Medicaid

For many years, Section 1115 waivers have been used in the Medicaid program and the Children’s Health Insurance Program, to provide states an avenue to test and implement coverage approaches that do not meet federal program rules. While these waivers have facilitated important program evolutions over time, some have also raised issues. This brief reviews the experience of Section 1115 Medicaid and CHIP waivers and discusses issues for the Obama administration to consider for the future.

Medicaid covers health and long-term care services for many millions of low-income Americans. Conversations were already underway at this event concerning the role of Medicaid as a vehicle for economic stimulus, and about health coverage expansion proposals, with particular discussion around the challenges facing states implementing the program in the recent economic downturn.

The authors present evidence in support of states investing in HCBS and nursing home diversion as strategies to deal with declining revenue. They review research reports illustrating how the balance of spending on institutional versus HCBS spending affects future long-term care costs. Using these data and case studies of Washington and Vermont programs, they conclude that HCBS is indeed cost-effective.

The question posed in the title is answered by analyzing state spending data from 1995-2005. The report shows that, for two distinct populations receiving long-term care services, spending growth was greater for states offering limited noninstitutional services than for states with large, well-established noninstitutional programs. Expansion of HCBS appears to entail a short-term increase in spending, followed by a reduction in institutional spending and long-term cost savings.

This fact sheet examines the assistance for Medicaid programs and key health provisions in the ARRA that President Obama signed into law on February 17, 2009. Subjects covered include the temporary increase in federal matching money for state Medicaid programs, subsidies for COBRA health coverage for laid off workers and funding for health information technology. It includes a breakdown of additional federal allocations to states for Medicaid costs under the act.

An interactive map displays how many 1915(c) waivers each state has. Clicking on a state’s name displays number of participant and expenditures by waiver type as compared to nationwide numbers. Participant and expenditure data are also available for personal care, home health, and individualized budget services. Clicking “Compare” in any data area displays a table illustrating selected data for all states. Information is taken from CMS form 372 and is downloadable.

Medicaid expenditures are often presented as a percentage of state or Federal spending. Here, they are illustrated in terms of market shares for 30 markets defined by provider category of service. In 21 markets, Medicaid plays a small role, but in the other 9, such as long-term care and mental health, Medicaid is the dominant payer. Some of the other markets researched include adult day, waiver, case management and home health services.

This report presents the Medicaid Commission's recommendations for the long-term sustainability of the Medicaid program. Review the recommendations about Long-Term Care, Benefits Design, Eligibility, Health Information Technology, Quality and Care Coordination. The Commission strongly recommends increased state flexibility in many areas to tackle more locally influenced issues.

This article outlines three potential models which may be adopted by states looking to develop programs designed to serve those individuals who are dually eligible for Medicare and Medicaid benefits. The article also discusses possible contractual issues important to state Medicaid agencies as well as environmental factors which may influence the choice of models and potential program's prospects for success.

CMS offers guidance to states on how to avoid payments to excluded entities and the consequences of failing to prevent these payments. The letter stresses that it is the states’ responsibility to clearly communicate to providers that it is their obligation to screen employees and contractors for exclusion prior to hiring or contracting. It also provides the location of the List of Excluded Individuals/Entities which can be used to prevent improper payment.