Individuals with disabilities who are eligible for both Medicare and Medicaid must also shift to a Medicare prescription drug benefit in 2006. This report analyzes how younger dual eligibles in Kansas enrolled in work incentive programs differ than other Medicare enrollees in the types of drugs they use and how much drug spending they have to better assess the impact of the Medicare drug benefit on this population.

Report (.pdf)

Medicaid: An Overview of Spending on “Mandatory” vs. “Optional” Populations and Services

This issue brief provides an overview of Medicaid’s optional beneficiaries and services. The brief demonstrates that although “optional” populations account for only 29 percent of Medicaid enrollment, 60 percent of all Medicaid expenditures for both “mandatory” and “optional” populations are “optional,” and the majority of these (86 percent) pay for services provided to the elderly and disabled.

Issue Paper (.pdf)

Key Implementation Dates for the Medicare Prescription Drug Benefit

This timeline presents important dates and deadlines of key implementation activities related to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). It runs from the beginning of 2005 through the end of 2006, the first year of the new Medicare drug benefit. Some of these dates are defined in the MMA statute, while others are from the final rule issued by the Centers for Medicare and Medicaid Services.

Download a printable version of this timeline

Date

Implementation Activity

January 1 –

March 31, 2005

Low-income beneficiaries enrolling in Medicare drug discount card program this quarter receive full-year $600 subsidy for 2005 (subsidy pro-rated for part-year enrollment for remainder of 2005)

January 2005

CMS launches “awareness” phase of message campaign for drug benefit

February 18, 2005

Deadline for “Notice of Intent to Apply” from standalone PDPs, new MA contractors, and regional PPOs

March 2005

CMS issues guidance for employers on retiree creditable coverage

March 1, 2005

Deadline for current MA contractors to submit a request for a special needs plan

March 15, 2005

SSA pilot mailing of low-income subsidy applications to 2,050 beneficiaries in 42 zip codes

March 23, 2005

Deadline for PDPs, MA-PDs, and cost contractors to submit Part D applications

March 23, 2005

Deadline for “Notice of Intent to Apply” from employers or unions directly contracting as a PDP or MA-PD

March 28 – April 18, 2005

CMS accepts CY 2006 formularies from PDPs and MA-PDs

April 2005

Information on low-income subsidy eligibility published on Medicare.gov

April 4, 2005

CMS announces MA capitation rates, MA local area benchmarks and adjustment factors for 2006

April 18, 2005

Deadline for employers to submit PDP or MA-PD applications

April 30, 2005

CMS releases letter with 2006 enrollment and payment instructions and releases instructions to states on how to process state eligibility determinations

May 31, 2005

CMS begins sending mailings to low-income subsidy-eligible beneficiaries and dual eligibles

June 1, 2005

Deadline for CMS to approve PDP plan applications and MA service area expansions

June 6, 2005

Deadline for submitting PDP and MA-PD bids to CMS

June 6, 2005

Deadline for employers to submit formularies to CMS

June 20 – 30, 2005

CMS mails informational letter to dual eligibles regarding transition to Medicare plans

June 30, 2005

CMS distributes CY 2006 summary of benefits instructions to MA contractors

June 31, 2005

Deadline for CMS to pre-qualify bidders from eligible fallback entities for plans starting in 2006

July 2005

CMS launches “discussion” phase of message campaign

July 1, 2005

Medicaid and SSA begin processing applications for low-income subsidies

July 1, 2005

Deadline for CMS to establish requirements and procedures for coordination between Part D plans and SPAPs and other insurers (Medicaid, group health plans, FEHBP, TRICARE)

August 3, 2005

CMS releases national average monthly bid amount and calls for reallocation of rebates for MA-PDs (if needed)

August 3 –

September 30, 2005

CMS accepts retiree drug subsidy applications from employers and unions

August 2005SSA begins sending decisions to those who applied for low-income subsidies

September 14, 2005 (tentative)

CMS approves bids for PDPs and MA-PDs

September 15, 2005PDP and MA-PD contracts signed

September 16 –

November 15, 2005

Medigap issuers send written disclosures to policyholders with drug coverage informing them of their options

September 30, 2005

Deadline for plan sponsors to submit to CMS attestation of actuarial equivalence

September 30, 2005

Deadline for plan sponsors to apply for retiree drug subsidy payment for 2006

October 1, 2005

Approved Part D plans begin marketing

October 1, 2005

Deadline for transfer of Medicare appeals from SSA to DHHS

October 13, 2005

CMS begins disseminating information comparing available Part D coverage to beneficiaries via mail with the Medicare & You handbook, 1-800-MEDICARE, and Plan Comparison Web Tool and Medicare Personal Plan Finder on Medicare.gov

October 15, 2005

Deadline for Secretary to notify states of their annual per capita drug payment amounts (“clawback”) for 2006

October 21, 2005

CMS announces decision on retiree drug subsidy applications

October 27 –

November 10, 2005

CMS mails auto-enrollment information to dual eligibles

November 15, 2005 – May 15, 2006

Coordinated election period for 2006 Part D enrollment for all beneficiaries

November 15, 2005 –

May 15, 2006

States and entities offering drug coverage provide written disclosure to Part D eligible individuals regarding actuarial equivalence

December 31, 2005

Medicaid drug coverage ends for full benefit dual eligibles

December 31, 2005

Medicare drug discount card program ends

January 1, 2006

• Part D coverage begins for all beneficiaries enrolled in a plan

• Dual eligibles’ auto-enrollment takes effect

• Low-income subsidies for Part D coverage begin

• Medigap insurers prohibited from selling new policies with drug coverage

January 1, 2006 –

December 2007

Moratorium on formation of new local Medicare PPOs

January 1 – June 30, 2006

Open enrollment period for MA-eligible individuals (during which they can change plans once)

January 1 – June 30, 2006

CMS launches “urgency” phase of message campaign

February 25, 2005States begin making monthly “clawback” payments to federal government for dual eligibles

February 28, 2006

Retiree drug subsidy payments begin

March 2006

CMS identifies all beneficiaries not enrolled in a Medicare prescription drug plan

April 2006

CMS mails spring enrollment reminder to beneficiaries

April – May 2006CMS facilitates enrollment in a prescription drug plan for those determined to be eligible for low-income subsidies but have not yet enrolled in a planMay 15, 2006

End of coordinated election period for 2006 Part D enrollment

June 1, 2006Coverage begins for low-income subsidy eligible beneficiaries who were assigned to a prescription drug plan by CMS

October 15, 2006

Deadline for Secretary to notify states of their annual per capita drug payment amounts (“clawback”) for 2007

November 15, 2006

States and entities offering drug coverage provide written disclosures to Part D eligible individuals regarding actuarial equivalence

November 15 –

December 31, 2006

Annual coordinated election period for 2007 Part D enrollment for all beneficiaries

Timeline last updated: June 8, 2005

With discussions on restructuring Medicaid occurring in state capitols and Washington, two new reports provide the latest data on how much of Medicaid’s spending is for covering mandatory versus optional populations and services. The analysis shows that although optional populations account for 29 percent of Medicaid enrollment, 60 percent of all Medicaid spending (whether for mandatory or optional populations) is optional and 86 percent of optional spending is for the elderly or individuals with disabilities. The issue paper is a brief summary of the data and the discussion of the practical implications for policy changes and the background report is a more detailed examination which includes the methodology of the analysis and many charts and tables.

Issue Paper – Medicaid: An Overview of Spending on “Mandatory” vs. “Optional” Populations and Services

Background Report – Medicaid Enrollment and Spending by “Mandatory” and “Optional” Eligibility and Benefit Categories

Medicaid Enrollment and Spending by “Mandatory” and “Optional” Eligibility and Benefit Categories

This report presents new estimates of the proportion of Medicaid beneficiaries and spending that is mandatory and optional to promote an increased understanding of how Medicaid restructuring proposals might affect the various groups and services covered by the program.

Report (.pdf)

The nation’s safety net financing is fragmented; consequently, providers must knit together resources from many different funding sources to create a stream of revenue to cover the costs of providing a very broad range of services. This report describes those sources of revenue, documenting that nearly 40% of all safety net revenues are from Medicaid. The report also describes challenges that safety net hospitals and health systems are experiencing as they attempt to rebound from the economic downturn of the early 2000s.

Report (.pdf)

Over the past few years, a number of states have implemented new or increased existing out-of-pocket costs for beneficiaries in their Medicaid, SCHIP, or other public coverage programs. This brief reviews the key findings from this recent activity, including the impact on enrollment in public coverage programs, access to care, and providers.

Issue Paper (.pdf)

In recent years, medical malpractice law and insurance have become popular topics for debate in Washington, DC and around the country. This report provides an overview of the issues surrounding medical malpractice law, including the legal changes that states have made over the past thirty years in response to periodic concerns about rising medical malpractice costs; some newer proposals for changing medical malpractice law; and trend data for malpractice claims.

This report was prepared for the Foundation by Peter P. Budetti of the University of Oklahoma Health Sciences Center and Teresa M. Waters of the University of Tennessee Health Science Center.

Report (.pdf)

This report from the The Center for Strategic and International Studies (CSIS) Task Force on HIV/AIDS Working Committee on Prevention, in collaboration with the Kaiser Family Foundation, provides an overview of the HIV prevention indicators used by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 15 focus countries and compares them to those used by other major international initiatives. The overview is designed to inform policymakers and other experts in an area that is complex, often controversial, and one that will become increasingly important in years to come.

The report was authored by the co-chairs of the Task Force’s Working Committee on Prevention, Jennifer Kates, vice president and director of HIV Policy at the Kaiser Family Foundation and Phillip Nieburg, senior associate at CSIS.

CSIS Report (.pdf)

This report explores how four state Medicaid programs — Washington, Wyoming, Minnesota, and North Carolina — differ in their use of Oregon’s Drug Effectiveness Review Project (DERP) to manage their prescription drug benefit.

Report (.pdf)