Medicaid and Complex Care

States continue to drive toward improving the health of their residents and, because health care costs are a large and growing component of state budgets, governors also are looking for long-term, transformational ways to improve the efficiency of their Medicaid programs. Generally, a small segment of the enrollee population account for large portion of states’ Medicaid expenditures. Those individuals with complex care needs, also known as “super-utilizers,” tend to have a history of chronic illness, multiple comorbidities, special needs and other non-clinical complications that may be related to unstable housing, employment, food and transportation and interaction with the criminal justice system. They often use emergency departments and inpatient services when home and community-based interventions could be employed with good outcomes and at lower costs. By appropriately redirecting state funds to address the comprehensive needs of people with complex care needs, states can rein in escalating costs and improve the quality of care delivered to high-risk and vulnerable Medicaid beneficiaries.

The NGA Center is currently working with nine states (AlaskaColoradoConnecticutKentuckyMichiganRhode IslandWest VirginiaWisconsin and Wyoming) over the course of 18 months in the second round of the Developing State-Level Capacity to Improve Health and Reduce Cost of Populations with Complex Care Needs Policy Academy. The first round finished in November 2014, with seven participating states (AlaskaColoradoKentuckyNew MexicoPuerto RicoWisconsin and West Virginia). Through this comprehensive technical assistance effort, NGA Center will assist states in identifying target complex care populations through data analytics; developing care delivery and payment models that incentivize best practices and provide return on investment through optimizing health and behavioral health care approaches; and adding wraparound services such as transportation and housing.

Publications and Resources

Projects and Meetings


  • Improving Coordination and Integration of Care for the Dual Eligible Population Roundtable | December 2018
  • State Policy Scans | November 2018 – December 2019
  • Building State Capacity to Evaluate Innovative Medicaid Policies | June 2018 – December 2018
  • Building Capacity to Improve Outcomes and Reduce Cost of Care for High Need, High Cost Populations with Behavioral Health and Social Support Needs: Behavioral Health Integration Learning Lab | August 2017 – January 2019
    • Learning Lab Kick Off | January 2018
  • Governors’ Bipartisan Health Reform Learning Network| 2017-2018
    • Bipartisan Health Reform Learning Network Mid-Project Meeting | October 2017
    • Bipartisan Health Reform Learning Network Kick-Off Meeting | May 2017
  • Maintaining Momentum on Transformation for a Healthier Next Generation: Identifying Priority Areas of Support for State Leaders to Successfully Transform Their Health Systems in Coming Years Roundtable | March 2017
  • Housing as Health Care | April 2016 – January 2017
    • Housing as Health Care Learning Lab | February 2016
  • Connecting Medicaid to State Workforce Needs | 2016 – 2018
  • Making the Business Case for Complex Care Needs Programs: Data Collection, Analytics and Evaluation | July 2015
    • Learning Lab Kick-Off Convening | July 2015
  • Creating a Dialogue with U.S. Health and Human Services and Treasury about Coverage Provisions of the Affordable Care Act to Maximize State Flexibility Roundtable | June 2015
  • Developing State-Level Capacity to Improve Health and Reduce Cost of Populations with Complex Care Needs |June 2015 – June 2017
    • Policy Academy Kick-Off Convening | July 2015
  • Medicaid Leadership Institute | 2015 – 2016
    • Medicaid Leadership Institute Closing Meeting | September 2016
  • Leveraging Medicaid to Create Statewide Health Care Transformation | 2014 – 2016
  • Learning from Each Other: The Roles of States in Transforming their Health Systems | January 2014
  • Developing State-Level Capacity to Support Super-Utilizers Policy Academy | August 2013 – November 2014
    • Policy Academy Kick Off Convening | August 2013
    • Policy Academy Closing Convening | November 2014
  • NGA Convening of State Innovation Model (SIM) Design States | May 2013
  • Health Care: Decision Points for States Meeting | July 2012