Improving Systems
-
Medicaid Managed Care Regs Released – Let the Reading Begin
While we all breathed a collective sigh of relief when CMS did not release the Medicaid and CHIP Managed Care proposed rules prior to the Memorial Day weekend, we have our work cut out for us the next few weeks (months) as CMS released 653 pages of proposed rules late yesterday. Organizations have until July 27th…
-
Child Emergency Room Visits as a Window into the Larger Landscape of Child’s Health Coverage
By Naomi Stark, Georgetown CCF Research Assistant The CDC’s National Center for Health Statistics (NCHS) recently published a report on Emergency Room (ER) use among children in the U.S. using data gathered from the 2012 National Health Interview Survey (NHIS). Authors explored the relationship of child coverage type (Private, Medicaid and Uninsured) to the frequency…
-
Washington Reduces Medicaid in Emergency Departments – Credit to Seven Best Practices?
By Keanan Lane, CCF Research Intern & McCourt School of Public Policy Graduate Student The recently released findings from the Oregon Health Insurance Experiment have renewed focus on Medicaid coverage and emergency department (ED) utilization. The results showed an overall increase in ED visits, driven primarily by those classified as “non-emergent,” “primary care treatable,” and…
-
Medicaid Access: Increased Demand for Primary Care Providers Will Vary Across Country
By Tara Mancini See CCF’s latest fact sheet on Medicaid Access Earlier this week, my colleague, Joan Alker, blogged about how Medicaid provides access to needed care. As she mentioned, the decision to extend Medicaid coverage to millions of the uninsured has often been met with skepticism over whether the health care system has the…
-
New Resources from CCF Shows Medicaid Provides Access to Needed Care
A perennial question that is raised about Medicaid is whether beneficiaries can actually find doctors to access the care they need. A new factsheet from CCF on access to health care summarizes available research which shows that in general the answer is a resounding yes. Studies have consistently found that access to primary and preventive…
-
The Election Results Are In: Now What Happens with the Affordable Care Act?
(Editor’s Note: We welcome Senator Rockefeller’s Senior Health Policy Aide Sarah Dash to Georgetown University’s Health Policy team. She is joining our colleagues at the Center on Health Insurance Reforms where she will direct a 50-state evaluation of state health insurance exchange implementation and its impact on access to affordable, high-quality health care. She will also…
-
What Do We Know About Managed Care in Medicaid?
By Joe Touschner Managed care has been part of the Medicaid landscape for many years. Those of us who focus on children and families enrolled in Medicaid are particularly familiar with it—the overwhelming majority of kids in Medicaid are in managed care as are most of the adults who are not elderly or experiencing disabilities. …
-
Study Finds Medicaid Beneficiaries’ Use of Hospital Emergency Departments Comparable to Privately Insured Patients
By Tara Mancini Medicaid seems to be a lightening rod for inaccurate assumptions such as it’s too expensive for states (it’s a good deal for states), overall cost (more cost-effective than private insurance) and beneficiaries using hospital Emergency Departments for routine care. Until recently, there had not been much research to refute the perception of…
-
Medical Homes: Local Focus, Better Health
As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates. Community Catalyst and Georgetown University Health…
-
Decisions, Decisions: ACOs in Medicaid
By Tara Mancini Accountable Care Organizations (ACOs) have been in vogue for some time when it comes to coordinating care for Medicare patients; however, it is a relatively novel ideal for managing Medicaid populations. The populations covered by Medicaid differ vastly from that of Medicare, and therefore Medicaid ACOs require some different practices. A new…
-
Holding Insurers Accountable: Should We Add an MLR to Medicaid?
A hot issue in many states today is whether or not to move more Medicaid beneficiaries, and often very vulnerable beneficiaries, into managed care. Indeed, many managed care companies are interested in getting or keeping a foot in the Medicaid market given the expansion of Medicaid coming in 2014. And many, though not all, states are…
-
Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues To Consider
By Laura Summer, Georgetown University Health Policy Institute (Editor’s Note: Given the increasing interest in Medicaid managed care among states eager to achieve cost-savings, we asked our colleague Laura Summer to blog for us on her latest report on managed care. Her report focused on long-term care services but it provides some helpful insights into broader…
-
Looking Ahead to 2012, What Changes Are In Store for Florida’s Medicaid Program?
Medicaid is a critical part of Florida’s health care system. It covers 3.1 million people in the state, the majority of whom are children. In 2006, a five-year pilot program that replaced traditional Medicaid with an unusual managed-care model and other features that required a Section 1115 waiver from the federal government. In 2012, there…
-
A Team Approach to Care
As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates. Community Catalyst and Georgetown University Health…
-
New Resources on Medicaid Managed Care
By Martha Heberlein States may choose to adopt managed care in Medicaid for a number of reasons. For example, they may be interested in improving care management and coordination. Others may wish to gain more predictability in spending or increase accountability for access to providers and quality of care. No matter what the reason (or…
-
Saving Money, Saving Lives: Maryland Paves the Way on Payment Reform
As policymakers across the country look to balance their budgets, some are turning to Medicaid, recycling the same harmful policies they’ve used year-after-year: eliminating coverage for vulnerable Americans, restricting critical benefits like prescription drug coverage, imposing premiums on those who can’t afford them, and slashing already-low provider reimbursement rates. Community Catalyst and Georgetown University Health…
-
CMS Asks Florida ‘Where’s the Beef’? (Do States Need a Waiver to do Managed Care?)
Last week the Centers for Medicare and Medicaid Services sent a letter to the Florida Agency for Health Care Administration in response to the state’s request for waiver authority to expand managed care statewide. CMS responded by saying that their Medicaid waiver extension request cannot be granted because it lacks a specific plan. The state’s…
-
As Legislators Wrestle to Define Next Generation of Florida Medicaid, Benefits of Reform Effort Are Far From Clear
Medicaid is a critical part of Florida’s health care system. It covers about 27% of the state’s children, pays for 51% of all deliveries and nearly 66% of nursing home days. In 2006, a five-year pilot program replaced traditional Medicaid with an unusual managed-care model and other features that required a Section 1115 waiver from…
-
Florida’s Proposed Medicaid Long-Term Care Changes Raise Host of Questions About Impact
Florida’s 2011 Managed Care Legislation, HB 7107, established “Medicaid Managed Care,” a new statewide managed care program for all covered services. Two separate components are anticipated for the new program: the Florida Long-Term Care Managed Care program, slated for implementation first, and the Florida Managed Medical Assistance program, an expansion of the Medicaid pilot program…
-
Medicaid Managed Care – States Should Look Before They Leap (Again!)
By Joel Ferber, Legal Services of Eastern Missouri and nationally recognized expert on Medicaid A recent article in USA Today focused on Medicaid managed care and its implications for health reform. Health insurance companies are clamoring for the substantial new business that will become available when Medicaid coverage is expanded to an estimated 16 million…