Medicaid

This report provides the latest national and state data on enrollment and spending for individuals enrolled in both Medicaid and Medicare, also known as dual eligibles. There were about 8.9 million dual eligibles in 2007. Dual eligibles are among the sickest and poorest individuals covered by either program. Although they comprised 15% of Medicaid enrollment, dual eligibles accounted for 39% ($121 billion) of Medicaid spending for medical services & for more than a quarter of Medicare spending.

With Medicaid slated to become the nation's single largest insurer covering 25 percent of all Americans, getting Medicaid payment right is critical. This policy brief examines the requirements of federal law that govern Medicaid payment practices and reflects on the implications of federal health reform. It is intended to provide federal and state government officials and other Medicaid stakeholders with an accessible legal context for understanding Medicaid payment as we know it.

The Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) held a briefing to examine the challenges facing states as they continue to struggle with the lingering impacts of the recession and begin preparing to implement health reform. Find links to three reports released at the event, archived presentations, video, podcast, transcript, agenda and more.

For the tenth consecutive year, a survey of Medicaid officials in all 50 states and DC was conducted to track trends in Medicaid spending, enrollment and policy initiatives. Findings are presented for FYs 2010 and 2011. As states grapple with historically difficult budget conditions, they must also plan for the implementation of the ACA. Review this report including background on the Medicaid program, as well as current issues the program faces.

Despite the current budget climate that has dampened the pace of some rebalancing efforts, 32 states expanded Medicaid long-term services and supports in FY 2010 (primarily expanding HCBS programs) and 32 states planned expansions for FY2011. This updated fact sheet provides an overview of long-term care services, delivery of such services, and the large role Medicaid plays in financing long-term care.

Arizona has issued reports detailing work the state has done in supporting individuals with disabilities transitioning to work,and self-sufficiency with work incentives, health care coverage, benefits planning, etc. Attached are documents regarding outreach done for the Medicaid Buy-In program including which individuals were trained to disseminate the information, and data on the increase in work incentive utilization for SSI recipients.

Key provisions of the reform law offer a blueprint for tightly-coordinated and consumer-friendly eligibility and enrollment systems with seamless coverage as their goal. This brief summarizes key requirements that states face to construct enrollment systems that help people understand their options, use electronic data-matching and online processes, ensure that people obtain appropriate coverage, and support seamless transitions between coverage in the Exchanges.

A new policy brief examines the ramifications of extending the American Recovery and Reinvestment Act on Medicaid. Without the extension states may have to take drastic measures to balance state budgets. Proponents of the extension say it is essential to support the safety net and that it stimulates economic growth. Others argue the extension should only be approved if the additional federal spending is fully offset by federal budget cuts or increased federal revenues.

This letter provides initial guidance on section 6411 of the Affordable Care Act, Expansion of the Recovery Audit Contractor (RAC) Program, which amends section 1902(a)(42) of the SSA requiring States to establish programs to contract with RACs to audit payments to Medicaid providers by December 31, 2010. CMS expects States to fully implement their RAC programs by April 1, 2011. As required by statute, CMS will be issuing regulations in this area shortly, providing additional guidance.

How does ACA provide new financial incentives for states, and create opportunities within existing programs to promote Medicaid HCBS for older persons and adults with disabilities? The number and variety of new options, combined with the prospect of additional federal funds, may give some states added flexibility in balancing their LTC system. Read this fact sheet which enumerates the new programs and modifications to existing ones.