Observations on the Initial Implementation of the Medicare Prescription Drug Program: Perspectives of State Medicaid Directors Through a Focus Group Discussion

Medicaid directors express the need to continue to focus on the interaction between Medicaid and the Medicare prescription drug benefit and to address the key system and coordination issues that remain, particularly with the potential disruptions that could occur in January 2007 when new Medicare drug plan contracts and recalculated benchmarks for the low-income subsidy take effect.

Report (.pdf)

Premiums and Cost-Sharing Features in Medicare’s New Prescription Drug Program, 2006

When Congress created the Medicare drug benefit in 2003, it also sought to generate more private plan options for senior and disabled beneficiaries in Medicare, with increased payments to attract sponsors and to support added benefits attractive to enrollees, especially in rural and other areas that previously had few such plans. The effects of these changes and additional payments are particularly visible this year, with a total of 1,314 Medicare Advantage plans and 1,429 stand-alone prescription drug plans being offered. Beneficiaries in most states have a choice of at least 40 stand-alone drug plans, and, in some areas, also have a choice of dozens of Medicare Advantage options.

A new analysis by Marsha Gold of Mathematica Policy Research, prepared for the Kaiser Family Foundation, provides a comprehensive look at premiums, deductibles and selected cost-sharing features of Medicare Advantage prescription drug plans in 2006, including Medicare HMOs, new regional (and traditional local) PPOs, and private fee-for-service plans, and compares them to stand-alone Medicare drug plans. The new analysis, Premiums and Cost Sharing Features Medicare’s New Prescription Drug Program, 2006, finds that Medicare Advantage plans on average charge less for their drug coverage ($18 per month) than stand-alone drug plans ($37 per month).

The growth in private plan options reflects a policy choice to pay private plans more to encourage more options for Medicare beneficiaries. Because Medicare now pays more for beneficiaries who enroll in private plans than it does for beneficiaries who enroll in traditional, government-run Medicare, increases in private-plan enrollment cost the government money. This reflects a significant departure from previous policy that sought to promote managed care without increasing total Medicare outlays or even to generate some savings. Currently about one in seven Medicare beneficiaries is enrolled in a Medicare Advantage plan, but the Medicare trustees project that enrollment will more than double over the next decade under current payment policies.

Issue Brief (.pdf)

On January 1, 2006, the six million Americans who are covered by both Medicare and Medicaid saw a change in how their prescription drugs are covered. The dual eligible population was transitioned from Medicaid into the Medicare prescription drug benefit. As a group, these beneficiaries are poorer and sicker than those on Medicare. Consequently, they have more extensive health and prescription drug needs than most Medicare beneficiaries.

Most of these dual eligible beneficiaries were automatically enrolled in coverage plans by the Centers for Medicare and Medicaid. Others made their own selections. In 2005, the Kaiser Family Foundation produced a video exploring the concerns some within this population had about this transition. This latest video, produced in 2006, follows up on what their experiences have been now that the program has been enacted and what challenges they may face as insurers re-evaluate their plans every year.

This issue brief provides some general background on Vermont’s Medicaid program and the Global Commitment waiver; answers a series of key questions about how it is designed to work; and discusses the potential implications for the state of Vermont, beneficiaries, and the Medicaid program.

In the fall of 2005, Vermont secured approval for a Section 1115 Medicaid waiver known as the “Global Commitment waiver” that allows the state to fundamentally restructure its Medicaid program. The waiver imposes a cap on the amount of federal Medicaid funding available to Vermont to provide acute care services to its Medicaid population. In combination with a second, long-term care waiver, the Global Commitment waiver makes Vermont the only state in the nation facing a fixed-dollar limit on the amount of federal funding available for its Medicaid program. In exchange for taking on the risk of operating under a capped funding arrangement, the waiver allows Vermont to use federal Medicaid funds to refinance a broad array of its own non-Medicaid health programs, creating a fiscal windfall for the state. It also gives Vermont new flexibility to reduce benefits, increase cost sharing and cap enrollment for many Medicaid beneficiaries.

Issue Brief (.pdf)

Outreach Strategies for Medicaid and SCHIP: An Overview of Effective Strategies and Activities

This paper highlights key components of effective outreach strategies to enroll children in Medicaid and SCHIP and also to get them access to care once enrolled. In addition, the paper examines how these strategies have been implemented in states and the challenges of continuing to push for enrollment as states face continued fiscal pressures and barriers to participation are resurrected.

Report (.pdf)

This national survey released by the Kaiser Family Foundation finds that Americans increasingly believe the U.S. should be a global leader on HIV/AIDS, including spending more money to fight the epidemic abroad and at home. This comes despite an American characteristic distaste for foreign aid and at a time when there is a growing budget deficit. Six in ten Americans agree that the U.S. is a global leader and has a responsibility to help fight HIV/AIDS in developing countries — up from 44% in 2002.

With this June marking the 25th year of the epidemic (on June 5, 1981, the U.S. Centers for Disease Control and Prevention issued its first warning about a disease that would become known as AIDS), there is an opportunity to reflect on the public’s general knowledge about the disease. According to the survey results, significant percentages of Americans still think HIV might be spread through kissing, sharing a drinking glass and touching toilet seat — 37%, 22% and 16% respectively.

The was designed and analyzed by survey researchers at the Kaiser Family Foundation. Interviews were conducted between March 24 and April 18, 2006, among a nationally representative random sample of 2,517 respondents 18 years old and older. The survey covers a variety of topics including HIV/AIDS as a problem for our nation, knowledge and perceptions about HIV/AIDS, domestic HIV spending and program priorities, views on the global HIV epidemic, and African Americans and HIV.

Toplines

Chartpack

Additional Findings: HIV Testing

Additional Findings: Opinions and Experiences of 18- to 25-Year-Olds

Despite the success of Medicaid and SCHIP in reducing the number of uninsured low-income children by one-third in the last decade, over eight million children remain uninsured. Seventy percent of these uninsured children are eligible for public health coverage. This report by the Children’s Partnership lays out a plan for creating a series of enrollment doorways that make enrollment and renewal of children both routine and timely — as close to automatic as possible. The recommendations require a combination of both state and federal action..

Report (.pdf)

This report examines the stability of dual eligibility for the seven million Americans who rely on Medicaid to fill the gaps in their Medicare coverage and its implications for Medicare’s new prescription drug benefits.

The analysis focuses on the duration of dual eligibility, the rates of gain and loss of Medicaid coverage and sources of Medicare supplementation preceding and following periods of Medicaid enrollment. The paper analyzes data from the Medicare Current Beneficiaries Surveys from 1997 to 2000 and finds that Medicaid is a very stable source of Medicare supplementation.

This report was prepared for the Foundation by Bruce Stuart and Puneet Singhal of the University of Maryland School of Pharmacy.

Report

These toplines provide the complete survey questions and responses to the Survey of Americans on HIV/AIDS conducted between March 24 and April 18, 2006. The survey covers a variety of topics including HIV/AIDS as a problem for our nation, knowledge and perceptions about HIV/AIDS, domestic HIV spending and program priorities, views on the global HIV epidemic, and African Americans and HIV.

Toplines (.pdf)

Chartpack: 2006 Survey of Americans on HIV/AIDS

These charts highlight data from the Survey of Americans on HIV/AIDS conducted between March 24 and April 18, 2006. The survey covers a variety of topics including HIV/AIDS as a problem for our nation, knowledge and perceptions about HIV/AIDS, domestic HIV spending and program priorities, views on the global HIV epidemic, and African Americans and HIV.

Chartpack (.pdf)