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  • How Much Will Medicaid Physician Fees for Primary Care Rise in 2013? Evidence from a 2012 Survey of Medicaid Physician Fees

    Issue Brief

    This brief presents 50-state data from the 2012 KCMU/Urban Institute Medicaid Physician Fee Survey. It estimates that average Medicaid fees to qualified physicians for Affordable Care Act primary care services will rise by 73 percent when the primary care fee increase takes effect on January 1, 2013, although there will be wide state variation. The paper presents data showing how states compare in their 2012 Medicaid fee levels, how Medicaid fees compared to Medicare fees,…

  • Increasing Medicaid Payments for Certain Primary Care Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule

    Issue Brief

    To help ensure that access in Medicaid expands to meet anticipated higher demand for care, the health reform law requires states to pay certain physicians Medicaid fees that are at least equal to Medicare’s for a list of 146 primary care services in 2013 and 2014. The idea is to attract new physicians to Medicaid and provide greater support for physicians who already participate. As a result, Medicaid fees paid to certain physicians for primary…

  • Medicaid Eligibility, Enrollment Simplification, and Coordination under the Affordable Care Act: A Summary of CMS’s March 23, 2012 Final Rule

    Issue Brief

    This brief provides a summary of the Centers for Medicare and Medicaid Services' (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule, which is effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid expansion and the streamlined and integrated eligibility and enrollment system created under the ACA. Achieving this goal will require substantial process and system changes among state…

  • Washington’s Managed FFS Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Washington is the first state to sign a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test a managed fee-for-service (FFS) financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, beginning on April 1, 2013. Washington’s managed FFS demonstration uses Medicaid health home services to coordinate care for high risk/high cost dual eligible beneficiaries with chronic conditions. This policy brief summarizes key aspects of the…

  • The Budget Control Act of 2011: Implications for Medicare

    Issue Brief

    Beginning January 2013, Medicare spending will be subject to automatic, across-the-board reductions, known as “sequestration,” which is slated to reduce Medicare payments to plans and providers by up to 2 percent. This sequestration results from provisions in the Budget Control Act of 2011, which raised the debt ceiling and will reduce net federal spending by $2.1 trillion over ten years. The Act was a bipartisan compromise negotiated between the Administration and Congressional leaders, just before…

  • Snapshots: Premiums, Cost-Sharing and Coverage at Public, Private and Non-Profit Firms

    Issue Brief

    There are important differences in the legal organization and mission of different employers in the United States. In addition to collecting information about premiums and employee cost sharing, the 2012 Employer Health Benefits Survey asked respondents to characterize their ownership structure. Respondents were asked to describe their organization as either a "private firm, including publicly traded companies and privately owned businesses," "a public firm, such as a state or local government agency," or as a "non-profit, such as a…

  • Snapshots: The Prevalence and Cost of Deductibles in Employer Sponsored Insurance

    Issue Brief

    Over the past several years enrollees in employer-sponsored health plans have contributed more towards their care through the use of increased cost sharing.  The growth in deductibles is one of the more visible increases in employee cost sharing. A deductible is an amount that must be paid out-of-pocket by an enrollee before some or all services are covered by their health plan.  Health plans may impose deductibles on specific services, such as outpatient surgery or…

  • Faces of the Medicaid Expansion: Experiences and Profiles of Uninsured Adults Who Could Gain Coverage

    Issue Brief

    These two papers provide insight into how state decisions to expand Medicaid under the Affordable Care Act are likely to impact people. Based on focus groups and interviews conducted in Cincinnati, Houston, Las Vegas and Tampa with uninsured adults who could be eligible for the Medicaid expansion in 2014, these papers highlight the experiences of uninsured adults and the significant health and financial consequences of being uninsured, which sometimes impact their ability to work and…

  • Seniors' Knowledge and Experience With Medicare's Open Enrollment Period and Choosing a Plan: Key Findings from the Kaiser Family Foundation 2012 National Survey of Seniors

    Issue Brief

    These key findings from the Foundation's 2012 National Survey of Seniors relate to seniors’ knowledge and experience with Medicare’s open enrollment period and choosing a plan. The survey finds one in four seniors say they are unaware of this annual opportunity to review and change their Medicare coverage, with even larger shares who say they are unaware of Medicare’s open enrollment period among blacks and Hispanics and those seniors in fair or poor health, with…