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  • Oversight and Enforcement of Medicare Part D Plan Requirements:  Federal Role and Responsibilities

    Issue Brief

    Oversight and Enforcement of Medicare Part D Plan Requirements: Federal Role and Responsibilities This Issue Brief was commissioned by the Kaiser Family Foundation to gain insights into legal advocates’ views of how federal authorities enforce compliance with requirements of the new Medicare Part D prescription drug benefit. The report was prepared by Toby Edelman of the Center for Medicare Advocacy, Inc. The views expressed in this report are those of the author and not necessarily…

  • Beneficiary Challenges in Using the Medicare Part D Appeals Process To Obtain Medically Necessary Drugs

    Issue Brief

    This paper describes the various steps of the Medicare Part D appeals process for obtaining necessary drugs not on a plan’s formulary. Using case reports collected from a network of beneficiary advocates, it illustrates the challenges and problems some beneficiaries encountered when navigating this aspect of the drug benefit. The paper concludes with a discussion of potential policy options including the implications of establishing an exceptions and appeals process that is uniform in paperwork and…

  • Who are the Uninsured?  A Consistent Profile Across National Surveys

    Issue Brief

    Who are the Uninsured? A Consistent Profile Across National Surveys This issue brief examines the differences in the estimates of the uninsured population from three major surveys and finds that the estimates are actually more consistent than what is often perceived. In addition, the analysis shows that who the uninsured are does not vary much across national surveys. Issue Brief

  • Health Affairs Article: Health Care in New Orleans Before and After Hurricane Katrina

    Issue Brief

    On the first anniversary of Hurricane Katrina’s landfall, a paper authored by Foundation staff, released as a web exclusive by the journal Health Affairs, examines the impact of the storm on New Orleans, the current state of health care in the city, and lessons learned about the city’s health care delivery system. Health Affairs article: Full Article Abstract

  • The Nuts and Bolts of Making Medicaid Policy Changes: An Overview and a Look at the Deficit Reduction Act

    Issue Brief

    The Deficit Reduction Act of 2005 (DRA), signed into law on February 8, 2006, contains a large number of changes in Medicaid policy that are expected to affect almost all elements of the Medicaid program—eligibility, benefits and cost-sharing, provider payments and program integrity. In most instances the policy changes are optional for state Medicaid programs, but in some the changes are mandatory. At the federal level, the interpretation and implementation of these legislative policy changes…

  • The Role of Employer-Sponsored Health Coverage for Immigrants: A Primer

    Issue Brief

    Access to employer-sponsored health insurance is declining for all families living in the United States, and this problem is especially acute for immigrant families. Employer-sponsored coverage is a particularly important source of insurance for immigrant families since their eligibility for public coverage through Medicaid and the State Children’s Health Insurance Program (SCHIP) is restricted. This primer examines the role of employer-based coverage for immigrants and the specific hurdles they face in obtaining this coverage. Issue…

  • Medicare Prescription Drug Enrollment Update

    Issue Brief

    Medicare Drug Benefit Enrollment Update This enrollment update breaks down and explains the statistics related to enrollment under the new Medicare drug benefit and the separate low-income subsidy program that provides additional assistance. The enrollment update summarizes the latest enrollment figures released by the Centers for Medicare & Medicaid Services and the Social Security Administration and compares them with earlier enrollment projections. Issue Brief (.pdf)

  • New Developments in Medicaid Coverage: Who Bears Financial Risk and Responsibility?

    Issue Brief

    A few recent state Medicaid initiatives have emerged that take the program into new directions. States have expressed a number of objectives in developing these approaches, including offering beneficiaries greater choice, promoting personal responsibility and healthier behaviors among enrollees, and, in some cases, relying more heavily on the private marketplace. In addition, states have sought to shape their initiatives in ways that could help them better predict and limit their exposure to costs. This brief…

  • Snapshots: Distribution of Out-of-Pocket Spending for Health Care Services

    Issue Brief

    How much people should pay out-of-pocket for health care is a much-debated issue in health policy. New health insurance products with higher out-of-pocket shares are becoming more evident in the private market, and some states are considering ways to increase enrollee financial responsibility in state Medicaid programs.  This paper presents information about current out-of-pocket spending by individuals with the purpose of providing context for future health policy discussions. Current proposals suggest that increasing the amount that…