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)

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 Administration’s waiver initiative, and the Texas waiver. Second is a fact sheet that provides greater detail on the Texas waiver and highlights some key questions raised by the waiver.

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)

Attention to the details of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) has largely focused on the new drug benefit and, to a lesser degree, to new payments and rules for private plan participation in Medicare. Less noticed is a provision in the law that created a new measure of financial health of the Medicare program to be included in the annual report of the Boards of Trustees of the Medicare Trust Funds.

The new financial measure established by the MMA assesses how much of Medicare spending is financed by general revenues (mainly made up of income taxes). When general revenues exceed 45 percent of total Medicare spending, general revenues are deemed to be used “in excess.” The intent of the measure is to treat a 45 percent contribution of general revenues to Medicare as the upper bound of reasonable support for the program from this one funding source.

This brief takes an in-depth look at the program’s new solvency test, how it differs from other commonly reported indicators of Medicare’s financial health, and some of the implications and issues it raises for the future.

It is authored by Marilyn Moon, who was a public trustee for the Social Security and Medicare trust funds and is now of the American Institute for Research.