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This issue brief compares the financial alignment demonstrations for beneficiaries who are dually eligible for Medicare and Medicaid in states that have memoranda of understanding approved by the Centers for Medicare and Medicaid Services.
As California ramps up its CalAIM initiative, the state will incorporate and transition its Whole Person Care pilot program's services statewide through the state’s Medicaid managed care system. This brief examines the lessons from those pilots in coordinating and integrating physical health, behavioral health, and social services.
This issue brief summarizes major provisions of the Notice of Proposed Rulemaking (NPRM) to modernize and strengthen federal Medicaid managed care regulations, which serves as an informational guide to key proposed new federal expectations and requirements of states and managed care arrangements, and federal oversight interests moving forward.
The July 28 special issue of the Journal of the American Medical Association (JAMA) includes an article written by Kaiser Family Foundation President and CEO Drew Altman and former U.S. Senate Majority Leader William H. Frist, MD, and two infographics from the Foundation that examine the past, present, and future of Medicaid and Medicare.
This brief highlights how state eligibility policies for incarcerated individuals differ, based on a review of state statutes, regulations, Medicaid eligibility manuals and other Medicaid agency guidance publicly available online and Medicaid managed care contracts. Overall, state Medicaid eligibility policies for justice-involved individuals moving into and out of incarceration vary, and these policies affect if and when individuals may enroll in Medicaid and the scope of any resulting savings.
This primer providers an overview of certain delivery system reform models that are being examined in traditional Medicare, and explains model goals, financial incentives, potential beneficiary implications, and results so far with respect to Medicare spending and care quality. The primer discusses accountable care organizations, medical homes and bundled payments.
Three quarters of reproductive age women on Medicaid are enrolled in managed care arrangements. This analysis explores the experiences and perspectives of leaders of Medicaid Managed Care Organizations (MCOs) in structuring their networks and services to provide family planning and reproductive health services to women. It finds that MCOs rely heavily on safety net clinics including Community Health Centers and Family Planning Clinics such as Planned Parenthood to provide in-network family planning services to their members. MCO leaders also identified churning in enrollment, the high costs of stocking IUDs and implants, global hospital payment methodologies for maternity care, and the inclusion of faith-based providers in plan networks as potential barriers to certain family planning services.
As the Trump Administration and Congress weigh major changes to Medicaid and programs that fund reproductive health care, new analyses from the Kaiser Family Foundation highlight the current state of coverage and challenges for family planning, pregnancy, and perinatal services in the Medicaid program that provides coverage for millions of low-income women across the nation.
This fact sheet provides a brief overview of quality measures related to long-term services and supports rebalancing.
This brief provides an overview of how Medicaid managed care organization (MCO) capitation rates are developed by states and approved by CMS, highlights options available to states to adjust current rates and/or risk sharing mechanisms, describes how MCOs pay providers, and outlines state options to direct MCO payments to providers in response to conditions created by the COVID-19 pandemic.
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