# Effects of Medicaid Coverage and State-Level Delivery Approaches on Healthcare Quality, Outcomes, and Costs for Adults with Diabetes

> **NIH ALLCDC U18** · NORTHWESTERN UNIVERSITY · 2020 · $446,177

## Abstract

Project Summary
Despite tremendous advances in diabetes, many Americans continue to have poor control over risk factors
such as blood glucose, blood pressure, and cholesterol. As a result, diabetes continues to be a leading cause
of death and many preventable complications, such as heart disease, stroke, chronic kidney disease, visual
loss, and amputation. Many adults with diabetes still lack access to a coordinated healthcare team and do not
complete evidence-based preventive services, receive medications or technologies that may improve disease
care, participate in self-management behaviors, or follow-up for early detection and treatment of comorbidities
and complications. This gap between evidence and practice disproportionately impacts the aged, those with
disabilities, and the poor. As the primary health insurer for these vulnerable groups, Medicaid policies that
expand eligibility requirements or lower barriers for initiating high value medications have the potential to
improve healthcare engagement, delivery, and outcomes. States have a great deal of flexibility in administering
Medicaid programs, and the Affordable Care Act and other health reforms further catalyzed state-level
variation in eligibility, coverage, population management services, and financing. This variation presents a
tremendous opportunity for natural experiments to evaluate the comparative effectiveness and costs of policy
shifts on the care and outcomes of diabetes in vulnerable groups for whom the burden of diabetes is highest.
 We propose a Natural Experimental Research Center that will evaluate: 1) health and economic effects of
state-specific variation in Medicaid managed care approaches for pharmacy utilization management affecting a
newer class of diabetes medications with high costs but unique benefits: SGLT2 inhibitors; and 2) the medium-
to longer-term effects of ACA expansion of health insurance coverage for adults with diabetes. We will
leverage our access to two unique longitudinal datasets: (i) national claims data from UnitedHealth Group, a
major Medicaid managed care provider for 6 million people in 27 states; and (ii) multi-state (Illinois, Indiana,
Wisconsin) electronic heath records linked to Medicaid and Medicare claims. Outcomes of interest will include
medication adherence, diabetes care quality, cardiometabolic risk factor control, acute diabetes complications,
other forms of healthcare utilization, and costs. To evaluate state policies for medication utilization
management, we will use difference-in-differences designs involving matched comparators in states with
different policies. We will use the linked EHR-claims data from three states in novel, hybrid regression
discontinuity (RD) and DiD designs to study the longer-term effects of ACA insurance expansion.
 Through direct engagement of collaborators and data contributors in participating states, our studies have
been designed around high priority questions involving the effectiveness of parti...

## Key facts

- **NIH application ID:** 10097549
- **Project number:** 1U18DP006524-01
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Ronald T. Ackermann
- **Activity code:** U18 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $446,177
- **Award type:** 1
- **Project period:** 2020-09-30 → 2025-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10097549

## Citation

> US National Institutes of Health, RePORTER application 10097549, Effects of Medicaid Coverage and State-Level Delivery Approaches on Healthcare Quality, Outcomes, and Costs for Adults with Diabetes (1U18DP006524-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10097549. Licensed CC0.

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