Medicaid

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

The OIG report examines state standards and requirements for network adequacy and access to care. The report was based on surveys and interviews of state officials, CMS employees, and External Quality Review Organizations. In the report, OIG notes that state standards on access to care vary widely, and that state oversight of health plans also varies. Based on its findings, OIG offers recommendations to CMS in the report.

Access to affordable health insurance is essential to the ability of people with disabilities to seek and maintain employment. As their income fluctuates, people may migrate between Medicaid and Marketplace coverage, and they may face changes in their benefits and out-of-pocket responsibilities as a consequence. This issue brief uses hypothetical examples of working people with disabilities to illustrate the experiences they might have with Medicaid and Marketplace coverage in four states.

Using data from 360 health care providers and 540 Medicaid eligible people with disabilities (PWD), the authors compared perceived barriers to care from the perspective of both providers and PWD. The results indicated major variations in provider and PWD perceptions. Policy responses to these findings should address the specific needs of people with different types of disabling conditions rather than assuming all PWD face similar challenges in accessing and utilizing health care.

This report provides statistics and information about uninsured individuals in the Medicaid coverage gap. The Medicaid gap is a term used to describe uninsured individuals who do not have enough income to qualify for ACA subsidies and who live in a state that has elected not to expand their Medicaid program. According to the Kaiser report, approximately four million individuals are in the Medicaid gap across the country. Of the uninsured individuals, 17% are in the 55-64 age range.

This report fulfills NCD’s statutory mandate to annually report and make recommendations concerning the state of disability policy in the United States. Specifically, the 2014 Progress Report focuses on seven key areas: the Convention on the Rights of People with Disabilities (CRPD), employment access and inclusion, subminimum wage, education outcomes, Medicaid managed care, mental health care, and data trends in disability policy.

In 2014, ADvancing States surveyed state aging and disability agencies regarding the significant policy, fiscal, and operational issues occurring within each state. The survey collected detailed information about the structure of agencies, the supports provided, and the populations served by aging and disability agencies. Of particular interest is the summary of services provided in Medicaid waivers across the country. All of this information is presented in the charts accompanying this document.

Supported by mobile technology, trained health coaches at Elder Services of Merrimack Valley (an AAA in Northeastern Massachusetts) visit recently discharged Medicare patients in their homes and monitor them via telephone to identify and address declines in health status that increase the risk of readmission. Review the AHRQ study that gave the program a moderate evidence rating for improving outcomes, decreasing cost of care.

CMS developed a web page of resources for integrated care available for health plans and providers. CMS has been supporting efforts to build provider and health plan capacity to deliver more integrated and coordinated care to Medicare-Medicaid enrollees. These resources are targeted to various types of organizations, including behavioral health providers, health plans, long-term service & support providers. Review the technical assistance and actionable tools developed.

The annual Medicaid Long Term Services and Supports expenditure report for FFY 2012 is now available. The report includes Medicaid expenditures for all LTSS, including institutional and non-institutional settings, by service category and state. The data comes primarily from CMS-64 reports.