Researchers from universities across the northeastern United States recently gathered at Yale’s Tobin Center for Economic Policy to share their work examining aspects of Medicaid, a government program that roughly a fifth of all Americans rely on for access to free or low-cost health care.
The one-day symposium — which linked state and federal policymakers with scholars from Yale, Harvard, Brown, Cornell, and Boston University — was part of an ongoing effort on the Yale campus to inform public policy through cutting-edge social science research.
Researchers from universities across the northeastern United States gathered at Yale’s Tobin Center to share their work on Medicaid.
“Medicaid is one of the country’s most important social programs and it faces a number of challenges and complexities that potentially affect the health and wellbeing of the tens of millions of people nationwide,” said Jacob Wallace, associate professor of public health (health policy) at the Yale School of Public Health (YSPH) and one of the symposium’s organizers. “We’re hoping to connect high-level researchers here at Yale and elsewhere with policymakers to inform a national conversation on how best to help this vital program run more efficiently and better serve those who rely on it for access to health care.”
Medicaid, a joint federal and state program, serves low-income individuals and families, pregnant women, the elderly, and people with disabilities. States administer their own programs in accordance with federal rules, and they fund their programs with support from federal subsidies. For most states, the program is their largest budget expenditure outside of K-12 education, according to the Pew Charitable Trusts.
It’s impossible to overstate the Herculean uphill walk around data access… Certainly, the folks at Yale who are part of convening this event have been really good standard bearers here.
The research presented at the symposium covered a broad range of topics involving Medicaid, including prescription drug access, reimbursement for postpartum depression screening, and various issues related to the winding down of a federal measure that kept people continuously enrolled in Medicaid through the COVID-19 public health emergency, which ended in May 2023.
“State Medicaid agencies often have to make decisions in real time with very little evidence,” said Chima D. Ndumele, associate professor of public health (health policy) at YSPH, who organized the symposium with Wallace and Benjamin Sommers, the Huntley Quelch Professor of Health Care Economics at the Harvard School of Public Health. “We’re interested in learning how best to inform those decisions with better evidence through rigorous research. Also, we occasionally want to look backwards and think about ways things might have been done more efficiently.”
The key, Ndumele said, is to figure out how to merge the data and institutional knowledge that state governments possess with cutting-edge data science.
Chima Ndumele, left, and Jacob Wallace, professors at YSPH, organized the symposium and are working with Connecticut officials on evidence-based research to improve the state’s Medicaid program.
To that end, the symposium convened a panel of policymakers that included William Halsey, Connecticut’s Medicaid director; Kate McEvoy, executive director of the National Association of Medicaid Directors; and Rebecca Haffajee, principal deputy assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services.
One major hurdle for state officials collaborating with academics is the lengthy amount of time required to finalize data-sharing agreements so that states can safely and securely share sensitive health care data with researchers, said Halsey, who runs Husky Health, Connecticut’s public health coverage program (which includes Medicaid and serves about 800,000 residents).
“We protect that data very carefully, but we want it to be available to researchers to inform policy,” he said. “… We are interested in partnering with researchers that can give us what I call actionable intelligence on how to inform policy in real time, not five or 10 years later.”
Currently, Wallace, Ndumele, and other Yale researchers are working with Halsey to secure agreements to access state data for research purposes.
McEvoy, who previously served as director of Husky Health, praised Yale’s willingness to work with state officials through the protracted legal process.
“It’s impossible to overstate the Herculean uphill walk around data access,” she said. “It is almost an endurance test… Certainly, the folks at Yale who are part of convening this event have been really good standard bearers here.”
By bringing together top economists from the Northeast and key policymakers, the Tobin Center supports our amazing faculty in engaging with key questions and enabling better, more effective policy.
In the spring of 2023, the administration of Connecticut Governor Ned Lamont announced a series of policy collaborations between Yale and the state, including an effort to employ data science to strengthen the state’s Medicaid program. Among other commitments, Yale has embedded a research team into Husky Health to help inform research and identify areas of need.
Later that spring, the Tobin Center hosted a brainstorming session with state Medicaid officials and Yale researchers, including Wallace and Ndumele, to think through how to best apply the latest evidence-based research techniques to making Husky Health operate more effectively and efficiently.
“Medicaid is increasingly at the forefront of national policy discussions,” said Dave Wilkinson, executive director of the Tobin Center. “By bringing together top economists from the Northeast and key policymakers, the Tobin Center supports our amazing faculty in engaging with key questions and enabling better, more effective policy.”
During the panel discussion with policymakers, McEvoy advised researchers to keep in mind that Medicaid programs operate on annual or biannual budgets, which creates a compressed cycle for making arguments in favor of new investments. Given that Medicaid programs account for, on average, about 30% of a state’s budget, research that identifies how to optimize existing resources or provide ways to make interventions more targeted and effective is extremely helpful, she said.
McEvoy and Halsey urged the researchers to contact Medicaid directors with any research that might be helpful.
We need to understand the realities that Medicaid directors face on the ground and use that to frame our research in ways that will be most helpful to them.
“If there is data out there that we think we can use to improve services and reduce downstream costs, we want to see it,” Halsey said. “We need that data.”
More to the point, McEvoy urged scholars to provide clear and concise summaries of their work and its relevance to public policy. “What’s the bottom line?” she said. “What are the pieces that we can act upon? Is there a return-on-investment aspect?”
Following the panel discussion, Wallace suggested that while one-page summaries can concisely communicate findings, they shed little light on the quality of the research.
“You can draft a nice one-pager for good research and for bad research,” he said, speaking after the symposium. “We’re thinking about whether we can help our policymaker friends by serving as a sort of referee layer to help them identify research that is rigorous and high quality.”
At the same time, researchers must become fluent in the issues that policymakers are dealing with every day for their work to have the greatest impact, Wallace added.
“We need to understand the realities that Medicaid directors face on the ground and use that to frame our research in ways that will be most helpful to them,” he said. “We’re doing that here in Connecticut, and it is something that should be happening nationwide.”
