The Kaiser Commission on Medicaid and the Uninsured has been monitoring the development of the Pharmacy Plus waiver initiated by the Bush Administration in 2002 and tracking the states that have pending or approved plans. The Commission has developed some materials describing the initiative, examining the financing mechanism, and discussing the implications for the Medicaid program and participating states.

The Pharmacy Plus initiative allows states to secure federal Medicaid matching funds for prescription programs for low-income seniors and/or individuals with disabilities. While much of the focus of the initiative has been on providing prescription drug coverage, the waiver would fundamentally change the financing of care under Medicaid. The main findings of the new reports are:

• Funding caps apply to all spending on elderly Medicaid beneficiaries, not just their Pharmacy Plus prescription programs.
• A function of closed negotiations between states and the Department of Health and Human Services, the generosity of the waiver funding caps varies markedly across states. For example, South Carolina would have been eligible for $900 million more in federal funding over the next five years if it had gotten a deal as generous as Illinois, while Florida would have been eligible for $760 million and Wisconsin $350 million.
• It is unlikely that prescription drug programs for seniors will pay for themselves.

• Policy Brief
• Background Paper
• Presentation Slides

This policy brief describes Pharmacy Plus waivers being considered by some states for their Medicaid program and their implications for Medicaid financing. These waivers offer an opportunity for prescription drug coverage for low-income seniors, but they also include a major change in the financing of care for all seniors on Medicaid — a cap on federal Medicaid funding for all services provided to seniors on Medicaid.

• Policy Brief

This issue brief examines women’s roles in family health care decision-making and coordination, the effect of that involvement for women who work, and women’s caregiving responsibilities. This analysis is based on data from the 2001 Kaiser Women’s Health Survey, a nationally representative sample of nearly 4,000 women between the ages of 18 and 64.

Issue brief (.pdf)

News Release: Mothers Still Carry Primary Responsibility for Family Health — Tradeoffs Between Caring for Children and Job Earnings Common

The CA Policy Program hosts an ongoing series of roundtable discussions focusing on key health policy issues facing the state as they emerge.

Medicaid Waivers: Lessons from CaliforniaThis roundtable discussion, hosted by the Foundation and the University of California, Berkeley Center for Health and Public Policy Studies, provided an overview of current Section 1115 waiver activity across the states, focusing on Health Insurance Flexibility and Accountability (HIFA) Initiative waiver efforts. Findings from recent studies of waiver programs in other states such as Oregon, Utah, and New Hampshire were presented and discussed. Panelists also discussed the possible implications of these studies for California’s proposed Medi-Cal waiver redesign. — July, 2004

The Future of Medi-Cal: Challenges at the Federal, State, and County LevelThis issue brief explores how California and other states are attempting to preserve a meaningful set of benefits under Medicaid during the current budget crisis, when services are most needed and state resources are most scarce. This brief is being distributed in Sacramento at the latest California Health Policy Roundtable on Tuesday, May 13, 2003. — May, 2003

Mandated Health Insurance Benefits: Tradeoffs Among Benefits, Coverage, and Costs? — Issue BriefAn issue brief that looks at mandated health insurance benefits and the tradeoffs among benefits, coverage, and costs. It explores the debate over mandated benefits legislation, the evidence about the impact of mandates, the status of mandated benefits in other states and in California. — July, 2002

Responding to the Threat of Bioterrorism: Is California’s Public Health System Ready? — Issue BriefA 4-page issue brief which looks at the threat of bioterrorism and the public health system’s role in responding to such an attack. The issue brief also addresses what can be done nationally and in California to prepare for a possible bioterrorist attack. The brief lists the panel for a California Health Policy Roundtable to be held in Sacramento, California on March 18, 2002. — March, 2002

Assessing the Status of California’s Physician Workforce: Shortage or Surplus? — Issue BriefA 4-page issue brief that looks at recent estimates of California’s present and future physician supply, various issues that affect the state’s physician workforce, and approaches for ensuring an adequate number and mix of primary care and specialty physicians, as well as a balanced geographic and demographic distribution. The brief lists the panel for a California Health Policy Roundtable held in Sacramento, California on October 24, 2001. — October, 2001

Employer-Sponsored Health Insurance in California: Current Trends, Future Outlook, and Coverage Expansions — Issue BriefA 4-page issue brief that looks at trends in employer-sponsored health insurance coverage in California. The brief also includes public and private sector strategies for expanding employment-based coverage, and discusses how other states have implemented incremental coverage expansions using public programs and financial incentives, with emphasis on New York State. The brief lists the panel for a California Health Policy Roundtable held in Sacramento, California on May 4, 2001. — May, 2001

The Prescription Drug Conundrum: Pharmaceutical Coverage, Costs, and Affordability — Issue BriefA 2-page issue brief that discusses significant trends in prescription drug coverage, expenditures, utilization, along with how the pharmaceutical industry prices drugs. The brief also looks at what states are doing to control drug costs and to address issues of affordability and access for low-income and elderly populations, how health plans are controlling prescription drug costs, and proposed prescription legislation in California. The brief lists the panel for a California Health Policy Roundtable held in Sacramento, California on September 11, 2000. — September, 2000

Reaching Out to California’s Uninsured Children: Increasing Enrollment in Medi-Cal and Healthy Families — Issue BriefA 2-page issue brief that discusses ways to increase enrollment of eligible but uninsured children in California’s Medi-Cal and Healthy Families Programs, barriers to such enrollment, and successful outreach and enrollment strategies undertaken by other states. The brief lists the panel for a California Health Policy Roundtable held in Sacramento, California on March 24, 2000. — March, 2000

A Risky Proposition? Risk-Bearing and Solvency in California’s Medical Groups — Policy BriefA Risky Proposition? Risk-Bearing and Solvency in California’s Medical Groups is an 8-page policy brief to provide information about medical groups in California, including a discussion on risk-bearing, solvency, and proposed regulatory approaches. The brief includes a variety of perspectives presented by speakers at a California Health Policy Roundtable held in Sacramento, California on July 20, 1999. — February, 2000

Health Care Information in California: Who Collects It? Who Needs It? — Issue BriefA 2-page issue brief about the collection and use of health care information for California’s public health, health care and managed care systems. The issue brief includes a brief outline of the kind of health care information that is currently being collected at both the state and national level to support policy development, government oversight, and consumer education. The Issue Brief lists Roundtable participants for a Roundtable Event: Tuesday, November 30, 1999 – 1:00-4:00 PM, State Capitol, Room 112, Sacramento, California. — November, 1999

Medical Groups — Issue BriefA 2-page issue brief about medical groups in California, including a discussion on risk-bearing, solvency and current regulatory approaches. In preparation for a Roundtable Event: Tuesday, July 20, 1999 – 1:00-4:00 PM, State Capitol, Room 447 – Sacramento, California. — July, 1999

Health Plan Liability — Policy BriefAn 8-page policy brief to inform the policy debate in California about health plan liability issues, including barriers to lawsuits (ERISA), liability approaches used in other industries, and potential impact on premiums. The brief includes a variety of perspectives presented by speakers at a California Health Policy Roundtable held in Sacramento, California on February 25, 1999. — June, 1999

External Review of Health Plan Decisions — Policy BriefAn 8-page policy brief on the external review of health plan decisions to inform the policy debate in California and nationally. The policy brief covers external review systems in other states and the Medicare program, the current status of external review in California, and issues regarding the design and implementation of external review. — January, 1999

HIPAA Compliance Strategies In California: Reforming the State’s Individual Health Insurance Market — Policy BriefA policy brief on reform of the individual insurance market and implementation of the Health Insurance Portability and Accountability Act (HIPAA) in California. The brief is based, in part, on discussion at a California Health Policy Roundtable held in Sacramento, California on March 12, 1998. — August, 1998

This fact sheet, updated in April 2003, profiles current sources of prescription drug coverage among the Medicare population, describes the characteristics of beneficiaries who lack drug coverage and the implications of being without such coverage, and provides current data on prescription drug use and spending.

Fact Sheet (.pdf)

This report details the rules governing prior authorization programs and the major steps in a model process based on key issues raised by beneficiary advocates, provider groups and states.

• Report

Health News Index March/April, 2003

The Health News Index measures public attention to and knowledge about leading health stories covered in the news in February and March. The Health News Index is designed to help news media and people in the health field gain a better understanding of which health stories Americans are following and what they understand about those issues.

• Summary of Findings
• Topline/Survey

The fifth in a series of fact sheets on topics related to children, media and health pulls together the most relevant research that has been conducted about the impact of news on children, in times of war and in times of relative peace. The fact sheet explores how children reacted to televised accounts of the terrorist attacks of 9/11, as well as the Oklahoma City bombing, and the 1991 Persian Gulf War. It also includes guidelines for parents on helping children cope with news coverage of traumatic events.

• Key Facts: Children and the News

This report is a case study of five states’ (California, Georgia, Oklahoma, Oregon, and Washington) implementation of prior authorization in their Medicaid programs.

Understanding how Medicare+Choice (M+C) plans manage their drug benefits may generate important lessons for Medicare. This report, based on interviews with both national and regional managed care firms, provides an in-depth look at how plans have managed their M+C outpatient pharmacy benefits in recent years. Findings show that plans rely on a number of cost management strategies to constrain the growth in drug spending including formularies, tiered-copayments, mail-order benefits, and fixed caps or dollar limits on drug benefits. When spending begins to spiral and Medicare capitation rates do not increase commensurately, plans may revert to more certain methods for controlling drug costs like capping drug benefit levels, which helps limit their financial exposure, but shifts risk onto beneficiaries.

• Executive Summary
• Report