This background paper examines various aspects of the Medicaid program that can expand access to home and community-based services (HCBS) and rebalance long-term care spending in favor of HCBS.

As a result of the long-standing requirement that states cover facility-based care, the majority of Medicaid long-term care (LTC) expenditures historically have been for institutional, rather than home and community-based, services. Over the past two decades, major efforts have been undertaken by states and the Centers for Medicare and Medicaid Services (CMS) to expand access to Medicaid HCBS and the Medicaid program presently offers numerous options for states to do so. These initiatives stem from the growing demand by people with disabilities to receive health care services in their homes for as long as possible, rather than be institutionalized.

Report (.pdf)

This issue brief provides an overview of California’s “Bridge to Reform” Medicaid Demonstration Waiver, which was approved in 2010 and will make up to roughly $8 billion in federal Medicaid matching funds available to California over a five-year period to expand coverage to low-income uninsured adults and preserve and improve the county-based safety-net. The waiver also allows the state to enroll Medicaid-eligible seniors and persons with disabilities into managed care plans that meet specified readiness and network adequacy requirements. Enrollment in the coverage expansion is targeted to begin on a county-by-county basis on July 1, 2011 and the transition of seniors and people with disabilities into managed care plans was scheduled to start on June 1, 2011.

The California waiver may serve as a model for other states to use Section 1115 Medicaid demonstration waivers to facilitate the transition to health reform in 2014. Operational experience from the waiver could help to inform implementation of the ACA by other states, safety net providers, and the federal government. A related fact sheet on the California waiver is also available.

Fact Sheet (.pdf)

Issue Brief (.pdf)

There is increased interest among states in operating Medicaid managed long-term services and support (MLTSS) programs rather than paying for long-term services and supports (LTSS) on a fee-for-service basis, as has been the general practice. This issue brief examines key issues for states to consider if they are contemplating a shift to covering new populations and LTSS benefits through capitated payments to traditional risk-based managed care organizations (MCOs). It draws on current literature as well as discussions conducted during the spring and summer of 2011 with a variety of respondents – federal and state officials, researchers, representatives from managed care organizations, service providers, and consumer advocates.

Issue Brief (.pdf)

This brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees. The rule, which implements a provision in the Affordable Care Act (ACA), is intended to make it simpler for consumers to compare health plans before they enroll and understand their coverage once they are enrolled. Currently, consumers in employer-sponsored plans receive summaries of their benefits, but in many cases they’re written in complex, technical language and can be 100 pages long.

The brief details what must be included in the summary of benefits and coverage and how the information must be presented to consumers. The brief also discusses the potential costs to insurers and third-party administrators for implementing the regulation and the benefits to consumers of having more understandable, standardized information about their health coverage.

Issue Brief (.pdf)

This data note examines public opinion among Washington, D.C.’s black residents about HIV/AIDS through a new analysis of the findings of the May 2011 Washington Post/Kaiser Family Foundation 2011 Survey of District of Columbia Residents. The District of Columbia has one of the highest AIDS rates in the nation, and black residents have been especially hard hit by the epidemic, accounting for about three-quarters of people living with HIV/AIDS in the city. Yet experiences and attitudes about HIV/AIDS can differ greatly across various groups of black residents, and this analysis – a joint project of the Disparities Policy Project and Public Opinion and Survey Research teams – examines that variation, taking into account the way views and concerns differ by age, education and geography.

Data Note (.pdf)

State revenues have been rebounding after experiencing a severe decline caused by the Great Recession that ran from December 2007 through June 2009. Nevertheless, tax collections remain below their 2008 peak level and state and local governments continue to shed jobs. As states prepare their fiscal year 2013 budgets, some are projecting a fifth consecutive year of gaps between expected revenues and spending.

This policy brief analyzes recent developments in state government finances and prospects for the future. After an overview of state revenue sources and spending priorities, it discusses what happened in the Great Recession and how states and the federal government responded. The brief then considers challenges to states’ long term fiscal sustainability.

Issue Brief (.pdf)

This analysis uses the Center for Studying Health System Change’s (HSC) 2010 Health Tracking Household Survey, the 2007 HSC Health Tracking Household Survey and the 2003 HSC Community Tracking Household Survey to describe the uninsured population and how it has changed over the past decade, especially between 2007 and 2010 when the recession caused many with previously stable coverage to become uninsured. It finds that although the uninsured population remains disproportionately made up of younger people, the poor and racial/ethnic minorities, uninsurance rose the fastest among the near-elderly, whites and those with higher incomes. Many of these demographic shifts may be attributed to the recent recession, which triggered a rise in unemployment and the loss of job-based health insurance for many laid off workers, while other trends in the characteristics of the uninsured have been longstanding and show little change.

Issue Brief (.pdf)

The Kaiser Family Foundation has issued a collection of analyses related to the Medicare Part D stand-alone drug plan options available to seniors for calendar year 2011.

These spotlights focuses on key aspects of the drug plan choices available and relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC and the Kaiser Family Foundation.

2012 Part D Data Spotlights Now Available

Analysis of Medicare Prescription Drug Plans in 2011 and Key Trends Since 2006

Medicare Part D 2011 Data Spotlight: The Coverage Gap

This issue brief provides a broad-based grounding in adolescent health and related policy by examining access to health services for adolescents, their insurance coverage, and the role of state and federal policies in shaping access to care. While generally enjoying good health, teenagers face a range of physiological and developmental changes, including puberty, burgeoning independence, experimentation and risky behaviors, which shape their health decisions and needs. There are multiple initiatives underway to improve future health outcomes for teens, such as development of teen-friendly health settings and initiatives to increase the supply of providers trained to address the sensitive health issues that arise in teenage patients. The brief also discusses how implementation of the the health reform law may affect health coverage, access, and incentives to use preventive care for adolescents.

Issue Brief (.pdf)

Beginning in 2014, state-based health insurance exchanges will be created to facilitate coverage and choice, with the hope that enhanced competition among insurers will help to moderate premiums for individuals and small groups. This analysis by the Foundation assesses the competitiveness of state insurance markets for individuals and small businesses to establish a baseline as implementation of the health reform law proceeds and to provide context for the policy decisions states will be considering.

The analysis finds that while substantial variation exists in insurance market competition, a single insurer dominated at least half of the individual market in 30 states and the District of Columbia. In the small group market, a single insurer accounted for at least half of the market share in 26 states and D.C.

The analysis identified that the market share of the largest plan in the small group market ranged from less than 24% in Oregon and Pennsylvania to 96% in Alabama; in the individual market, the market share held by one plan ranged from 21% in Wisconsin to 86% in Alabama. The analysis also found that states in the West generally had more competitive markets, while more rural states in the upper Midwest and parts of the South and Mid-Atlantic were generally less competitive. The level of competition in a state was similar in the small group and individual markets, with a few exceptions.

Issue Brief (.pdf)