Medicaid

To understand both the needs of people who use long-term services and supports (LTSS) through Medicare and Medicaid coverage and ways to apply quality measurement to this population, the National Committee for Quality Assurance (NCQA), supported by The SCAN Foundation, developed a roadmap for evaluating the quality of integrated care for dual eligibles.

This issue brief reviews the structure of the prescription drug benefit in Medicaid and the traditional policy levers states have used to control drug spending. It also describes state strategies to contain costs, such as efforts to obtain greater rebates, actions concerning generic drugs and biosimilar alternatives, transparency laws and new efforts to draw on federal resources.

Older adults are affected by the opioid public health emergency because they often use prescription opioids to cope with painful chronic conditions or procedures. This issue briefing provides a summary about the problem, treatments, federal strategies to address the crisis, and funding and programs that are addressing this issue. The briefing also highlights innovative programs to address the opioid public health emergency in Arizona, Colorado, Nevada, and New Hampshire.

This report examines state and federal oversight of assisted living services in Medicaid. Individuals receiving long-term care services from Medicaid in community residential settings is expected to grow. This report describes state spending on and coverage of these services; describes how state Medicaid agencies oversee the health and welfare of beneficiaries in these settings; and examines the extent that CMS oversees state Medicaid agency monitoring of assisted living services.

CMS regularly reports data on health plan enrollment, quality, and compliance that states can use to monitor the performance of the Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) they contract with to serve Medicare-Medicaid enrollees. This technical assistance tool shows how states can use these data to create tables, graphs, and figures and interpret their meaning in order to assess D-SNP performance.

The CMS Medicare-Medicaid Coordination Office (MMCO) regularly reports data on Medicare-Medicaid enrollee demographics, service utilization, spending, and other characteristics that can give states a more comprehensive view of this population. This tool shows states how to use these data to create tables, graphs, and figures and interpret their meaning for a wider audience of stakeholders.

This issue brief from the Kaiser Family Foundation examines the implications of work requirements for Medicaid recipients with disabilities. Kaiser’s analysis finds that waivers that condition Medicaid eligibility on meeting a work requirement could affect people with disabilities who have limitations that interfere with their ability to work but do not rise to the stringent SSI level of disability.

This resource identifies key challenges related to oral health care access and utilization for low-income adults, and outlines states’ current coverage of dental benefits for adults in Medicaid.

The Administration for Community Living (ACL), joined the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the HHS Office of Civil Rights to produce a report on ensuring beneficiary health and safety in group homes through state implementation of comprehensive compliance oversight. This report serves as a resource for states to use as a part of efforts to ensure that all group homes are safe and healthy places for people with disabilities.

The Government Accountability Office (GAO) examined states’ needs assessment processes for provision of long-term services and supports. GAO studied six states that differed in the following ways: assessment tools in use, participation in federal initiatives, HCBS delivery systems, and geographic location. GAO also reviewed federal requirements and documents and interviewed CMS officials and stakeholders.