Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2016 and FY 2017

Introduction
  1. Centers for Medicare and Medicaid Services. National Health Expenditures (Washington, DC: Centers for Medicare and Medicaid Services, December 2015). http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-andReports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.

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Maryland
  1. U.S. Department of Commerce, Bureau of Economic Analysis. GDP for Maryland (Washington, DC: U.S. Department of Commerce, accessed September 27, 2016). http://www.bea.gov/regional/bearfacts/action.cfm?geoType=3&fips=24000&areatype=24000.

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  2. U.S. Department of Labor, Bureau of Labor Statistics. Databases, Tables & Calculators by Subject (Washington, DC: U.S. Department of Labor, accessed September 27, 2016). http://data.bls.gov/timeseries/LASST240000000000003?data_tool=XGtable.

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  3. State of Maryland Board of Revenue Estimates. Maryland General Fund Revenues September 2016 Update (Annapolis, MD: State of Maryland Board of Revenue Estimates, September 21, 2016).  http://finances.marylandtaxes.com/static_files/revenue/BRE_reports/FYI_2017/2016_BRE_September_Revision.pdf.

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  4. The Office of Governor Larry Hogan. Governor Larry Hogan Announces Fiscal Year 2017 Budget (Annapolis, MD: The Office of Governor Larry Hogan, January 20, 2016). http://governor.maryland.gov/2016/01/20/governor-larry-hogan-announces-fiscal-year-2017-budget/

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  5. Maryland Department of Budget and Management. FY2017 Fiscal Digest (Annapolis, MD: Maryland Department of Budget and Management, accessed September 27, 2016). http://www.dbm.maryland.gov/budget/Pages/operbudget/2017-FiscalDigest.aspx.

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  6. Maryland Department of Health and Mental Hygiene. Maryland Chronic Health Homes (Baltimore, MD: Department of Health and Mental Hygiene, accessed September 27, 2016) https://mmcp.dhmh.maryland.gov/pages/health-homes.aspx.

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  7. The RTCW had been offered under a Congressionally authorized, but time-limited, 1915(c) waiver pilot to provide HCBS for children who would otherwise be served in an inpatient Psychiatric Residential Treatment Facility.

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  8. Maryland Department of Health and Mental Hygiene. 1915(i) Intensive Behavioral Health Services for Children, Youth and Families (Baltimore, MD: Department of Health and Mental Hygiene, accessed September 27, 2016) https://mmcp.dhmh.maryland.gov/pages/1915(i)-Intensive-Behavioral-Health-Services-for-Children,-Youth-and-Families.aspx.

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  9. Centers for Medicare and Medicaid Services. Balancing Incentive Program (Baltimore, MD: Centers for Medicare and Medicaid Services, accessed September 27, 2016) https://www.medicaid.gov/medicaid-chip-program-information/by-topics/long-term-services-and-supports/balancing/balancing-incentive-program.html.

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  10. Maryland Department of Health and Mental Hygiene. 1115 HealthChoice Waiver Renwal (Baltimore, MD: Department of Health and Mental Hygiene, accessed September 27, 2016) https://mmcp.dhmh.maryland.gov/Pages/1115-HealthChoice-Waiver-Renewal.aspx.

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  11. Links to the Maryland HealthChoice Waiver Renewal summary and full application can be found at: https://mmcp.dhmh.maryland.gov/Pages/1115-HealthChoice-Waiver-Renewal.aspx.

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  12. On July 27, 2015, CMS issued a State Health Officials letter (SHO) that outlined an opportunity for such waiver coverage for states seeking to demonstrate the effectiveness of a comprehensive, evidence-based approach to substance use disorder treatment. The SHO can be found at: https://www.medicaid.gov/federal-policy-guidance/downloads/SMD15003.pdf.

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  13. Centers for Medicare and Medicaid Services. Maryland All-Payer Model (Baltimore, MD: Centers for Medicare and Medicaid Services, accessed September 27, 2016) https://innovation.cms.gov/initiatives/Maryland-All-Payer-Model/.

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  14. Health Services Cost Review Commission. Maryland All-Payer Model Agreement (Baltimore, MD: Health Services Cost Review Commission, February 11, 2014). http://www.hscrc.state.md.us/documents/md-maphs/stkh/MD-All-Payer-Model-Agreement-(executed).pdf.

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  15. Centers for Medicare and Medicaid Services. Maryland All-Payer Model (Baltimore, MD: Centers for Medicare and Medicaid Services, accessed September 27, 2016) https://innovation.cms.gov/initiatives/Maryland-All-Payer-Model/.

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  16. Maryland Health Care Commission. Maryland Medical Care Data Base (MCDB) (Baltimore, MD: Department of Health and Mental Hygiene, accessed September 27, 2016).  http://mhcc.maryland.gov/mhcc/pages/apcd/apcd_mcdb/apcd_mcdb.aspx.

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  17. Maryland Department of Health and Mental Hygiene. Medicaid and Medicare Dual Eligibles Care Delivery Strategy (Baltimore, MD: Department of Health and Mental Hygiene, accessed September 27, 2016) https://mmcp.dhmh.maryland.gov/sim/Pages/Home.aspx.

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  18. Maryland Department of Health and Mental Hygiene. Overdose Prevention in Maryland (Baltimore, MD: Department of Health and Mental Hygiene, accessed September 27, 2016)  http://bha.dhmh.maryland.gov/OVERDOSE_PREVENTION/Pages/Index.aspx.

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  19. Meredith Cohn. Overdose Deaths in Maryland Continued Grim Spike Last Year (Baltimore, MD: The Baltimore Sun, June 9, 2016) http://www.baltimoresun.com/health/bs-hs-heroin-overdoses-20160609-story.html. Heroin-related fatal overdoses role 29 percent; deaths from Fentanyl rose 83 percent.

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Montana
  1. University of Montana Bureau of Business and Economic Research. The State and National Economic Outlook: Back to Full Employment (Missoula, MT: Bureau of Business and Economic Research, 2016) http://www.bber.umt.edu/pubs/econ/CountyOutlooks/16MT.pdf;

    University of Montana Bureau of Business and Economic Research. Montana Economic Report (Missoula, MT: Bureau of Business and Economic Research, 2016) http://www.bber.umt.edu/pubs/Seminars/2016/EconRpt2016.pdf.

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  2. Census & Economic Information Center. CEIC Industry Dashboard (Helena, MT: Department of Commerce, accessed September 27, 2016) http://ceic.mt.gov/Economics/IndustryDashboard.aspx.

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  3. U.S. Bureau of Labor Statistics. Regional and State Employment and Unemployment Summary (Washington, DC: U.S. Department of Labor, August 19, 2016) http://www.bls.gov/news.release/laus.nr0.htm.

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  4. Matt Volz. Montana’s Economic Health Emerges as Election Factor (Kalispell, MT: Flathead Beacon, September 7, 2016) http://flatheadbeacon.com/2016/09/07/montanas-economic-health-emerges-election-factor/.

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  5. Governor’s Office of Budget and Program Planning. Governor’s Budget Fiscal years 2016 – 2017: Economic Overview (Helena, MT: Governor’s Office of Budget and Program Planning, June 2014) https://budget.mt.gov/Portals/29/execbudgets/2017_Budget/Volume_2.pdf

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  6. Montana Legislative Fiscal Division. General Fund Updated Revenue Trends (Helena, MT: Legislative Fiscal Division, September 7, 2016) http://leg.mt.gov/content/Committees/Interim/2015-2016/Revenue-and-Transportation/Meetings/Sept-2016/lfd-revenue-trends-2016.pdf.

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  7. Ibid.

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  8. Montana Legislative Fiscal Division. FY 2015 FYE Report (Helena, MT: Legislative Fiscal Division, September 24, 2015) http://leg.mt.gov/content/Committees/Interim/2015-2016/Revenue-and-Transportation/Meetings/Sept-2015/FYE2015-Report.pdf.

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  9. Governor’s Office of Budget and Program Planning. Governor’s Budget Highlights Fiscal Years 2016 -2017 (Helena, MT: Governor’s Office of Budget and Program Planning, November 2014) https://budget.mt.gov/Portals/29/execbudgets/2017_Budget/Orange%20Book.pdf.

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  10. Jackie Yamanaka. Medicaid Expansion Passes House In Saturday Vote, Now Back To Senate (Missoula, MT: Montana Public Radio, April 12, 2015)  http://mtpr.org/post/medicaid-expansion-passes-house-saturday-vote-now-back-senate.

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  11. Montana State 64th Legislature. An Act Appropriating Money to Various State Agencies for the Bienniums Ending June 30, 2015, and Ending June 30, 2017; And Providing Effective Dates (HB0002) (Missoula, MT: Montana State Legislature, 2015) http://leg.mt.gov/bills/2015/billpdf/HB0002.pdf.

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  12. Lisa Baumann Gov. Introduces Proposal for Medicaid Expansion (Great Falls, MT: Great Falls Tribune, January 19, 2015) http://www.greatfallstribune.com/story/news/local/2015/01/19/gov-introduces-proposal-medicaid-expansion/22009775/.

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  13. Eric Whitney. Why Montana Hospitals Back Bullocks Medicaid Expansion Plan (Missoula, MT: Montana Public Radio, March 3, 2015) http://mtpr.org/post/why-montana-hospitals-back-bullocks-medicaid-expansion-plan.

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  14. Jackie Yamanaka. Montana Republicans Unveil Healthcare Plan, Minus Medicaid Expansion (Missoula, MT: Montana Public Radio, February 10, 2015)  http://mtpr.org/post/montana-republicans-unveil-healthcare-plan-minus-medicaid-expansion.

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  15. Eric Whitney. Montana Senate Republicans Release Health Plan (Missoula, MT: Montana Public Radio, December 31, 2014) http://mtpr.org/post/montana-senate-republicans-release-health-plan.

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  16. Josh Burnham. Governor's Medicaid Expansion Bill Killed On Party Line Vote (Missoula, MT: Montana Public Radio, March 6, 2015) http://mtpr.org/post/governors-medicaid-expansion-bill-killed-party-line-vote.

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  17. Steve Jess. Democrats Cry Foul Over Medicaid Expansion Vote (Missoula, MT: Montana Public Radio, March 9, 2015) http://mtpr.org/post/democrats-cry-foul-over-medicaid-expansion-vote.

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  18. Steve Jess. Sen. Buttrey Seeks Compromise With His Health Care Plan (Missoula, MT: Montana Public Radio, March 20, 2015) http://mtpr.org/post/sen-buttrey-seeks-compromise-his-health-care-plan.

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  19. Jackie Yamanaka. Medicaid Expansion Passes House In Saturday Vote, Now Back To Senate (Missoula, MT: Montana Public Radio, April 12, 2015) http://mtpr.org/post/medicaid-expansion-passes-house-saturday-vote-now-back-senate.

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  20. Centers for Medicare and Medicaid Services. Montana Health and Economic Livelihood Partnership (HELP) Program Approved 1115 Waiver (Baltimore, MD: Centers for Medicare and Medicaid Services, December 30, 2015) https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/mt/mt-HELP-program-ca.pdf.

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  21. Exempt groups include those with incomes at or below 50 percent FPL, American Indian/Alaskan Natives, individuals who are medically frail, those with exceptional health care needs as determined by the state, people who live in regions where there are insufficient number of providers contracted with the TPA, and people who require continuity of coverage not available or effectively delivery through the TAP.

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  22. HELP Act Oversight Committee. Report to the Governor and Legislative Finance Committee (Helena, MT: Department of Public Health and Human Services, July 15, 2016,) http://dphhs.mt.gov/Portals/85/Documents/MedicaidExpansion/HELP%20Act%20Oversight%20Committee%20Report%20FINAL7_15_2016.pdf.

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  23. Ibid.

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  24. Ibid.

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  25. Ibid.

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  26. The Kaiser Commission on Medicaid and the Uninsured. Medicaid Expansion in Montana (Washington, DC: The Kaiser Family Foundation, November 20, 2015) https://www.kff.org/medicaid/fact-sheet/medicaid-expansion-in-montana/.

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  27. HELP Act Oversight Committee. Report to the Governor and Legislative Finance Committee (Helena, MT: Department of Public Health and Human Services, July 15, 2016,) http://dphhs.mt.gov/Portals/85/Documents/MedicaidExpansion/HELP%20Act%20Oversight%20Committee%20Report%20FINAL7_15_2016.pdf.

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New York
  1. Alex Gray. Which American state has a bigger economy than India (Geneva, Switzerland: World Economic Forum, July 8, 2016)  https://www.weforum.org/agenda/2016/07/american-state-bigger-economy-than-india/.

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  2. New York State Assembly Ways and Means Committee. Economic and Revenue Report, Fiscal Years 2015-16 and 2016-17 (Albany, NY: New York State Assembly Ways and Means Committee, February 2016) http://assembly.state.ny.us/Reports/WAM/2016economic_revenue/2016ecrev.pdf.

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  3. Bureau of Economic Analysis. New York (Washington, DC: U.S. Department of Commerce, accessed September 27, 2016) http://www.bea.gov/regional/bearfacts/pdf.cfm?fips=36000&areatype=STATE&geotype=3.

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  4. Bureau of Economic Analysis. Gross Domestic Product by State: First Quarter 2016 (Washington, DC: U.S. Department of Commerce, accessed July 27, 2016) http://www.bea.gov/newsreleases/regional/gdp_state/2016/pdf/qgsp0716.pdf.

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  5. New York State Department of Labor. Unemployment Rate Drops to 4.7% in May Lowest Level Since August 2007 (Albany, NY: Department of Labor, June 16, 2016) http://www.labor.ny.gov/pressreleases/2016/june-16-2016.shtm.

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  6. HMA calculations based on fiscal year end results published by the New York State Division of the Budget in the Enacted Budget Financial Plan for FYs 2015, 2016 and 2017, Census table 3 (Albany, NY: Division of the Budget, accessed September 27, 2016) http://openbudget.ny.gov/budgetArchives.html.

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  7. New York State Division of the Budget. FY 2017 Financial Plan First Quarterly Update (Albany, NY: Division of the Budget, August 2016) https://www.budget.ny.gov/budgetFP/FY2017FPQ1.pdf.

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  8. New York State Division of the Budget. FY 2017 Enacted Budget Financial Plan (Albany, NY: Division of the Budget, May 2016) https://www.budget.ny.gov/budgetFP/FY2017FP.pdf.

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  9. Office of Governor Cuomo. Governor Cuomo and Legislative Leaders Announce Agreement on 2016-17 State Budget (Albany, NY: Division of the Budget, March 31, 2016) https://www.budget.ny.gov/pubs/press/2016/pressRelease16_enacted.html.

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  10. New York State Division of the Budget. FY 2017 Enacted Budget Financial Plan (Albany, NY: Division of the Budget, May 2016) https://www.budget.ny.gov/budgetFP/FY2017FP.pdf.

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  11. Office of Governor Cuomo. Governor Cuomo and Legislative Leaders Announce Agreement on 2016-17 State Budget (Albany, NY: Division of the Budget, March 31, 2016) https://www.budget.ny.gov/pubs/press/2016/pressRelease16_enacted.html.

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  12. Ibid.

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  13. Ibid.

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  14. New York State Division of the Budget. FY 2017 Financial Plan First Quarterly Update (Albany, NY: Division of the Budget, August 2016) https://www.budget.ny.gov/budgetFP/FY2017FPQ1.pdf.

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  15. Ibid.

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  16. Ibid.

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  17. Kaiser Family Foundation State Health Facts. “State Health Insurance Marketplace Types.” Data Source: Data compiled through review of state legislation and other Marketplace documents by the Kaiser Family Foundation, 2016. Accessed September 27, 2017. https://www.kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/.

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  18. Centers for Medicare and Medicaid Services. New York Basic Health Program Blueprint (Baltimore, MD: Centers for Medicare and Medicaid Services, September 2015) https://www.medicaid.gov/basic-health-program/downloads/ny-blueprint.pdf.

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  19. V. Smith, K. Gifford, E. Ellis, R. Rudowitz, L. Snyder and E. Hinton. Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results form a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016. (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2015) http://files.kff.org/attachment/report-medicaid-reforms-to-expand-coverage-control-costs-and-improve-care-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2015-and-2016.

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  20. Citizens Budget Commission. What Ails Medicaid in New York, And Does the Medicaid Redesign Team Have a Cure? (New York, NY: Citizens Budget Commission, May 20, 2016) http://www.cbcny.org/content/what-ails-medicaid-new-york-and-does-medicaid-redesign-team-have-cure.

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  21. Ibid.

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  22. New York State Department of Health. Redesigning New York’s Medicaid Program (Albany, NY: Department of Health, accessed September 27, 2016) https://www.health.ny.gov/health_care/medicaid/redesign/.

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  23. Citizens Budget Commission. What Ails Medicaid in New York, And Does the Medicaid Redesign Team Have a Cure? (New York, NY: Citizens Budget Commission, May 20, 2016) http://www.cbcny.org/content/what-ails-medicaid-new-york-and-does-medicaid-redesign-team-have-cure.

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  24. Ibid.

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  25. Ibid.

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  26. Ibid.

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  27. Ibid.

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  28. New York State Office for People with Developmental Disabilities. Fully Integrated Duals Advantage (Albany, NY: Office for People with Developmental Disabilities, accessed September 27, 2016) https://www.opwdd.ny.gov/opwdd_services_supports/people_first_waiver/care_management/FIDA_IDD.

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  29. Citizens Budget Commission. What Ails Medicaid in New York, And Does the Medicaid Redesign Team Have a Cure? (New York, NY: Citizens Budget Commission, May 20, 2016) http://www.cbcny.org/content/what-ails-medicaid-new-york-and-does-medicaid-redesign-team-have-cure.

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  30. New York State Department of Health. DSRIP Overview (Albany, NY: Department of Health, accessed September 27, 2016) http://www.health.ny.gov/health_care/medicaid/redesign/dsrip/overview.htm.

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  31. Jocelyn Guyer, Naomi Shine, Robin Rudowitz, and Alexandra Gates. Key Themes from Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States. (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, April 2015) http://files.kff.org/attachment/issue-brief-key-themes-from-delivery-system-reform-incentive-payment-dsrip-waivers-in-4-states.

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  32. Ibid.

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  33. Citizens Budget Commission. What Ails Medicaid in New York, And Does the Medicaid Redesign Team Have a Cure? (New York, NY: Citizens Budget Commission, May 20, 2016) http://www.cbcny.org/content/what-ails-medicaid-new-york-and-does-medicaid-redesign-team-have-cure.

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  34. New York State Department of Health. A Path Toward Value Based Payment (Albany, NY: Department of Health, June 2015) https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/docs/vbp_roadmap_final.pdf.

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  35. Rob Houston, Katherine Heflin and Tricia McGinnis, Navigating the New York State Value-Based Payment Roadmap (New York, NY: Medicaid Institute at the United Hospital Fund, November 2015) https://www.uhfnyc.org/assets/1439.

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  36. New York State Department of Health. Managed Care Organization (MCO) Baseline Survey – Results (Albany, NY: Department of Health, June 28, 2016) https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/vbp_library/docs/2016-07-25_mco_survey_results.pdf.

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Oklahoma
  1. Oklahoma Employment Security Commission. Oklahoma Economic Indicators (Oklahoma City, OK: Oklahoma Employment Security Commission, August 2016) https://www.ok.gov/oesc_web/documents/lmiEconIndPub.pdf.

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  2. Chad Wilkerson. How is Oklahoma’s economy performing relative to other oil and gas states (Oklahoma City, OK: Federal Reserve Bank of Kansas City, June 9, 2016) https://www.kansascityfed.org/publications/research/oke/articles/2016/comparing-oklahomas-economy.

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  3. Ibid.

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  4. Office of Management & Enterprise Services. Weak GRF receipts to cause revenue failure this fiscal year (Oklahoma City, OK: Office of Management and Enterprise Services, December 15, 2015) https://content.govdelivery.com/accounts/OKOMES/bulletins/12b1e2f.

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  5. Oklahoma Employment Security Commission. Oklahoma Economic Indicators (Oklahoma City, OK: Oklahoma Employment Security Commission, August 2016) https://www.ok.gov/oesc_web/documents/lmiEconIndPub.pdf.

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  6. U.S. Energy Information Administration. Petroleum & Other Liquids (Washington, DC: U.S. Department of Energy, accessed September 27, 2016) https://www.eia.gov/dnav/pet/hist/LeafHandler.ashx?n=PET&s=RWTC&f=D.

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  7. Oklahoma Employment Security Commission. Oklahoma Economic Indicators (Oklahoma City, OK: Oklahoma Employment Security Commission, August 2016) https://www.ok.gov/oesc_web/documents/lmiEconIndPub.pdf.

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  8. NewsChannel4. Oklahoma unemployment rate tops national average for first time in 26 years (Oklahoma City, OK: NewsChannel4, September 6, 2016) http://kfor.com/2016/09/06/oklahoma-unemployment-rate-tops-national-average-for-first-time-in-13-years/.

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  9. Office of Management & Enterprise Services. Final FY 2016 revenues 9.4% below estimate (Oklahoma City, OK: Office of Management & Enterprise Services, July 27, 2016) https://content.govdelivery.com/accounts/OKOMES/bulletins/15930ad.

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  10. Office of the State Treasurer. Oklahoma Economic Report (Oklahoma City: OK, Office of the State Treasurer, Volume 5 Issue 12, December 31, 2015) https://www.ok.gov/treasurer/documents/OER_12-31-15.pdf.

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  11. Office of Governor Mary Fallin. Gov. Fallin Signs Budget Bill, Highlights Successes in 2015 Legislative Session (Oklahoma City, OK: Office of Governor Mary Fallin, June 1, 2015) https://www.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=15912.

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  12. Oklahoma Policy Institute. Budget Trends and Outlook – March 2016 (Tulsa, OK: Oklahoma Policy Institute, March 4, 2016) http://okpolicy.org/budget-trends-and-outlook-march-2016/.

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  13. Office of Governor Mary Fallin. Gov. Fallin Signs Budget Bill, Acts on Other Measures to Close out 2016 Legislative Session (Oklahoma City, OK: Office of Governor Mary Fallin, June 10, 2016)  https://www.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=22720.

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  14. News9.com. Oklahoma Governor, Lawmaker Reach Budget Agreement (Oklahoma City, OK: News9.com, May 24, 2016) http://www.news9.com/story/32051727/oklahoma-lawmakers-reach-budget-agreement.

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  15. Office of Governor Mary Fallin. Gov. Fallin Signs Budget Bill, Acts on Other Measures to Close out 2016 Legislative Session (Oklahoma City, OK: Office of Governor Mary Fallin, June 10, 2016)  https://www.ok.gov/triton/modules/newsroom/newsroom_article.php?id=223&article_id=22720.

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  16. Ibid. (The Tax Commission, Elections Board and Legislative Services Bureau were the other agencies to receive an increase).

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  17. Ibid.

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  18. Ibid.

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  19. Rick Green. Oklahoma governor decides against special session for teacher raises (Oklahoma City, OK: The Oklahoman, September 1, 2016) http://newsok.com/oklahoma-governor-decides-against-special-session-for-teacher-raises/article/5516389.

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  20. Associated Press. Tobacco tax for Medicaid plan faces challenge in Oklahoma (Chicago, IL: Modern Healthcare, April 30, 2016) http://www.modernhealthcare.com/article/20160430/NEWS/304309937.

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  21. Oklahoma Health Care Authority. Medicaid Rebalancing act of 2020 (Oklahoma City, OK: Oklahoma Health Care Authority, April 2016) https://www.okhca.org/about.aspx?id=18804.

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  22. Rick Green. Oklahoma Health Care Authority official resigns, takes job with nursing home group (Oklahoma City, OK: The Oklahoman, August 31, 2016) http://newsok.com/article/5516184.

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  23. Oklahoma Health Care Authority. Data and Reports - Insure Oklahoma Fast Facts (Oklahoma City, OK: Oklahoma Health Care Authority, August 2016) http://www.okhca.org/research.aspx?id=87&parts=7447.

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  24. Oklahoma’s ranking dropped to 49th in the most recent 2016 report. United Health Foundation. America’s Health Rankings Senior Report (Minnetonka, MN: United Health Foundation, 2016) http://assets.americashealthrankings.org/app/uploads/final-report-seniors-2016-edition-1.pdf.

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  25. The Pacific Health Policy Group, “Presentation to the SoonerHealth+ Stakeholder Meeting,” July 26, 2016; accessed at http://okhca.org/about.aspx?id=17366.

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  26. Oklahoma Health Care Authority. Health Care Model Advances (Oklahoma City, OK: Oklahoma Health Care Authority, August 31, 2016) http://okhca.org/about.aspx?id=17366.

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  27. Centers for Medicare & Medicaid Services. Comprehensive Primary Care Plus (Baltimore, MD: Centers for Medicare & Medicaid Services, accessed September 27, 2016) https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/.

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  28. Centers for Medicare & Medicaid Services. Comprehensive Primary Care Plus (CPC+) Fact Sheet (Baltimore, MD: Centers for Medicare & Medicaid Services, April 11, 2016) https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-11.html.

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  29. Ibid.

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  30. V. Smith, K. Gifford, E. Ellis, R. Rudowitz, L. Snyder and E. Hinton. Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results form a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016. (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2015) http://files.kff.org/attachment/report-medicaid-reforms-to-expand-coverage-control-costs-and-improve-care-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2015-and-2016.

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