Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries October 1, 2012 Issue Brief Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS’s capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will…
Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries September 30, 2012 Issue Brief This paper provides an overview of the joint efforts of states and the Centers for Medicare and Medicaid Services (CMS) to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. Dual eligible beneficiaries…
Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable September 1, 2012 Issue Brief Half of all Medicaid enrollees receive care through comprehensive risk-based managed care organizations (MCOs). Most Medicaid MCO enrollees today are low-income children and parents, but states are increasingly moving beneficiaries with more complex needs into MCOs. Managed care enrollment may grow more rapidly as states work with the Centers for…
Health Care Use and Chronic Conditions Among Childless Adult Medicaid Enrollees in Arizona May 29, 2012 Issue Brief Under the Affordable Care Act (ACA), beginning in 2014, Medicaid eligibility will expand to 133% of the federal poverty level for nearly all individuals. Arizona is one of the few states that already cover adults without dependent children in Medicaid through a longstanding Section 1115 waiver. This report, based on…
An Overview of Recent Section 1115 Medicaid Demonstration Waiver Activity May 1, 2012 Issue Brief This brief summarizes and examines the implications of recent Section 1115 Medicaid waiver activity. Section 1115 waivers provide states flexibility to test new approaches in Medicaid that differ from federal program rules and can have significant impacts for beneficiaries, providers, and states. While recent waivers and waiver proposals vary in…
Massachusetts Health Care Reform: Six Years Later May 1, 2012 Issue Brief In 2006, then-Gov. Mitt Romney signed Massachusetts’ comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts’ experience with…
The Massachusetts Health Care Landscape May 1, 2012 Fact Sheet This fact sheet summarizes the Massachusetts health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)
Quick Take: Medicaid MCOs and Medical Loss Ratio (MLR) Requirements April 13, 2012 Fact Sheet One mechanism for ensuring that health insurance provides value to consumers for the premiums that they pay, or that others pay on their behalf, is to require insurers to meet a minimum “medical loss ratio” or MLR standard. The MLR is the share of premium revenues that an insurer or…
The New Review and Approval Process Rule for Section 1115 Medicaid and CHIP Demonstration Waivers March 1, 2012 Fact Sheet For many years, Section 1115 waivers have been used in the Medicaid program to provide states an avenue to test and implement coverage approaches that do not meet federal program rules, but there have been longstanding concerns about the lack of public input and transparency in the waiver approval process.…
The Texas Health Care Landscape December 1, 2011 Report This fact sheet summarizes the Texas health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)