Kaiser Family Foundation

This survey reports on trends in Medicaid spending, enrollment and policy initiatives for FY 2012 and FY 2013. The report describes policy changes in reimbursement, eligibility, benefits, delivery systems and long-term care, as well as detailed appendices with state-by-state information, and a more in-depth look through four state-specific case studies of the Medicaid budget and policy decisions in Massachusetts, Ohio, Oregon and Texas.

Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid. This policy brief summarizes the MOU terms in the several key areas, including enrollment, care delivery model, benefits, financing, beneficiary protections and monitoring and evaluation.

This paper examines the contents of the 26 states’ proposals, which intent to test on two models related to financing dual eligible beneficiaries, in the areas of target population, implementation date, enrollment, financing, benefits, beneficiary protections, stakeholder engagement, and demonstration evaluation as set out in the states’ initial submission to CMS. Negotiations between CMS and the states are ongoing and are likely to result in some changes from the states’ initial proposals.

This document provides an overview of the joint efforts of states and the CMS to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. As an outgrowth of the Affordable Care Act, CMS is reviewing proposals from states to test two new models to align Medicare and Medicaid benefits and financing for dual eligible beneficiaries with the goal of delivering better coordinated care and reducing costs.

A new paper provides an overview of the Federal Medicaid Assistance Percentage (FMAP), the formula which is used to determine the federal government's share of the cost of covered services in state Medicaid programs. It also reviews the various temporary changes to the FMAP formula that have taken place over the history of the Medicaid program. Beginning in 2014, the Affordable Care Act (ACA) establishes highly enhanced FMAPs for the cost of services to low-income adults.

This article takes a look at who is covered by Medicaid and the important role that Medicaid plays in the lives of many Americans. It also examines Medicaid's role under the Affordable Care Act, how growth in per capita Medicaid spending is slower than growth in private health care spending, how Medicaid improves access to needed health care, and which groups receive the majority of Medicaid spending.

As state and federal policymakers move to develop and test integrated care models for people dually eligible for Medicare and Medicaid, two new Kaiser Family Foundation articles in the June 2012 issue of Health Affairs highlight the diverse needs and challenges facing these 9 million beneficiaries, describe their current care arrangements, and raise issues to consider for proposed reforms aimed at better coordinating their care and reducing health care spending.

An Accountable Care Organization (ACO) is a provider-run organization in which the participating providers are collectively responsible for the care of an enrolled population. This brief examines the existing Medicaid payment and care delivery landscape in states undertaking Medicaid ACO initiatives to gain insights into how ACOs fit into states’ Medicaid programs, and to identify important differences between Medicaid ACOs and ACOs in Medicare and the private insurance market.

Section 1115 waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states significant flexibility in how they operate programs and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. This brief provides an overview of Section 1115 waiver authority, the waiver approval process, and recent waiver activity and discusses the implications.

This brief explains how Medicare beneficiaries become eligible for Medicaid, provides national & state-by-state data on enrollment, & examines national & state-specific data on Medicaid spending for dual-eligible beneficiaries by service & eligibility group. The Foundation also has a collection of resources on dual-eligible beneficiaries, including basic facts & data, and analysis & explanation of specific issues, which include provisions of health reform affecting dual-eligible beneficiaries.