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  • A Guide to the Medicaid Appeals Process

    Issue Brief

    This background brief provides a comprehensive look at the appeals process for the Medicaid program, which differs significantly from those available through the Medicare program and private health insurance. The Medicaid appeals process provides redress for individual applicants and beneficiaries seeking eligibility for the program or coverage of prescribed services, but the process is multi-layered and can be complex to navigate. The guide describes Medicaid's appeals system, including the fair hearing process and the appeals…

  • Making Medicaid Managed Care Work:  An Action Plan for Persons Living with HIV

    Other Post

    Making Medicaid Managed Care Work: An Action Plan for Persons Living with HIV This report, by the National Association of People with AIDS (NAPWA) with support from The Kaiser Family Foundation, describes nine key points for people living with HIV to keep in mind when trying to influence the development of a managed care system that will serve them effectively. Senator John Chafee (R-RI), an acknowledged ally of NAPWA, gratefully accepted the report upon its…

  • Medicaid and Managed Care

    Fact Sheet

    This fact sheet provides an overview of the Medicaid program's increasing reliance on managed care to deliver services. Fact Sheet

  • Protection For Consumers In Managed Care Plans: A Comparison Of Medicare, Medicaid and the Private Insurance Market

    Report

    This policy paper describes key requirements of consumer protection regulation under Medicare, Medicaid and federal and state laws as they apply to private health insurance. These include choice and availability of plans, disclosure of information, marketing, access, quality, and the grievance and appeals process. The discussion highlights differences and similarities across public programs and private insurance and compares public and private insurance protection with provisions of the Consumer Bill of Rights (CBRR) developed by the…

  • Public Health in a Changing Health Care System: Linkages Between Public Health and MCOs In the Treatment and Prevention of STDs

    Report

    Public health agencies and managed care organizations share responsibility for the health of the populations they serve. Their relationships are particularly important in the area of STDs. This study analyzes the evolving relationships between managed care organizations and public health agencies in how they manage the prevention, treatment, and tracking of STDs. Report

  • Managed Care and Low-Income Populations: Four Years’ Experience with the Oregon Health Plan

    Report

    This report updates an earlier study of Oregon's experience with restructuring their Medicaid programs. It is one of a series of reports from The Kaiser/Commonwealth Low-Income Coverage and Access Project. This project examines how changes in the Medicaid Program have affected health insurance coverage and access to care for the low-income population in eight states: Maryland, California, Florida, Minnesota, New York, Oregon, Tennessee and Texas. Report

  • The Characteristics and Roles of Medicaid-Dominated Managed Care Plans

    Report

    This policy brief (Publication #2180) provides a national profile of Medicaid-dominated managed care plans - those in which Medicaid enrollees make up at least 75 percent of total enrollment. While recent policy and market forces have encouraged the growth of these plans, basic information about them has been lacking, partly because many are not licensed as HMOs by states. As of June 1997, 118 of these Medicaid-dominated plans served 3.4 million Medicaid enrollees across the…

  • Medicaid Enrollment in 50 States: June 1997 to December 1999

    Report

    This report provides current national and state-level data on the number of persons enrolled in Medicaid and CHIP. In addition to identifying recent trends in Medicaid and CHIP enrollment, this report also examines trends in the various eligibility categories within Medicaid. The report reveals that enrollment in Medicaid increased by 1.1 million individuals, or 3.6 percent, in December 1999 compared to the previous December. Executive Summary Report Link to December 2001 Data Update