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  • Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long‐Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care

    Report

    Medicare Spending and Use of Medical Services for Beneficiaries in Nursing Homes and Other Long‐Term Care Facilities: A Potential for Achieving Medicare Savings and Improving the Quality of Care This report documents the relatively high rates of hospital stays, emergency room visits and skilled nursing facility admissions among long-term care facility residents. It finds that Medicare per capita spending for Medicare beneficiaries living in nursing homes, assisted-living centers and other long-term care facilities, $14,538 in…

  • Papers on Issues For People With Medicare Raised By Proposed Drug Benefit Regulations

    Issue Brief

    Papers on Issues For People With Medicare Raised By Proposed Drug Benefit Regulations The Kaiser Family Foundation has commissioned a series of papers to explore key issues that may be of concern for Medicare beneficiaries as the new Medicare drug benefit is implemented. These papers focus on specific areas of potential concern for people with Medicare. In addition, the Foundation also has produced a timeline of upcoming important dates leading up to the implementation of…

  • Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable

    Issue Brief

    Half of all Medicaid enrollees receive care through comprehensive risk-based managed care organizations (MCOs). Most Medicaid MCO enrollees today are low-income children and parents, but states are increasingly moving beneficiaries with more complex needs into MCOs. Managed care enrollment may grow more rapidly as states work with the Centers for Medicare & Medicare Services (CMS) to implement initiatives to better integrate Medicare and Medicaid benefits and care for dual eligibles. The Foundation’s Kaiser Commission on…

  • An Update on CMS’s Capitated Financial Alignment Demonstration Model For Medicare-Medicaid Enrollees

    Issue Brief

    Beginning in January, 2013, the Centers for Medicare and Medicaid Services (CMS) will implement a three year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs. On January 25, 2012, CMS issued a memorandum providing additional guidance for…

  • Federal Core Requirements And State Options In Medicaid: Current Policies And Key Issues

    Fact Sheet

    Medicaid is a jointly financed partnership between the federal government and states. The federal-state financing and administrative structure of Medicaid provides a framework of federal core requirements along with broad state options for program design and administration. This issue brief presents an overview of the current Medicaid program framework, with a focus on eligibility, benefits and cost sharing, care delivery and provider payment, long-term services and supports, and dual eligibles, as well as key issues…

  • A Challenge for States: Assuring Timely Access to Optimal Long-Term Services and Supports in the Community

    Issue Brief

    The Medicaid program is a major payer for long-term services and supports (LTSS) in the United States, accounting for 40 percent of total spending for long-term services and supports. The federal government has played an active role in sponsoring initiatives to promote a shift to community-based care; and evidence from several states suggests that providing care in the community can be less expensive than providing institutional care. The Affordable Care Act (ACA) provides incentives for…

  • 2001 Retiree Health and Prescription Drug Coverage Survey-6020

    Report

    2001 Retiree Health and Prescription Drug Coverage Survey This survey, released by the Kaiser Family Foundation, The Commonwealth Fund, and HRET, profiles retiree health coverage for Medicare-age (65+) retirees, including the amount retirees pay for coverage compared to active workers, cost-sharing for prescription drugs, and eligibility requirements for retiree benefits. The survey is based on the annual KFF/HRET Employer Health Benefits Survey News Release: New Survey Shows Retiree Health Benefits Continue to Decline Chart Pack

  • Retiree Health Trends and Implications of Possible Medicare Reforms

    Other Post

    Background Health care benefits had been offered to active employees for a long period of time before health coverage became a retiree benefit offered by employers. The key event that made employer-sponsored retiree health care a possible benefit for retirees was the enactment of Medicare in 1965. It was then felt possible to provide a widely desired benefit at a relatively low cost, since the Medicare program would pay the majority of the costs. Millions…

  • Medicaid’s New “Health Home” Option

    Issue Brief

    This brief provides key information about the new option for state Medicaid programs to provide "health home" services for enrollees with chronic conditions. The option, established under the new health reform law, took effect on Jan. 1, 2011. Health homes are designed to facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care and long-term community-based services and supports. Brief (.pdf)

  • Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities

    Issue Brief

    On May 18, 2016, the Department of Health and Human Services (HHS) published a final rule to implement Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination in health coverage and care based on race, color, national origin, age or disability, and, for the first time sex. This Issue Brief provides a technical summary of Section 1557 and the final rule and highlights new protections and provisions included in the law and rule.…