Medicaid

Integral to the coverage framework laid out in the reform law is a dramatic expansion of the Medicaid program. This primer provides key information about the program today, including a definition of what it is, who and what services are covered, Medicaid expenditures and how they are financed, and information of how health reform reshapes the program for the future.

According to the authors, transforming Medicaid’s LTC programs is an urgent priority given states’ challenging fiscal environment. Based on this paper’s model, more than 35 percent of a state’s budget will be needed for Medicaid by 2030, of which half will be for LTC services. The brief examines Medicaid expenditures for LTC, in both institutional and community settings, and presents ideas for consideration for states to transform their programs to help address budget constraints.

The Affordable Care Act (ACA) includes the extension of the MFP Demonstration Program for an additional 5 years. This letter provides background about the MFP Demonstration Program, explains improvements made by the ACA, details how the ACA will impact current MFP grantees, and provides preliminary information for non-participating States that may be interested in pursuing new funding.

Find a concise summary of new opportunities under the health reform law for states to balance their Medicaid long-term care delivery systems by expanding access to Medicaid HCBS programs. The brief outlines key provisions of the new law that expand HCBS benefit options, broaden financial and functional eligibility criteria, and provide additional financial incentives for states to further shift their Medicaid long-term services budgets to non-institutional settings.

Review recommendations offered for maximizing the new Center for Medicare and Medicaid Innovation’s effectiveness in promoting reforms to improve the quality and value of care, while helping achieve health reform’s goals of more efficient, coordinated, and effective services. Suggestions include implementing a variety of payment reform initiatives, including global and bundled payment, and encouraging the implementation of innovative models developed by states and the private-sector.

Find national and state by state estimates of the increases in coverage and the associated costs compared to a baseline scenario without the Medicaid expansions in health reform. Findings show there will be large increases in coverage and federal funding in exchange for a small increase in state spending. Since it is impossible to predict the behavior of each state, the analysis examines two participation rate scenarios differing in the strength of outreach and enrollment efforts.

Changes CMS is making in the State plan amendment (SPA) review process are explained in this letter. CMS has identified a process that will expedite the review of SPAs while ensuring that CMS and States resolve other questions that may arise. States will now have the option to resolve issues related to State plan provisions that are not integral to the SPA through a separate process. Several examples based on actual State plan issues are included.

Explore Medicaid expansion under health care reform and savings for states through Medicaid “modernization.” This report examines three broad categories of savings opportunities including the greater use of coordinated care techniques, the greater use of managed care for LTC, and the upgrading of Medicaid’s administrative processes. Find national and state-specific projections of increases in Medicaid enrollees as a result of health reform legislation and of the associated Medicaid costs.

Effective July 1, 2010, this rule makes significant clarifications regarding benchmark benefits packages. States have utilized these packages to provide expanded HCBS beyond those available through the Medicaid State Plan. Clarifications include the provision of non-emergency medical transportation, and children’s access to the full range of Medicaid EPSDT benefits. The attached file contains the official text of the rule as entered into the Federal Registry.

Learn about the status of the public LTC delivery system, and opportunities and obstacles for LTSS reform and rebalancing. The study surveys states’ current HCBS expenditures and utilization, analyzes factors underpinning Medicaid’s institutional bias, looks at federal and state initiatives to improve the ratio between institutional and community-based care, and points to statutory and regulatory “fixes” that could enhance the states’ ability to improve their LTC delivery systems.