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  • Managing Care Transitions in Medicaid: Spotlight on Community Care of North Carolina

    Issue Brief

    Community Care of North Carolina’s Transitional Care Program (TCP) provides robust transition planning for high-risk Medicaid inpatients to support sound transitions from the hospital back to the community and reduce emergency department use and readmissions. Integral elements of the TCP are hospital-based care managers who coordinate with care managers in medical home practices; centralized health information technology, and standard care management training and tools.

  • Leveraging Medicaid in a Multi-Payer Medical Home Program: Spotlight on Rhode Island’s Chronic Care Sustainability Initiative

    Issue Brief

    Rhode Island's Chronic Care Sustainability Initiative (CSI) is a multi-payer patient-centered medical home program in which the one Medicaid health plan and all commercial health plans in the state participate. Hallmarks of the initiative are engaged leadership, mandatory participation but participatory governance, a common contract used by all payers, and investments in health information technology and other support for practice transformation.

  • Medicaid Managed Care in the Era of Health Reform – Briefing and Panel Discussion

    Event Date:
    Event

    Amid increasing state and national interest in using managed care delivery models for Medicaid beneficiaries, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) hosted a public briefing on Tuesday, June 25, 2013 to provide information on recent transitions from fee-for-service to managed care, and to discuss their implications for care access and…

  • Quality of Care in Community Health Centers and Factors Associated with Performance

    Issue Brief

    This study examines quality among health centers relative to Medicaid managed care organizations (MCOs). Chronic care quality among health centers is high; gaps in women’s preventive care are a concern. Lower-performing health centers have very high uninsured and homeless rates. The expansion of Medicaid and private insurance under the ACA may foster gains in health center quality performance.

  • Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff

    Issue Brief

    More than a year into the public health emergency, the COVID-19 pandemic continues to impact the lives of Americans including those living in the U.S. territories. Differences in Medicaid financing, including a statutory cap and match rate, have contributed to broader fiscal and health systems challenges for the territories. While additional federal funds have been provided over the statutory caps, these funds are set to expire at the end of September 2021. Without additional Congressional action, the territories will lose the vast majority of Medicaid financing which could result in reductions in coverage, services, and provider rates which could negatively impact the territories as they deal with the long-term health and economic consequences of the pandemic. This brief looks at how the pandemic is affecting the territories as well as issues related to the upcoming Medicaid fiscal cliff.

  • CMS’s 2020 Final Medicaid Managed Care Rule: A Summary of Major Changes

    Issue Brief

    On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in areas including network adequacy, beneficiary protections, quality oversight, and rates and payment.

  • The State Innovation Models (SIM) Program: A Look at Round 2 Grantees

    Fact Sheet

    This fact sheet provides information about the grants awarded under Round 2 of the State Innovation Models (SIM) initiative, with a focus on Model Test grants. Key themes are identified as well as similarities and differences among state approaches. Eleven states – Colorado, Connecticut, Delaware, Idaho, Iowa, Michigan, New York, Ohio, Rhode Island, Tennessee, and Washington — received Model Testing awards to implement and test their Innovation Plans over 48 months.

  • Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees

    Issue Brief

    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 data from the 2019 American Community Survey (prior to the COVID-19 pandemic) and assesses the limited role that Medicaid can play in helping to address these challenges.

  • Key Themes From Delivery System Reform Incentive Payment (DSRIP) Waivers in 4 States

    Issue Brief

    Building on an earlier brief that provided an overview of the components of DSRIP waivers, this analysis relied upon interviews with stakeholders to identify emerging trends and themes from DSRIP waivers in four states – California, Massachusetts, New York and Texas. It highlights that DSRIP waivers are spurring major change in relationships among providers; allowing providers to launch new initiatives aimed at improving care and reducing costs; and fostering a stronger focus on the social service needs of Medicaid beneficiaries. At the same time, the rapid pace of implementation is straining the ability of stakeholders to keep pace, including consumer advocates who are hard-pressed to track and respond to the DSRIP-driven changes that are fundamentally re-shaping the way that care is delivered to Medicaid beneficiaries.