Medicaid Arrangements to Coordinate Medicare and Medicaid for Dual-Eligible Individuals
This issue brief describes how state Medicaid programs are implementing arrangements aimed at coordinating Medicare and Medicaid for dual-eligible individuals.
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Dual Eligible Demonstrations: The Beneficiary Perspective
Issue BriefThis issue brief provides insights about initial implementation of the financial alignment demonstrations from the perspective of dual eligible beneficiaries in Massachusetts, Ohio, and Virginia, based on 12 individual interviews conducted in early 2015. Profiles of six beneficiaries are presented to illustrate representative program experiences, along with key findings from across all of the interviews.
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Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
Issue BriefResearch demonstrates that improving population health and achieving health equity will require broad approaches that address social, economic, and environmental factors that influence health. This brief provides an overview of the broad factors that influence health and describes efforts to address them, including initiatives within Medicaid.
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A First Look at North Carolina’s Section 1115 Medicaid Waiver’s Healthy Opportunities Pilots
Issue BriefMedicaid funds typically cannot be used to pay for non-medical interventions that target the social determinants of health. However, in October 2018, CMS approved North Carolina’s Section 1115 waiver which provides financing for a new pilot program, called “Healthy Opportunities Pilots,” to cover evidence-based non-medical services that address specific social needs linked to health/health outcomes. The pilots will address housing instability, transportation insecurity, food insecurity, and interpersonal violence and toxic stress for a limited number of high-need Medicaid enrollees. This brief summarizes key features of the pilots.
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Testimony: Promoting Integrated and Coordinated Care for Medicare Beneficiaries
Issue BriefGretchen Jacobson, Associate Director of the Foundation's Program on Medicare Policy, testified on June 7, 2017 before the U.S. House Committee on Ways and Means, Subcommittee on Health. Her testimony focused on three approaches for integrating and coordinating care for Medicare beneficiaries, and the opportunities and challenges presented by these approaches.
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Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments
ReportThis primer providers an overview of certain delivery system reform models that are being examined in traditional Medicare, and explains model goals, financial incentives, potential beneficiary implications, and results so far with respect to Medicare spending and care quality. The primer discusses accountable care organizations, medical homes and bundled payments.
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Health Plan Enrollment in the Capitated Financial Alignment Demonstrations for Dual Eligible Beneficiaries
Fact SheetThis fact sheet shows enrollment in the capitated financial alignment demonstrations for dual eligibles as of July 2017.
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“What is CMMI?” and 11 other FAQs about the CMS Innovation Center
Fact SheetThe Center for Medicare and Medicaid Innovation (CMMI), also known as the "Innovation Center," was authorized under the Affordable Care Act with the goals of designing, implementing, and testing new payment and delivery system reform models to address concerns about rising costs, quality of care, and inefficient spending. These FAQs provide an overview of the Innovation Center, as well as details on model performance, beneficiary involvement, and more.
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California Efforts to Address Behavioral Health and SDOH: A Look at Whole Person Care Pilots
Issue BriefAs California ramps up its CalAIM initiative, the state will incorporate and transition its Whole Person Care pilot program's services statewide through the state’s Medicaid managed care system. This brief examines the lessons from those pilots in coordinating and integrating physical health, behavioral health, and social services.
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Medicaid Authorities and Options to Address Social Determinants of Health
Issue BriefSocial determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. While there are limits, states can use Medicaid – which, by design, serves a primarily low-income population with greater social needs – to address social determinants of health. This brief outlines the range of Medicaid authorities and flexibilities that can be used to add benefits and design programs to address the social determinants of health.