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  • Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage

    Issue Brief

    This issue brief examines the health care needs and health costs of individuals with special health challenges, focusing on those with low-to-moderate incomes. It finds that even under a benefit package more generous than most offered in the private insurance market, individuals and families can face significant gaps in coverage and large out-of-pocket costs, especially if they have serious health conditions. The findings have implications for the health reform debate as policymakers consider minimum standards…

  • Long-term Services and Supports: A Rebalancing Act

    Event Date:
    Event

    The ongoing debate over the federal budget and deficit reduction presents a balancing act for policymakers, as many compelling interests compete for scarce dollars. But for 10 million older adults and people with disabilities who need long-term services and supports, there is a "rebalancing act" in progress. The aim is to serve more people at home and in the community, and fewer people in institutions. Are there sufficient home- and community-based programs in all states…

  • States’ Management of Medicaid Home Care Spending Ahead of H.R. 1 Effects

    Issue Brief

    Using data from the 23rd KFF survey of officials administering Medicaid home care programs, this issue brief describes the mechanisms states are currently using to limit Medicaid spending on home care and their plans for adopting new mechanisms in state fiscal year (FY) 2026.

  • Utilization of Health Care Services by Medicaid Expansion Status

    Issue Brief

    Some critics of Medicaid expansion have argued that expansion diverts resources away from other groups of Medicaid enrollees, including people with disabilities and children, and that expansion enrollees are “able-bodied” implying they have minimal health care needs. However, data show that expansion states spend more per enrollee overall and on each eligibility group than non-expansion states and that nearly half of expansion enrollees have a chronic condition. This data note analyzes 2021 Medicaid claims data…

  • The Connection Between Social Security Disability Benefits and Health Coverage Through Medicaid and Medicare

    Issue Brief

    This analysis examines who was eligible for Medicare and/or Medicaid between 2002 and 2022 because they received disability benefits from one of the country's Social Security disability programs, Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Many who receive SSDI and SSI qualify for both Medicare and Medicaid, known as dual-eligible individuals.

  • Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles: A Look at the 15 State Design Contracts Funded By CMS

    Issue Brief

    This brief summarizes 15 states' preliminary proposals to better coordinate care for people who are in both the Medicare and Medicaid programs. The design contracts, funded by the federal Center for Medicare and Medicaid Innovation (CMMI), are an outgrowth of new efforts under the health reform law to develop service delivery and payment models that integrate care for the nation’s nearly 9 million "dual eligibles," whose medical needs and health care costs typically exceed those…