Medicaid

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.

Medicaid finances nearly half of all LTSS spending. Review an update to existing data on Medicaid financial eligibility standards for nursing home and HCBS waiver services for older persons and adults with disability. 2009 data were obtained on state selection of optional pathways for eligibility, income and asset standards, cost-sharing and other post-eligibility financial requirements. A copy of the survey instrument and accompanying letter to state Medicaid Directors are included.

State-authorized health plans whose members are qualified to receive both Medicare and Medicaid benefits face administrative challenges. This study examines care management practices in four health plans that serve persons who are dually eligible. The authors describe how health plans operationalize their integrated care management approaches and identify a common framework for integrating care.

A number of health reform provisions give states additional options for financing HCBS services. This brief analyzes scenarios whereby states, which have significant roles in implementing many aspects of the ACA, might implement a combination of new Medicaid state plan options, enhanced Medicaid matching payments, and demonstration projects to expand HCBS care. In determining whether to adopt these options, states will assess whether they improve upon the current Medicaid authorities they use.

Many low-income individuals with severe mental illness leave state institutions without health insurance and therefore without financial access to the treatment they need to live successfully in their communities. Read an evaluation of Oklahoma’s efforts to develop and implement a model program to ensure that eligible individuals with mental illness were enrolled in Medicaid at discharge from state prisons and institutions for mental diseases.

What are some of the essential components of Medicaid long-term care programs? This brief, geared towards people working in Medicaid or disability employment, discusses payment for long-term care, range of services, administration, eligibility, functional assessment and rebalancing of long-term care systems. Also find examples of how some states have incorporated aspects of long-term care services and supports (LTSS) into their Medicaid Buy-In (MBI) programs.

Find an analysis of changes the new law makes to Medicaid, Medicare Part D and Medicare Advantage that impact low income individuals in particular. There is also a brief discussion of the coverage expansion and its potential impact on this population. This brief is part of a series of issue briefs prepared by NSCLC which discuss the impact of the new law on low income older adults.

Millions of low-income adults without children who currently cannot qualify for coverage, as well as many low-income parents and children now covered through the CHIP program will become eligible for Medicaid. These programs are expected to cover an additional 16 million people by 2019. This brief provides the details of the benefit and cost-sharing rules that will govern the coverage available to newly-eligible adult Medicaid beneficiaries.