Fee-for-Service

On February 29, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of November 2023, over 66.7 million people are enrolled in Medicare; more than 34.1 million are enrolled in fee-for-service Medicare, and over 32.6 million are enrolled in Medicare Advantage or other health plans. Over 85.8 million enrollees have Medicaid and CHIP. More than 78.7 million individuals have Medicaid and over 7.1 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

On January 11, Mathematica published a blog titled “A Quick Guide to Choosing Federal Medicaid Authorities to Address Health-Related Social Needs.” This blog explores the three most common federal Medicaid authorities that enable states to offer health-related social needs (HRSN) services to Medicaid-enrolled individuals: Section 1915 HCBS waivers, Managed Care In Lieu of Services (ILOS), and Section 1115 demonstrations. It also discusses key factors to contemplate as a state Medicaid official when choosing how to cover HRSN services, emphasizing considerations such as the intended population, types of services, and program features.

On January 31, the Centers for Medicare & Medicaid Services (CMS) released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of October 2023, over 66.6 million people are enrolled in Medicare; more than 34 million are enrolled in fee-for-service Medicare, and close to 32.6 million are enrolled in Medicare Advantage or other health plans. Over 87.2 million enrollees have Medicaid and CHIP. More than 80.2 million individuals have Medicaid and over 7 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

Hospital readmissions are a large source of wasteful healthcare spending, and current care transition models are too expensive to be sustainable. One way to circumvent cost-prohibitive care transition programs is complement nurse-staffed care transition programs with those staffed by less expensive nonmedical workers. A major barrier to utilizing nonmedical workers is determining the appropriate time to escalate care to a clinician with a wider scope of practice.

This Primer is a design guide for state policy makers who are considering acuity-based resource allocation. Included in the report is: background information on different HCBS case mix approaches, the steps in the development of a case-mix resource allocation system, essential decision points to consider during the state policy development process, and best practice recommendations. This Primer is recommended as a tool for policy makers, state staff, and stakeholders.