Principles for Designing Consumer-Friendly Wellness Programs in Medicaid
A growing number of states are interested in adding wellness incentives to their Medicaid programs, either as part of a Medicaid expansion or as a change to traditional Medicaid.
Wellness programs can be designed in consumer-friendly ways that help enrollees make healthy behavior changes. But some wellness program designs change enrollees’ health care costs or benefits based on enrollees’ participation in health-related activities. This kind of wellness program has not been proven more effective than other program designs, and it can hinder enrollees’ access to care.
To help enrollees make healthy behavior changes, Medicaid wellness programs must protect all enrollees’ access to affordable care and address the economic and social barriers that can prevent people from engaging in healthy behaviors. States should avoid models that vary enrollees’ benefits or health care costs based on whether enrollees meet certain requirements.
This brief explains wellness reward and penalty programs, and it discusses the options advocates can suggest if their state proposes a penalty-based wellness program that could harm enrollees’ access to care.