Questions About Essential Health Benefits
The Institute of Medicine (IOM) recently issued its long-awaited report on defining the essential health benefits under the Affordable Care Act (ACA).
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Medicaid’s Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings
Issue BriefThe nation's primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions.
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Uniform Coverage Summaries for Consumers
Issue BriefThis brief explains the proposed federal rule that requires private health plans to provide a short, easy-to-read uniform summary of benefits and coverage to all health insurance applicants and enrollees.
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Medicaid Payment for Outpatient Prescription Drugs
Fact SheetThis fact sheet summarizes Medicaid’s role as the major source of outpatient pharmacy services for low-income Americans. Medicaid spent $25.4 billion on prescription drugs in fiscal year 2009, and outpatient prescription drug coverage is an optional benefit that all state Medicaid programs currently provide. Fact Sheet (.
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The Role of Clinical and Cost Information in Medicaid Pharmacy Benefit Decisions: Experience in Seven States
Issue BriefThis policy brief provides perspective on the potential for using comparative effectiveness research in Medicaid pharmacy programs by looking at seven states to determine how they currently evaluate relative clinical and cost information about prescription drugs when making coverage decisions for their Medicaid pharmacy benefits.
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Managing Medicaid Pharmacy Benefits: Current Issues and Options
ReportThis report examines reimbursement, benefit management and cost sharing issues in Medicaid pharmacy programs.
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What is a Mini-Med Plan?
PerspectiveOne of the early insurance market changes in the Affordable Care Act (ACA) phases out caps that some insurance plans impose on the annual dollar amount of benefits they will cover. Plans issued or renewed after September 23, 2010 cannot have annual limits of less than $750,000, and the threshold goes up to $1.
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An Employer Health Benefits Balance Sheet
PerspectiveThere seems to be growing interest in the question of how many employers will keep offering coverage to their full-time employees once the Affordable Care Act (ACA) is fully implemented in 2014, or instead will choose to stop offering coverage and pay a penalty.
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Preventing Chronic Disease: The New Public Health
Event Date:EventThere is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans live, learn, work, and play.
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Federal Core Requirements And State Options In Medicaid: Current Policies And Key Issues
Fact SheetMedicaid is a jointly financed partnership between the federal government and states. The federal-state financing and administrative structure of Medicaid provides a framework of federal core requirements along with broad state options for program design and administration.