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  • New Reports Explain Medicaid’s Role in Long-Term Care and Track Trends

    Issue Brief

    With short and long-term policy changes to the Medicaid program being discussed, its role in providing long-term care is receiving closer examination. Medicaid is the single largest source of financing for long-term care, accounting for nearly half of all the nation’s spending for long-term care services, and demographic trends are likely to place additional pressure on Medicaid. New attention is being focused on who relies on Medicaid for help with nursing home bills and how…

  • Medicare Part D Issue Briefs

    Issue Brief

    These issue briefs, prepared by the Centers for Medicare Advocacy, Inc., provide information about how the Medicare drug benefit will affect beneficiaries. The briefs address issues related to dual eligibles, residents of nursing home and assisted living facilities, and the Part D exceptions and appeals processes. Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns…

  • The Exceptions and Appeals Process: Issues and Concerns in Obtaining Coverage Under the Medicare Part D Prescription Drug Benefit

    Issue Brief

    This issue brief describes how Medicare beneficiaries navigate the Medicare Part D exceptions, appeals, and grievances processes to get access to medically necessary prescriptions not covered under their Medicare prescription drug plans. It identifies and describes policy issues that may make it difficult for beneficiaries to utilize the processes. Issue Brief (.pdf)

  • Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation

    Issue Brief

    Medicare Part D: Issues for Dual Eligibles on the Eve of Implementation This issue brief describes how dual eligibles are treated under the Medicare drug benefit and the issues raised by their transition from Medicaid to Medicare drug coverage. The brief also explores key differences in the Medicare drug benefit compared to Medicaid drug coverage (formularies, copayments, and appeals policies) which could make the shift especially challenging for dual eligibles. Issue Brief (.pdf)

  • Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns

    Issue Brief

    This issue brief describes Medicare drug benefit policy issues for residents of nursing homes and other long-term care settings, such as assisted living facilities and board and care facilities. The brief addresses differing rules for nursing home and non-nursing home settings, as well as for dual eligibles residing in long-term care facilities. Issue Brief (.pdf)

  • Financing Health Coverage:  The Fiscal Relief Experience

    Issue Brief

    Financing Health Coverage: The Fiscal Relief Experience This paper provides an overview of the context which prompted federal fiscal relief to the states in 2003 and discusses the implications of this experiment in federal intervention for financing the Medicaid program. Policy Brief (.pdf)

  • Dual Eligible Home and Community-Based Waiver Program Participants and the New Medicare Drug Benefit

    Issue Brief

    Dual eligible beneficiaries who participate in Medicaid home and community-based waiver programs usually do not have a centralized care provider to manage their health care benefits and services. For the new Medicare prescription drug benefit, no individual is designated to assist participants with their prescription drug plan selection, comparison of formularies, and if necessary, management of their exceptions and appeals should a medication be denied by their plan. This paper offers state and federal policymakers…

  • Health Care Coverage and Financing Issues in California:  An October 2005 Update

    Issue Brief

    Health Care Coverage and Financing Issues in California: An October 2005 Update This brief summarizes recent health insurance coverage trends in California and the Medi-Cal program, provides an overview of the state’s newly adopted FY 2005-06 budget agreement, and discusses key issues driving the current health policy agenda. The brief concludes with a discussion on Medicaid reform actions at the federal level and the potential implications for California. Issue Brief (.pdf)

  • Health Coverage for Individuals Affected by Hurricane Katrina:

    Issue Brief

    A Comparison of Different Approaches to Extend Medicaid Coverage Approaches have been put forward to extend Medicaid coverage to Hurricane Katrina survivors, but they differ significantly regarding the extent to which they extend Medicaid eligibility and in the role of federal funding for coverage of Hurricane survivors. This publication provides an overview of these approaches and their key differences. First is a table comparing the major components of the September 15, 2005 Senate bill, the…