino , Política de Salud/legislación & jurisprudencia , Humanos , Masculino , Medicaid/legislación & jurisprudencia , Medicaid/normas , Medicare/legislación & jurisprudencia , Medicare/normas , Persona de Mediana Edad , Formulación de Políticas , Estados UnidosRESUMEN
As Pennsylvania implements its managed long-term services and supports program, we explore how home- and community-based providers are preparing for and perceiving the transition through an online survey. We summarize responses and conduct chi-square analysis to measure differences between select provider groups. Despite high levels of uncertainty about program impact, over 84% of respondents plan to participate. We found that providers in the first implementation phase had more strategic and operational discussions with MCOs than the other two phases (p < .03). As program rollout continues, we anticipate changes in MCO-provider conversation frequency and topics based upon implementation zone.
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Servicios de Salud Comunitaria/normas , Participación de la Comunidad , Programas Controlados de Atención en Salud/normas , Medicaid/normas , Garantía de la Calidad de Atención de Salud/organización & administración , Humanos , Pennsylvania , Planes Estatales de Salud/normas , Estados UnidosRESUMEN
Background: A cascade of care (CoC) model may improve understanding of gaps in addiction treatment availability and quality over current single measure methods. Despite increased funding, opioid overdose rates remain high. Therefore, it is critical to understand where the health-care system is failing to provide appropriate care for people with opioid use disorder (OUD) diagnoses, and to assess disparities in receipt of medication for OUD (MOUD).Objective: Using a CoC framework, assess treatment quality and outcomes for OUD in the Florida Medicaid population in 2017/2018 by demographics and primary vs. secondary diagnosis.Methods: Data from Florida Medicaid claims for 2017 and 2018 were used to calculate the number of enrollees who were diagnosed, began MOUD, were retained on medication for a minimum of 180 days, and who died.Results: Only 28% of those diagnosed with OUD began treatment with an FDA approved MOUD (buprenorphine, methadone, or injectable naltrexone). Once on medication, 38% of newly diagnosed enrollees were retained in treatment for180 days. Those who remained on MOUD for 180 days had a hazard ratio of death of 0.226 (95% CI = 0.174 to 0.294) compared to those that did not initiate MOUD, a reduction in mortality from 10% without MOUD to 2% with MOUD.Conclusions: Initiating medication after OUD diagnosis offers the greatest opportunity for intervention to reduce overdose deaths, though efforts to increase retention are also warranted. Analyzing claims data with CoC identifies system functioning for specific populations, and suggests policies and clinical pathways to target for improvement.
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Atención a la Salud/normas , Medicaid/normas , Trastornos Relacionados con Opioides/tratamiento farmacológico , Adolescente , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Buprenorfina/uso terapéutico , Sobredosis de Droga/tratamiento farmacológico , Femenino , Florida/epidemiología , Humanos , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Sobredosis de Opiáceos/tratamiento farmacológico , Tratamiento de Sustitución de Opiáceos/estadística & datos numéricos , Trastornos Relacionados con Opioides/epidemiología , Modelos de Riesgos Proporcionales , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: We aimed to analyze the impact of the Affordable Care Act's Medicaid Expansion on clinical outcomes and patient disposition after burn injury. We hypothesized that increased insurance coverage results in improved outcomes and higher rates of discharge to inpatient rehabilitation. METHODS: We reviewed the University of Washington Regional Burn Center registry data for patients admitted from 2011 to 2018. Patients were grouped into two categories: before (2011-2013) and after (2015-2018) Medicaid expansion; we excluded 2014 data to serve as a washout period. Outcomes assessed included length of hospital stay, patient disposition, and mortality. Multivariable logistic and linear regression models with covariates for sex, age, burn size, ethnicity ethnicity, distance from burn center, etiology of burn, and presence of inhalation injury were used to determine the impact of Medicaid expansion on outcomes. RESULTS: Rates of uninsured patients decreased while Medicaid coverage increased. Despite increased median burn size after Medicaid expansion, inpatient mortality rates did not change, but average acute care length of stay increased. More patients were discharged to rehabilitation centers. CONCLUSIONS: Our study corroborates prior findings of increased insurance coverage since Medicaid expansion. Increased insurance coverage is associated with higher rates of discharge to inpatient rehabilitation programs after burn injury.
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Quemaduras/economía , Medicaid/normas , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Patient Protection and Affordable Care Act/normas , Adolescente , Adulto , Quemaduras/complicaciones , Quemaduras/epidemiología , Niño , Femenino , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/normas , Cobertura del Seguro/tendencias , Modelos Logísticos , Masculino , Medicaid/economía , Medicaid/tendencias , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Patient Protection and Affordable Care Act/economía , Patient Protection and Affordable Care Act/tendencias , Sistema de Registros/estadística & datos numéricos , Estados Unidos , Washingtón/epidemiologíaRESUMEN
PURPOSE: There is a lack of consensus on how to evaluate health and social service programs for people with mental health (MH) conditions. Having service users be the primary decision makers in selecting outcome measures can inform a meaningful evaluation strategy. We sought to identify the quality of life (QoL) survey preferences of high-need adult service users with MH conditions. METHODS: A systematic review identified generic, self-reported QoL surveys with evidence of validity in MH populations of interest. An advisory panel selected the most promising surveys to assess the success of programs like Medicaid for MH service users. Three groups of high-need, adult service users with MH conditions and one group of direct care staff ranked the surveys from the advisory panel, and generated and ranked characteristics that were desirable or undesirable in a QoL survey. RESULTS: Twenty-two surveys met the inclusion criteria. Of the six surveys selected by the advisory panel, groups of service users and direct care staff most preferred the Warwick-Edinburg Mental Well-being Scale (WEMWBS). The WEMWBS best embodied the features prioritized by the groups: to have a user-friendly format and positive focus, to be clearly worded and brief, and to avoid presumptive or unrealistic items. Service user groups appreciated survey topics most amenable to self-report, such as satisfaction with relationships. CONCLUSION: Using QoL surveys that service users prefer can reduce the chance that deteriorating QoL is going unchecked, and increase the chance that decisions based on survey findings are meaningful to service users.
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Medicaid/normas , Trastornos Mentales/terapia , Servicios de Salud Mental/normas , Salud Mental/normas , Humanos , Trastornos Mentales/psicología , Evaluación de Resultado en la Atención de Salud , Calidad de Vida/psicología , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Concise history of fascinating magnetoencephalography (MEG) technology and catalog of very selected milestone preclinical and clinical MEG studies are provided as the background. The focus is the societal context defining a journey of MEG to and through clinical practice and formation of the American Clinical MEG Society (ACMEGS). We aspired to provide an objective historic perspective and document contributions of many professionals while focusing on the role of ACMEGS in the growth and maturation of clinical MEG field. The ACMEGS was born (2006) out of inevitability to address two vital issues-fair reimbursement and proper clinical acceptance. A beacon of accountable MEG practice and utilization is now an expanding professional organization with the highest level of competence in practice of clinical MEG and clinical credibility. The ACMEGS facilitated a favorable disposition of insurances toward MEG in the United States by combining the national replication of the grassroots efforts and teaming up with the strategic partners-particularly the American Academy of Neurology (AAN), published two Position Statements (2009 and 2017), the world's only set of MEG Clinical Practice Guidelines (CPGs; 2011) and surveys of clinical MEG practice (2011 and 2020) and use (2020). In addition to the annual ACMEGS Course (2012), we directly engaged MEG practitioners through an Invitational Summit (2019). The Society remains focused on the improvements and expansion of clinical practice, education, clinical training, and constructive engagement of vendors in these issues and pivotal studies toward additional MEG indications. The ACMEGS not only had the critical role in the progress of Clinical MEG in the United States and beyond since 2006 but positioned itself as the field leader in the future.
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Competencia Clínica , Magnetoencefalografía/tendencias , Neurología/tendencias , Sociedades/tendencias , Competencia Clínica/normas , Humanos , Magnetoencefalografía/normas , Medicaid/normas , Medicaid/tendencias , Medicare/normas , Medicare/tendencias , Neurología/normas , Sociedades/normas , Encuestas y Cuestionarios , Estados Unidos/epidemiologíaAsunto(s)
Medicaid/normas , Neoplasias/mortalidad , Adulto , Humanos , Análisis de Supervivencia , Estados UnidosRESUMEN
BACKGROUND: Twitter is a potentially valuable tool for public health officials and state Medicaid programs in the United States, which provide public health insurance to 72 million Americans. OBJECTIVE: We aim to characterize how Medicaid agencies and managed care organization (MCO) health plans are using Twitter to communicate with the public. METHODS: Using Twitter's public application programming interface, we collected 158,714 public posts ("tweets") from active Twitter profiles of state Medicaid agencies and MCOs, spanning March 2014 through June 2019. Manual content analyses identified 5 broad categories of content, and these coded tweets were used to train supervised machine learning algorithms to classify all collected posts. RESULTS: We identified 15 state Medicaid agencies and 81 Medicaid MCOs on Twitter. The mean number of followers was 1784, the mean number of those followed was 542, and the mean number of posts was 2476. Approximately 39% of tweets came from just 10 accounts. Of all posts, 39.8% (63,168/158,714) were classified as general public health education and outreach; 23.5% (n=37,298) were about specific Medicaid policies, programs, services, or events; 18.4% (n=29,203) were organizational promotion of staff and activities; and 11.6% (n=18,411) contained general news and news links. Only 4.5% (n=7142) of posts were responses to specific questions, concerns, or complaints from the public. CONCLUSIONS: Twitter has the potential to enhance community building, beneficiary engagement, and public health outreach, but appears to be underutilized by the Medicaid program.