Medicaid

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.

This November 2004 issue brief addresses the federal medical assistance percentage (FMAP). The reimbursement percent is calculated according to a formula established in the Medicaid statute & based on the per capita income in each state. The fact that the FMAP is based on historical data is sometimes of concern to states. Additionally, the current system makes no specific provision for changes in the economy, leaving states confronted with increased costs when they can least afford them.

This November 2004 issue brief on Premium Assistance, a strategy in which a state uses public funds (e.g.,Medicaid dollars) to pay for a portion of the cost of private coverage (usually employer-sponsored insurance). Current use of premium assistance by states is minimal; only about one-third operate such programs, and recent reports indicate that enrollment in these programs is modest in most of these states. Nonetheless, state interest remains high due to the potential benefits.

When Medicaid was first enacted, payment for long-term services was made solely to institutions such as nursing homes. Medicaid now pays for a comprehensive range of home & community services that provide alternatives to institutional care. Medicaid is a flexible program but it is also a complex program. It is no surprise that there are a host of questions about what is allowable under Medicaid law and regulation. This Primer on Medicaid Home and Community Services serves as a reference guide.

This report summarizes a study supported by the Robert Wood Johnson Foundation examining how 18 states simplified the Medicaid eligibility process. Study Highlights: The type & extent of Medicaid application simplification measures, times which simplification occured, contact types varied to assist Medicaid eligible individuals with the application, Medicaid budget cuts are likely to negatively impact the application process.

This report summarizes a study supported by the Robert Wood Johnson Foundation examining how states are addressing declining enrollments in Medicaid by renewing outreach. A decline in Medicaid enrollments in recent years and the creation of the Children’s Health Insurance Program prompted many states to undertake renewed outreach efforts to those potentially eligible for medical assistance. The extent and nature of these outreach efforts, however, have varied widely across states.

About half of Medicaid LTC spending is for the elderly; the rest goes for services to non-elderly disabled people, especially people with developmental disabilities. There is wide variation in the resources states are currently devoting to LTC. In coming years, different rates of population aging may shift the financial burdens among states. One result may be growing interest in reassessing the federal & state roles in financing. This paper examines the implications for state Medicaid programs.

This bulletin from the National Association of State Directors of Developmental Disabilities Services focuses on the operation of what have come to referred to as \"supports\" waiver programs - i.e., Medicaid home & community-based waiver programs that offer a broad, flexible array of comparatively low cost services and supports that are intended primarily to assist individuals living in their own home or the home of their family to avoid placement in a licensed, out-of-home residential facility.

This study compared the use of treatments for attention-deficit hyperactivity disorder (ADHD) among three distinct subpopulations of Medicaid-insured youths who have very different mental health needs and patterns of service use: those with federally documented disability, those in foster care, and those in families with low income. This one-year, cross-sectional study of community mental health services used administrative data.