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 ideas for what to monitor to ensure that waiver participants maintain equal access to prescription drugs as their institutionalized peers, and can remain in waiver programs without increased physical harm or financial hardship

Issue Brief (.pdf)

Executive Summary (.pdf)

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)

This survey conducted jointly by the Washington Post, the Kaiser Family Foundation and the Harvard School of Public Health assesses the views and attitudes of DC-area teens and their parents on priorities involving career, child-rearing and family; their personal hopes and fears; their outlook towards the nation’s future; and generational differences in experiences and expectations. The survey also includes comparative data from a national survey of teens.

The was conducted among 800 pairs of parents and teenagers in the region, including the District of Columbia, Maryland, and Virginia. Interviews were conducted by telephone between April 26 and May 29, 2005 by ICR/International Communication Research. Not all questions were asked of parents. Teenagers were defined as those between 14 and 18 years of age. The survey also includes additional questions asked of a national sample of 570 teenagers between 14 and 18 years of age.

Survey (.pdf)

This Kaiser Family Foundation study estimates the potential impact in monthly Medicare drug premiums if enrollment does not reach 29 million in 2006 as the Congressional Budget Office (CBO) assumed, and if those who do enroll have relatively high total prescription drug costs.

The study, prepared by Avalere Health LLC and based on a model developed by Actuarial Research Corporation, looks at various participation scenarios for the beneficiaries who are projected by the Congressional Budget Office (CBO) to enroll in a Medicare drug plan in 2006. The paper examines the effects of varying enrollment on monthly premiums and federal costs of the Medicare prescription drug benefit, particularly if beneficiaries with relatively low drug spending do not enroll.

This analysis solely focuses on the impact of various participation scenarios, based on beneficiaries’ prescription drug costs, on average Medicare prescription drug plan premiums. The analysis holds constant other factors that also could affect average plan premiums in the future, including drug prices and utilization, and other market dynamics that could affect plan participation. These factors were held constant to illustrate the implications of various beneficiary participation scenarios on Medicare drug plan premiums.

The study was prepared for the Kaiser Family Foundation by Jonathan Blum, Jennifer Bowman, and Chiquita White of Avalere Health LLC.

Report (.pdf)

In recent years states have been trying to shift resources from institutional to home and community based long-term care services. This report examines “transition” and “diversion” policies and practices in eight states. It provides a sense of what state Medicaid programs are doing or could be doing to promote diversion.

Report (.pdf)

Executive Summary (.pdf)

Three KCMU state surveys indicate improving economy and sustained state cost-containment actions have improved the outlook for Medicaid and SCHIP, but long-term challenges remain due to factors affecting overall health care system.

News Release

Summary of Findings (.pdf)

Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006

State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey, 2005 Update

In a Time of Growing Need: State Choices Influence Health Coverage Access for Children and Families

News on State Medicaid Programs: July through September 2005 Update

Webcast of policy briefing releasing new surveys

The annual 50-state survey of enrollment and eligibility policies in Medicaid and SCHIP for low-income families reveals that 20 states are taking actions to simplify procedures and requirements for beneficiaries and, in some cases, expand eligibility.

Report (.pdf)

Executive Summary (.pdf)

This update summarizes state Medicaid actions from July through September 2005 highlighting changes that governors and state legislators have announced or implemented.

Issue Brief (.pdf)

The 50-state annual survey of about budget conditions and Medicaid cost containment actions in FY2005-06 shows that all states implemented and planned more Medicaid cost-containment actions, but are also implementing expansions as the gap between Medicaid spending growth and state tax revenue narrowed.

Report (.pdf)

Executive Summary (.pdf)

State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey, 2005 Update

This survey of state Medicaid pharmacy programs supplements surveys conducted in 2003 and 2000 and reports Medicaid prescription drug policies in effect in early 2005. It covers key elements of utilization management, drug purchasing and potential impacts of the implementation of the Medicare prescription drug benefit.

Report (.pdf)

Executive Summary (.pdf)