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Most states today rely heavily on risk-based managed care organizations (MCOs) to serve Medicaid beneficiaries. This Data Note discusses the current role of managed care in Medicaid and examines differences in managed care growth between states that expanded Medicaid to low-income adults under the Affordable Care Act (ACA) and states that did not expand Medicaid.
On August 3, the Kaiser Family Foundation and the Center for Strategic and International Studies (CSIS) hosted a briefing to assess the major outcomes of the 2016 International AIDS Conference (AIDS 2016), held from July 18-22 in Durban, South Africa. The discussion touched on the latest scientific advancements, the current funding climate for HIV response, and other developments and contributions to the field emerging from the conference. Panelists included Chris Beyrer, Immediate Past President of the International AIDS Society;…
Our updated explainer provides an overview of comprehensive managed care, the most common way states deliver Medicaid services to enrollees.
The nearly nine million dual eligibles who receive both Medicare and Medicaid benefits are a high cost, high need population, accounting for a disproportionate share of expenditures relative to their enrollment in both programs. In April 2011, the Centers for Medicare and Medicaid Services (CMS) announced the award of design contracts to 15 states to develop service delivery and payment models to integrate care for dual eligibles. CMS and the participating states have recognized that…
Recent legislation, including the stimulus package and the new health reform law, invests substantial funds in health information technology which can help prevent medical errors and improve the quality and value of care. However, questions have been raised about the cost of implementation and personal privacy considerations. This briefing addressed questions such as: What have the U.S. and other countries learned from their experience with health IT? How is the adoption of this technology progressing…
This background paper examines various aspects of the Medicaid program that can expand access to home and community-based services (HCBS) and rebalance long-term care spending in favor of HCBS. As a result of the long-standing requirement that states cover facility-based care, the majority of Medicaid long-term care (LTC) expenditures historically have been for institutional, rather than home and community-based, services. Over the past two decades, major efforts have been undertaken by states and the Centers…
This 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.
The 2010 Affordable Care Act (ACA) included many provisions affecting the Medicare program and the 57 million seniors and people with disabilities who rely on Medicare for their health insurance coverage. This brief explains the Medicare provisions in the ACA and explores the implications for Medicare and beneficiaries of repealing these provisions.
This brief describes current network adequacy and availability standards for Medicaid managed care plans, presents related findings from KFF’s 22nd annual Medicaid budget survey, and summarizes proposed changes to network adequacy and access rules in the Managed Care NPRM.
The COVID-19 pandemic and the ensuing economic disruption have drawn more attention to longstanding issues related to housing and internet access and how these issues can impact health. As the primary source of health insurance for low-income populations, Medicaid covers a considerable share of people living in homes that are unaffordable, inadequate, or have limited access to the internet. This brief examines housing adequacy, affordability, and internet access within the homes of Medicaid enrollees using…
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