Medicaid and Managed Care
This fact sheet provides an overview of the Medicaid program’s increasing reliance on managed care to deliver services.
Falling Through the Cracks: Health Insurance Coverage of Low-Income Women
Access to health coverage is a challenge for millions of low-income women. Because they are more likely to be low-wage workers and work in industries that don’t offer benefits, access to job-based coverage is often problematic. Avenues for assistance are available to some through Medicaid. However, despite the program s broadened focus on children and pregnant women, restrictive income and categorical requirements still leave millions of women ineligible and often uninsured. Recent changes in public and private health and welfare policies have had a disproportionate impact on low-income women and have resulted in increased numbers of women who lack coverage. This report, created for a Capitol Hill briefing series on women’s health issues, reviews the challenges facing low-income women and assesses the impact on health coverage of policy changes associated with the 1996 federal welfare reform law, tracing changes in coverage between 1994 and 1998.
CHIP Program Enrollment: June 2000
The report reveals that the total number of children enrolled in state CHIP programs had grown to 2.3 million by June 2000, showing a steady increase in enrollment. The report is part of a larger project to track Medicaid and CHIP enrollment in all 50 states.
Poll Finding
Post-Election Survey: The Public and the Health Care Agenda for the New Administration and Congress
This Kaiser Family Foundation-Harvard School of Public Health survey, conducted immediately after the 2000 Presidential election, finds that health care issues ranked near the top of voters priorities for spending the surplus. Medicare ranked among the top three priorities, along with education and Social Security, and ahead of paying off the national debt and cutting taxes. Education ranked first. The survey also found that voters support patients rights legislation and some action to help the uninsured. However, the survey found wide differences between Republican and Democratic voters that will complicate the ability of the next President and Congress to forge any consensus on health care priorities.
Poll Finding
Parents’ Views of Children’s Health Insurance Programs: A Survey of Denied Applicants for Kaiser Permanente’s Child Health Plan
In 1997, Kaiser Permanente launched the Child Health Plan to provide subsidized health insurance for low income California children not eligible for Medi-Cal (California’s Medicaid program) or Healthy Families (California’s State Children’s Health Insurance Program). As part of a broader evaluation of the Child Health Plan funded jointly by the Kaiser Family Foundation and the California HealthCare Foundation, these reports provide findings from a survey of low income parents who were eligible for Medi-Cal or Healthy Families but applied to the Child Health Plan instead and were denied coverage because their incomes were too high. The study was conducted by researchers at the Institute for Health Policy Studies, University of California at San Francisco.
South African Review 2000
During the 1980 s many South Africans spent the greater part of their weekends at funerals. As we move into the first decade of the 21st Century this pattern is re-emerging, although for entirely different reasons. Every South African is becoming increasingly intimate with the effects of the HIV/AIDS epidemic, and, as with most preventable diseases, it is the most vulnerable and poorest communities whose lives are most adversely affected. The attention given to HIV/AIDS by many chapters in the 2000 South African Health Review reflects the seriousness of the disease and the widespread impact that the epidemic is already having.
Previous South African Health Reviews have highlighted that in most areas of our health system excellent policies are now in place, and the challenge is to ensure implementation. In contrast, what is disturbing in relation to HIV, is that in some critical areas including Mother to Child Transmission and HIV and breastfeeding, there are not even clear policy guidelines.
In important areas of health care progress has been achieved, and in particular the development of detailed guidelines for a number of areas of specialty bear testament to improved policy implementation. For example 84% of districts have clinics offering tuberculosis treatment based on the principles of the DOTS strategy. Integrated Management of Childhood Illnesses (IMCI) has been adopted as a national programme to address acute childhood illnesses and a Vitamin A supplementation policy has been developed and approved. The Tobacco Products Control Amendment Act, an example of our model legislation, will serve to reinforce the declining prevalence of smoking, down from 34% in 1992 to 24% in 1998.
Unfortunately the benefits in terms of health status that could be expected to accrue from improved care are already being compromised by both the HIV/AIDS epidemic and by funding. There have been declines in per capita funding of the public health sector, and even declines in per capita funding of primary health care(PHC). This is cause for concern when the availability of various types of laboratory tests performed as part of PHC is unsatisfactory; when HIV testing in clinics is low with only six out of every ten fixed clinics offering this test; when essential PHC equipment is unavailable at some fixed clinics; when one quarter of fixed and satellite clinics have no ambulance available and when one third of mobile clinic workers believe that the vehicles they use are unsuitable for the roads they travel.
Promotion of equity is a cherished ideal of key policy documents relating to health care. It is regrettable that in respect of the most basic prerequisite for equity in the public sector, financing, the trend towards increased equity which took place during the first few years of democratic government appears to have been reversed as a result of changes in mechanisms of funding. Resource distribution between the public and private sectors remains the site of greatest inequity. The introduction of Social Health Insurance as it is presently construed will have only limited impact on this gap, and there is a need for re-examination of the objectives and design of existing policy. The 1998 re-regulation of medical schemes also aims to contribute to promoting equity through encouraging risk pooling and avoiding “dumping” of private patients on the public sector. Attention to the process, and to effectively involving stakeholders is crucial to the future of both Social Health Insurance and to the effective implementation of the Medical Schemes Act.
Transformation is ongoing in a number of critical areas. The transformation of Local Government heralds the opportunity for successful establishment of the District Health System, with the potential to improve the quality of life of many poor South Africans. A number of complex issues have to be addressed as part of this process and without a clearly articulated strategic plan there is the possibility that devolution of PHC will result in increased inequity.
Inherent in a Review of this type is the fact that a number of authors refer to the same issue, and this is especially so in the context of the HIV/AIDS epidemic. An overarching chapter on Health Status and Determinants provides an overview of mortality and morbidity data, and more detail is provided in chapters concentrating on programmatic issues such as Tuberculosis and Child Health. There are a few examples where small differences appear in data that is presented. These result from authors and researchers drawing upon different databases and sources of information.
As always, the Review does not expect to provide an exhaustive analysis of every facet of health services in the country. Rather it aims to examine and report on the general degree to which government is succeeding in achieving its aims in the stated health reform policies and objectives. In doing so attention is focused on critical elements that are being addressed in the system during the year in question. This year marks the beginning of a new millennium and the end of the first five years of new administration in the new South Africa. The report card demonstrates a mixed picture and the comments highlight areas of concern for trends into the future.
Enabling Services: A Profile of Medicaid Managed Care Organizations
The report provides basic statistics on Medicaid managed care organizations providing enabling services – transportation, translation, education, and case management. The report also identifies the extent of variation across plans.
Commercial Health Plan Participation in Medicaid Managed Care: An Examination of Six Markets
The issue paper studies health care markets of Denver, Detroit, Milwaukee, Miami, New York, and Seattle. The paper identifies key determinants for plan participation.
Mandatory Medicaid Managed Care–Plan and Enrollee Perspectives on the Enrollment Process
The issue paper discusses the enrollment process from the perspectives of both beneficiaries and participating plans in nine states with mandatory Medicaid managed care programs: California, Connecticut, Florida, Maryland, Michigan, Missouri, New Mexico, Oklahoma, and Oregon.
Poll Finding
Sexual Activity and Substance Use Among Youth
Teens and young adults face many pressures and decisions involving alcohol, drugs, and sexual activity decisions that often occur simultaneously. Almost one quarter of sexually active young people aged 15-24 report having sex without a condom because they were drinking or using drugs at the time. These findings are from a new national survey conducted by the Kaiser Family Foundation and released at a conference, Dangerous Liaisons: Substance Abuse and Sexual Behavior, sponsored by the National Center on Addiction and Substance Abuse (CASA) at Columbia University.