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This report describes the new legal and policy framework within which the shift of state Medicaid programs from fee-for-service to managed care will take place over the next few years.
This report discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals. The paper relies on an extensive review of federal and state administrative responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors.
A number of states have used the flexibility of the Medicaid program to develop innovative payment and delivery systems designed to coordinate and improve quality of care. This brief, based on site visits from November 2009 through March 2010, highlights care coordination and related efforts in five states: Alabama, Oklahoma, Oregon, Pennsylvania and Washington state.
There is increased interest among states in operating Medicaid managed long-term services and support (MLTSS) programs rather than paying for long-term services and supports (LTSS) on a fee-for-service basis, as has been the general practice.
As many states expand their use of managed care in Medicaid, a growing number of beneficiaries with disabilities are being enrolled in risk-based managed care arrangements for at least some of their care.
This report updates a 1994 case study of California's Medicaid managed care initiative. California uses three predominant managed care models in its Medi-Cal program: county organized health (COHS), geographic managed care (GMC), and the two-plan model. This case study focuses specifically on Los Angeles County's two-plan model and Orange County's COHS model.
Medicaid's Role for the Disabled Population Under Age 65 Defines the non-elderly disabled and summarizes Medicaid's role in their health care coverage. Includes a description of enrollment requirements, benefits, spending and managed care concerns for the population.
The fourth in a series of reports on implementation issues and challenges in the first year of S-CHIP finds that states have been able to enter arrangements with plans for their S-CHIP population fairly easily.
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 brief examines how health service providers, plan administrators, and community-based organizations in Contra Costa, Kern, and Los Angeles Counties experienced the transition of Medi-Cal-only seniors and persons with disabilities (SPDs) to managed care as part of the state’s “Bridge to Reform” Medicaid waiver. Findings presented may inform similar transitions of high-need beneficiaries in other states and coverage expansions in 2014 under the Affordable Care Act.
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