More than one quarter of the entire Massachusetts state budget is spent on the Medicaid program, yet, noted HSPH lecturer Nancy Turnbull: "Medicaid is not well understood, even by many of the policymakers who have to make decisions related to the program."

A former state deputy insurance commissioner, Turnbull has been named executive director of the new Massachusetts Medicaid Policy Institute. She will balance the appointment with her continuing duties as lecturer on health policy in the Department of Health Policy and Management at HSPH.

Created with a $1 million donation from Blue Cross Blue Shield of Massachusetts, the institute's purpose is to provide non-partisan research, information and analysis of the Medicaid program in Massachusetts, said Turnbull.

The Massachusetts Medicaid Policy Institute will start out under the aegis of the Blue Cross Blue Shield of Massachusetts Foundation, which was formed in 2001 through a $50 million endowment from the health insurance company Blue Cross Blue Shield of Massachusetts. The foundation is a separate entity from the insurer.

The goal is to eventually establish an affiliation between the institute and a university, said Turnbull. She envisions opportunities for researchers and students to formulate and conduct projects that would promote policy approaches to strengthen the effectiveness of the Medicaid program in Massachusetts, in addition to dispelling some common misunderstandings.

For example, said Turnbull, many people confuse the federal entitlement program Medicare with the federal/state program Medicaid. While Medicare offers the same benefits across the country, Medicaid programs differ from state to state. After fulfilling baseline requirements from the federal government, each state has considerable leeway in deciding what services will be available through Medicaid and who is eligible to receive them.

In fact, the recipients of Medicaid are more varied than many taxpayers tend to presume. While people may correctly associate Medicaid with care for poor women and children, most Medicaid spending goes to help the elderly as well as people with disabilities. Turnbull noted that approximately half of the increased spending on the program in Massachusetts over the past five years has gone toward medical care for people with disabilities, a trend that the Massachusetts Medicaid Policy Institute intends to study, she said.

"We hope to foster better understanding about Medicaid members with disabilities," said Turnbull. "Medicaid is a critical source of support for many children and adults with complex health needs, but we don't know enough about this very heterogeneous group: who they are, what services they use and need, and how we might improve systems of care in ways that will enhance quality of care and moderate spending."

The business community may also benefit from a clearer grasp on how the Medicaid program works. Payments made through the program to health care providers such as hospitals and community health centers help keep many of those institutions afloat. Cuts in Medicaid eligibility and spending can lead to costs being shifted to private payers.

The Massachusetts Medicaid Policy Institute has established a board of directors that includes two former state Medicaid commissioners, a former state senator, and a former Massachusetts Health and Human Services secretary, as well as representatives of health care providers, businesses and taxpayers.

Turnbull expects that the institute will put out its first request for proposals for research studies within the next few weeks.