Medicaid

This paper, prepared for presentation to NGA, discusses issues, problems and challenges facing Medicaid in 2005 and suggests principles and proposals for reform.

The Alliance for Health Reform offered a briefing on Medicaid fundamentals, for those wanting to brush up on their knowledge as well as those new to the subject. Speakers included Senator Jay Rockefeller, Alliance for Health Reform, Ed Howard, Alliance for Health Reform, Diane Rowland, Kaiser Commission on Medicaid and the Uninsured Rodney Whitlock, Senate Finance Committee Republican Staff, Alan Weil, NASHP The transcript, materials, webcast and evaluation are all available.

This topic paper summarizes how states can use Medicaid to pay for most institutional transition program costs on a permanent basis as a result of policy change since 2000. It also describes how states are currently using Medicaid HCBS Waivers to pay for community transition services-temporary supports people need when trying to move such as housing deposits, utility set-up fees, and furniture.

Collaboration between state Medicaid and Mental Health programs has varied greatly across states and administrations. The purpose of this paper is to identify and describe the basic elements of successful collaboration through 1) a review of the literature on collaboration, and 2) a description of collaboration in two states. The state examples highlight the mechanisms through which successful collaboration occurs and describe the types of activities in which collaborating agencies engage.

This guide explains the critical role Medicare and Medicaid have come to play in the lives and the futures of roughly 20 million children, adults, and seniors with disabilities - and gives people new information. This guides answers many questions such as: How do people with disabilities apply and can they get help with the process? What is the policy for covering durable medical equipment? How to appeal coverage decisions? Can a person be employed and still keep their coverage?

This electronic briefing book was distributed at a seminar requested by congressional staff to provide an overview of the Medicare, Medicaid, and State Children’s Health Insurance programs. The sessions featured experts from the Government Accountability Office, Medicare Payment Advisory Commission, Congressional Research Service, and Centers for Medicare & Medicaid Services, plus public and private entities. This link contains presentations, handouts, reports, websites, and other resources.

Improving Health and Long-Term Care Coverage for Low-Income Americans This report—the product of a year-long effort to identify changes that would make the 40-year-old Medicaid program more effective—was developed in collaboration with a workgroup of state officials and national experts. The group’s final recommendations identify numerous opportunities for improving the program and are focused on three key areas: eligibility, benefits and financing.

Individuals with certain combinations of needs who enroll in both the state-administered Medicaid program and the federally-administered Medicare program are referred to as dual eligibles. Currently, they receive prescription drugs and most LTC benefits from Medicaid, while they are covered by Medicare for acute benefits. Because dual eligibles receive benefits from both programs, many care coordination challenges arise in delivering high-quality, cost effective, & comprehensive benefits.

Despite preference for community-based long-term care, spending & policy is biased toward institutional services. More flexible policies were passed in 1981, when coverage was extended to non-medical services for people who meet criteria. States still must obtain a waiver for community-based services, and the law requires that Medicaid programs provide institutional care. As a result, policymakers face challenges when creating balanced systems that offer access to quality service choices.

This November 2004 issue brief addresses how states can control costs of the Medicaid program, often the second largest item in state budgets, after education. Every state has taken cost containment actions, & all plan to take additional measures to constrain growth. Enrollment has increased as a result of declining household incomes and declining rates of employer-sponsored insurance. Other factors such as the aging of the population will continue to affect the whole health care system.