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  • Grievance and Appeals Procedures: An Analysis of the MMA and Proposed Regulations

    Issue Brief

    This paper, by Sara Rosenbaum, J.D., Director of the Center for Health Services Research and Policy at George Washington University, examines the procedures for resolving beneficiaries' grievances and appeals under the new Medicare drug benefit. It is one in a series commissioned by the Kaiser Family Foundation that analyzes issues surrounding the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and the proposed regulations. Issue Brief (.pdf)

  • Premiums and Cost-Sharing in Medicaid: A Review of Research Findings

    Issue Brief

    Medicaid covers nearly 60 million Americans. Because the population covered by the program is low-income, federal law limits the extent to which states can charge premiums and cost-sharing amounts, particularly for pregnant women, children and adults with incomes below poverty. Yet there is renewed interest in the use of premiums and cost-sharing in Medicaid given the continued focus on cost-containment due to ongoing state budget pressures as well as recently proposed changes to federal regulations…

  • Retiree Health Trends and Implications of Possible Medicare Reforms

    Fact Sheet

    The availability of employer-sponsored retiree health benefits from large companies has declined since 1991, according to a new study conducted for the Kaiser Family Foundation by Hewitt Associates LLC. The study also shows that the number of big businesses charging premiums, tightening eligibility requirements, encouraging use of managed care, and placing dollar caps on coverage increased. In addition, the report concluded that potential changes in the Medicare program, such as a higher eligibility age, could…

  • Views of the New Medicare Drug Law – Toplines

    Poll Finding

    This document includes the toplines from a comprehensive survey of people on Medicare and their attitudes toward the new Medicare drug law. The survey provides detailed insight in their perceptions and opinions about the law, the Medicare-approved drug-discount card program and the new Medicare drug benefit set to begin in January 2006. It also assesses views on the law’s implications for the 2004 elections. Survey Toplines (.pdf)

  • Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration

    Report

    This report features nine seniors and people with disabilities living in Florida, Georgia, Kansas, Louisiana, North Carolina, and Tennessee, who rely on home and community-based services (HCBS). These profiles illustrate how beneficiaries’ finances, employment status, relationships, well-being, independence, and ability to interact with the communities in which they live---in addition to their health care---are affected by their Medicaid coverage and the essential role of HCBS in their daily lives.

  • New Analysis of Historical Rates of Medicaid Enrollment Churn Sheds Light on the Implications for the End of the Continuous Enrollment Requirement Tied to Pandemic Funding

    News Release

    For more than a year-and-a-half, the continuous enrollment requirement tied to enhanced Medicaid funding during the COVID-19 pandemic has all but halted enrollment “churn,” the temporary loss of coverage in which people disenroll from Medicaid and then re-enroll within a short period of time. Such disenrollments are expected to resume once the requirement ends and states begin processing Medicaid eligibility redeterminations. Individuals may lose coverage if they are no longer eligible or face barriers during…

  • Key Issues in Long-Term Services and Supports Quality

    Issue Brief

    This issue brief discusses four key issues related to long-term services and supports (LTSS) including institutional and home and community-based services (HCBS) quality, highlighting major legislative and policy changes over the last 30 years since the passage of the Nursing Home Reform Act.

  • Health Care Reform and the CLASS Act

    Issue Brief

    This issue brief examines the Community Living Assistance Services and Supports (CLASS) program, a component of the health reform law that establishes a national, voluntary insurance program for purchasing community living services and supports that is designed to expand options for people who become functionally disabled and require long-term help. This brief describes the major components of the CLASS program including its financing, eligibility criteria, benefit design and interaction with Medicaid. Issue Brief (.pdf)