Medicaid

This policy brief from Georgetown University, produced with support from The SCAN Foundation, reviews Medicaid's importance and current funding limitations for long-term care and makes the case for strengthening Medicaid two possible ways - full federal responsibility for Medicare beneficiaries who also rely on Medicaid or an enhanced federal match for Medicaid long-term care services. Each approach carries with it a federal commitment to bear the brunt of a growing elderly population.

Both of these large state waivers affect hundreds of thousands of Medicaid beneficiaries, involve billions of federal Medicaid matching funds, and are designed, in part, to promote changes in the health care delivery system that will result in better care for individuals, better population health, and reductions in costs through system improvements. They have a number of key similarities and differences as summarized in the side-by-side table within this fact sheet.

Medicaid program integrity is among the highest priorities of the nation’s Medicaid Directors and is a key component of every initiative and program states conduct. Program integrity is about creating a culture where there are consistent incentives to provide better health outcomes within a context that avoids over-or underutilization of services. Directors seek to promote economy, efficiency, accountability, and integrity in the management and delivery of services.

MITA provides a common framework for all Medicaid stakeholders to focus on opportunities to build common and shared services by decoupling legacy systems and processes, and liberating data previously stored and contained in inaccessible silos. The newest version takes into account new legislative requirements outlined in the Health Information Technology for Economic and Clinical Health Act, the Children's Health Insurance Program Reauthorization Act, and the Affordable Care Act.

Have you seen the new site sponsored by CMS? This space offers a resource center for states, up to date information about the affordable care act and additional federal policy guidance. The waiver section organizes information by state, program name, waiver authority and status of a application. This chart gives an overview of the four primary types of waivers and demonstration projects: Section 1115, Section 1915(b) Managed Care, Section 1915(c) HCBS, and Concurrent Section 1915(b) and 1915(c).

State Medicaid agencies fund supports & services for individuals with disabilities. As national public policy recognizes & emphasizes the ability of individuals with disabilities to work, states are integrating employment supports into the continuum of long-term care in Medicaid. This brief discusses federal legislative & regulatory framework for funding employment supports in Medicaid, highlights examples of state innovations & best practices to promote positive employment outcomes.

A growing number of beneficiaries with disabilities are being enrolled in risk-based managed care arrangements. Further growth in managed care is expected in 2014, when the Affordable Care Act expands Medicaid eligibility to many uninsured low-income adults, including those with disabilities. This issue brief looks at issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities.

This issue brief looks at issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities. Drawing on existing research on Medicaid managed care and people with disabilities, the brief highlights policy considerations related to setting plan payment rates, developing adequate provider networks and delivery systems, and ensuring sufficient beneficiary protections and plan oversight.

The 9 million individuals enrolled in both Medicare and Medicaid often receive care that is fragmented, poorly coordinated, and high-cost. Integrating their care is difficult because of the challenges associated with aligning the programs' financial incentives and reimbursement processes. This brief explores considerations for establishing reimbursement rates and performance incentives for the capitated and managed fee-for-service financial models.

Overview provided about individuals and families who can be expected to receive assistance under insurance affordability programs, which include Medicaid, CHIP, advance premium tax credits and cost-sharing reductions, and Basic Health Programs. Particular focus is placed on the characteristics of individuals whose incomes place them at or near the Medicaid/exchange dividing line. The authors identify opportunities for greater collaboration and alignment in key areas.