Medicaid

This policy brief provides information on Washington, DC and the 37 states that are planning to better integrate care for participants who are dually eligible for Medicare and Medicaid. The Center for Medicaid and Medicare Services (CMS) will allow states to select a capitated model, or a managed fee-for-service model, or they can use both models. Included is a chart explaining the main differences between the two models.

Developing home & community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of Medicaid long-term care dollars still go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 19% in 1995 to 43% in 2008. More than 3 million people were served by Medicaid HCBS programs in 2008 and hundreds of thousands of people are on waiting lists.

In an effort to improve care & reduce costs, states & the federal government are seeking new ways to provide services to people eligible for both Medicare & Medicaid. Missing from the discourse are the voices of these dual eligibles. Changes to the way their care is organized & delivered could have profound effects on their health, quality of life, & satisfaction. This project aims to complement state & federal efforts by offering perspectives on what duals want from their models of care.

This policy brief is part of Center for Health Care Strategies’ Technical Assistance for Dual Eligible Integrated Care Demonstrations program, made possible through The SCAN Foundation and The Commonwealth Fund. Through this program, CHCS is helping demonstration states develop and implement integrated-care models for individuals eligible for both Medicare and Medicaid services.

This paper provides recommendations on changes to improve delivery of the Qualified Medicare Beneficiary (QMB) program so that it can more fully serve the purposes for which the program was established. It is the last in a series of four papers that highlight pressing issues facing dual eligibles and provide recommendations to the federal Medicare-Medicaid Coordination Office (MMCO), state Medicaid agencies and other interested policymakers and stakeholders on how to address them.

Medicaid officials in every state are enacting a variety of cost cutting measures as states’ spending is projected to increase 28.7% in FY2012 to make up for the loss of federal stimulus money. The survey finds cost containment actions ranging from restrictions on payments to providers & benefits, to new copayments for beneficiaries & additional efforts to contain the costs of prescription drugs. States are also trying to make their programs more efficient through a number of procedures.

This Primer has been updated to include all relevant statutory, regulatory and other policy changes that have occurred in the last 10 years in Medicaid home and community services. Given the significance of recent changes, this Primer will be an even more useful tool for all those working to ensure that people with disabilities can live in the most integrated settings appropriate to their needs.

Is your state looking for a nice example of how to introduce waiver programs to the community? Review this guide, which provides an overview of the various programs. The guide outlines what services are covered and how to apply for various programs.

This report is the latest in a series on expenditures for Medicaid waivers authorized under Section 1915(c) of the Social Security Act, also known as home and community-based services waivers. For the first time, the tables include state-reported data for 1915(c) waiver services provided through managed care programs that are not identifiable in the state CMS 64 reports. Thomson Reuters collected these data for FY 2008 and FY 2009.

This Chart Book reports on nursing facility services provided to Maryland Medicaid beneficiaries aged 19 years and older. It summarizes demographic, service utilization, acuity, expenditure, and length of stay data for fiscal years 2006 through 2009. This Chart Book was prepared for the Maryland Department of Health and Mental Hygiene and is intended to monitor trends. Hilltop updates the chart book annually.