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This brief examines the role of Medicare and Medicaid in the lives of dually eligible beneficiaries – low-income seniors and younger adults with disabilities who are eligible for both programs – through personal profiles. It includes a glossary of eligibility and service delivery system terms and state-level enrollment and expenditure data for dual eligibles.
This issue brief presents current state-level data about COVID-19 cases and deaths in settings that primarily serve nonelderly people with disabilities and summarizes available research on this population’s elevated risk of severe illness and death; explains how nonelderly people with disabilities and their LTSS providers are reflected in state vaccine prioritization plans; and discusses key issues related to vaccine access for these populations.
The nation's primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions. This report provides an overview of long-term care users and their acute and long-term care service spending. The report finds that although the individuals who rely on long-term care…
To Hospitalize or Not to Hospitalize? Medical Care for Long-Term Care Facility Residents This report explores factors that appear to drive relatively high rates of hospitalizations, based on interviews with doctors, nursing home staff and families in four cities. Key factors include liability concerns, limited onsite staff capabilities, difficulty reaching residents' physicians for care instructions on nights and weekends, better and more timely access to diagnostic tests in hospitals, and patient preferences. Physicians with patients…
This primer is on Medicaid's role as the major provider of health coverage for non-elderly persons with disabilities and on the policy challenges that lie ahead. It also provides short profiles of people with disabilities from across the country. Report (.pdf)
: An Assessment of Coordination Efforts Between State SCHIP and Title V Programs This study explores how the State Children’s Health Insurance Program serves children with special needs and assesses the role of the Title V Maternal and Child Health Services Block Grant program in filling in gaps in coverage. It also discusses the implications of state choices on publicly-funded health coverage for pediatric health care. Report (.pdf)
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)
This paper, by Joy Pritts of the Health Policy Institute at Georgetown University, looks at issues related to drug plan marketing activities and privacy under the MMA. Issue Brief (.pdf)
These three reports examine the relatively high use of hospital and other Medicare-covered services and the associated costs of medical care for Medicare beneficiaries who live in nursing homes and other long-term-care facilities. They also explore the potential for delivery system reforms to improve quality and reduce costs. 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…
This brief summarizes and examines the implications of recent Section 1115 Medicaid waiver activity. Section 1115 waivers provide states flexibility to test new approaches in Medicaid that differ from federal program rules and can have significant impacts for beneficiaries, providers, and states. While recent waivers and waiver proposals vary in their specific goals and approaches, some key themes are emerging, including using Section 1115 waiver authority to get a jump start on the 2014 Medicaid…
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