CSHP Medicaid-Related Research & Evaluation Portfolio

Improving Care for High Utilizers

In a 2014 budget address, then New Jersey Governor Christie noted that, in the prior year, 5% of Medicaid recipients accounted for 50% of its costs, calling out impacts of those with “chronic emergency room visits,” “complex medical conditions,” and repeat inpatient stays on New Jersey’s health care spending. The Governor then tasked Rutgers “to expand the scope” of its research to help “innovate and improve” care for Medicaid patients with high utilization inside New Jersey.  

I am calling on New Jersey’s most important medical and research institutions - Rutgers Biomedical and Health Sciences, University Hospital, and Rutgers Camden - to join with our Medicaid managed care organizations to help us devise a program to innovate and improve health care delivery under Medicaid and Family Care.

Chris Christie, February 2014

Governor of New Jersey

In response to this request, Rutgers convened a Working Group on Medicaid High Utilizers, which analyzed Medicaid data and convened stakeholders to develop recommendations for policymakers grappling with how to improve care for these patients. CSHP confirmed that small groups accounted for large shares Medicaid’s $9.4 billion spending in 2013, with the top 1% of spenders having 20 times the rate of avoidable hospitalizations than the bottom 90%, and the top 10% of spenders accounting for 75% of all spending. Read the Working Group's full report here.

Moreover, looking over time, CSHP found “persistence” in high-spend among this population, with high rates of overall inpatient admissions, including avoidable hospitalizations and readmissions. Those within the top 1% were more likely to have a disability, be near the end of life, or receive Long-Term Services and Supports. A striking 85% of these patients had a mental health or substance abuse diagnosis. These findings set the table for additional CSHP work focused on improving care for New Jersey’s at-risk populations.

Monitoring Trends in Cancer Screening

New Jersey has the tenth-highest rate of cancer incidence rate in the United States. The second leading cause of death in New Jersey, thousands of residents die from preventable cancers each year. NJ FamilyCare provides coverage for cancer prevention services and screenings to thousands of beneficiaries throughout the state. However, the New Jersey Department of Human Services estimates nearly 1 in 5 Medicaid recipients could lose coverage under President Donald Trump’s 2025 tax cut and spending bill.

CSHP colleague Jennifer Tsui, PhD, MPH, then an Assistant Professor at Rutgers Cancer Institute of New Jersey and the Rutgers School of Public Health, worked with Rutgers Center for State Health Policy to examine screening patterns among Medicaid enrollees diagnosed with colorectal cancer. Subsequent studies would focus on screening patterns among the entire Medicaid population – not just for colorectal cancer, but for lung cancer as well.

Building on this work, CSHP Associate Research Professor Ann M. Nguyen led an analysis of Medicaid cancer screening trends in New Jersey, the most up-to-date at the time, as well as companion studies of best practices and key factors for facilitating cancer screenings, working closely with Anita Kinney, associate director for Population Science and Community Outreach at Rutgers Cancer Institute and director of ScreenNJ. Learn more in this Rutgers Today Q&A featuring Drs. Nguyen and Kinney.

Articles

• Tsui, J., DeLia, D., Nova, J. Rotter, D. Kulkarni, A., Demissie, K. Stroup, A.M. & Cantor, J.C. (2018). Primary Care Utilization, Late-Stage Diagnosis, and Timeliness of Treatment among Medicaid Cancer Patients: Early Signals following the ACA Expansion. Cancer Epidemiology, Biomarkers & Prevention, 27(7 Supplement), PR07.
• Tsui, J., DeLia, D., Stroup, A.M., Nova, J., Kulkarni, A. Ferrante, J.M. & Cantor, J.C. (2019). Association of Medicaid Enrollee Characteristics and Primary Care Utilization with Cancer Outcomes for the Period Spanning Medicaid Expansion in New Jersey. Cancer, 125(8), 1330–1340.
• McGee-Avila, JK., Doose, M., Nova, J., Kumar, R., Stroup, A.M. & Tsui, J. (2020). Patterns of HIV Testing among Women Diagnosed with Invasive Cervical Cancer in the New Jersey Medicaid Program. Cancer Causes & Control, 31(10), 931–941.
• Nguyen, A.M., Waldron Corredor, A., Liu, F. Y., Yun, X., Nova, J., Kinney, A.Y., Cantor, J.C. & Tsui, J. (2025). Breast, Cervical, and Colorectal Cancer Screening Among New Jersey Medicaid Enrollees: 2017-2022. JCO Clinical Cancer Informatics, 9.
• Waldron Corredor, A., Nguyen, A.M., Nova, J., Ma, Y., Cantor, J.C., Kinney, A.Y. & Tsui, J. (2025). Provider and Organizational Factors Impacting Routine Cancer Screening Among Older Medicaid Enrollees. Health Services Research, 61(2).
• Xie, J., Waldron Corredor, A., Yun, X., Nova, J., Kinney, A.Y., Tsui, J., Cantor, J.C. & Nguyen, A.M. (2026). Lung cancer screening among Medicaid older adults in New Jersey, 2017–2022. Preventive Medicine, 213, 108668.

Reports

• Tsui, J., Michael, M., Koller, M., Nova, J., Davis, S.N., Carey Perez de Alejo, E., Cantor, J.C. & Kinney, A.Y. (2021). Trends in Cancer Screening among Medicaid Enrollees in New Jersey: 2011–2017. Rutgers Center for State Health Policy.

Support for Development of the New Jersey Medicaid Office of Business Intelligence

The NJ Medicaid program established its Office of Business Intelligence to improve its capacity to conduct rapid analyses of importance for the development of innovations in Medicaid. To help accomplish this goal, the NJ Medicaid agency engaged CSHP to assist in the development, staffing, and operations of the Business Intelligence Unit. This assistance expands the current data analytic capabilities of Medicaid and enables it to rapidly identify and address emerging trends relevant to Medicaid beneficiaries and develop actionable intelligence on ways to improve quality of care and improve program efficiency within the NJ FamilyCare (Medicaid) population. 

CSHP is recruiting, training, and mentoring/supervising data analysts who are deployed to the Medicaid BIU. The Center is also providing research technical assistance to the Medicaid team. This project is funded by the NJ Division of Medical Assistance & Health Services. Learn more.