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  • Among Dual Eligibles, Identifying The Highest Cost Individuals Could Help In Crafting More Targeted And Effective Responses

    Report

    This Health Affairs article by researchers at the Urban Institute analyzes linked Medicare and Medicaid data to examine dual eligibles' utilization and spending in both programs in 2007. It finds that while the population of people dually eligible for Medicare and Medicaid is indeed costly, it is not monolithic. For instance, although 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending, nearly 40 percent of dual eligibles…

  • Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries

    Issue Brief

    This paper provides an overview of the joint efforts of states and the Centers for Medicare and Medicaid Services (CMS) to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. Dual eligible beneficiaries comprise many of the poorest and sickest people covered by either program, and they account for a disproportionately large share of Medicare and Medicaid spending.…

  • Health Reform Opportunities: Improving Policy for Dual Eligibles

    Issue Brief

    As the nation considers national health reform, this brief provides an overview of opportunities to realign federal and state policy for the dual eligibles to promote a more rational, cost-efficient system for 9 million of the poorest, sickest and highest-cost people covered by both Medicaid and Medicare. Navigating two programs with different rules and financing incentives is complex for beneficiaries and providers, impedes efforts to improve care coordination and results in cost-shifting between programs that…

  • Primers on Key Health Care Topics and Programs

    Issue Brief

    The Kaiser Family Foundation maintains a number of primers providing overviews of key health care programs and issues. Written by Foundation staff, each primer provides key data and information that helps illustrate the topic and its relevance for the nation's health care system. Medicaid: A Primer Medicare: A Primer The Uninsured: A Primer Health Care Costs: A Primer How Private Health Coverage Works: A Primer Mental Health Financing in the United States: A Primer The…

  • Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, with enrollment beginning on April 1, 2013. Starting in 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people who are eligible for both federal health programs. Massachusetts' demonstration…

  • Medicare Prescription Drug Coverage for Residents of Nursing Homes and Assisted Living Facilities: Special Problems and Concerns

    Issue Brief

    This issue brief describes Medicare drug benefit policy issues for residents of nursing homes and other long-term care settings, such as assisted living facilities and board and care facilities. The brief addresses differing rules for nursing home and non-nursing home settings, as well as for dual eligibles residing in long-term care facilities. Issue Brief (.pdf)

  • Nursing Home Care Quality:  Twenty Years After the Omnibus Budget Reconciliation Act of 1987

    Report

    Nursing Home Care Quality: Twenty Years After the Omnibus Budget Reconciliation Act of 1987 To mark the 20th anniversary of the passage of landmark federal legislation to improve the quality of nursing home care, the Omnibus Budget Reconciliation Act of 1987 (known as OBRA '87), this report explains the key provisions of OBRA ’87 related to nursing home care and examines the progress and problems in quality assurance in nursing homes over the past twenty…

  • The Sleeper in Health Reform: Long-Term Care and the CLASS Act

    Event Date:
    Event

    The Kaiser Family Foundation briefing examines a little-noticed but major provision in two leading health reform bills that would change the way that the U.S. pays for long-term care. The provision, known as the Community Living Assistance Services and Supports (CLASS) Act, would establish a national voluntary insurance program that would allow for voluntary pre-financing of long-term care through payroll deductions and then provide a cash benefit to purchase services. The briefing included a summary…

  • States Focus on Cost Containment as a Loss of Federal Stimulus Funds Means State Costs for Medicaid Will Jump in FY 2012

    News Release

    NEWS RELEASEThursday, October 27, 2011 New 50-State Survey Finds Cuts In Provider Payments And Changes In Delivery Of Services WASHINGTON, D.C. - Faced with the end of stimulus money and a continuing weak economy, Medicaid officials in virtually every state are enacting a variety of cost cutting measures as states’ spending for Medicaid is projected to increase 28.7 percent this fiscal year to make up for the loss of federal funds, according to a new survey…