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Medicaid and Managed Care June 1995 This year, Medicaid will finance health and long-term care services to more than 35 million low-income Americans. In its role as a purchaser of health services for low-income families, Medicaid increasingly relies on managed care to deliver care.
Completed for the National Conference of State Legislatures and the Kaiser Commission on Medicaid and the Uninsured, by Health Management Associates. Compiled from Medicaid State Plans and Amendments approved by the Centers for Medicare and Medicaid Services, and from State websites, with verification by State and Territorial Medicaid officials in March 2003.
As federal and state governments advance efforts to better coordinate care and reduce costs for people dually eligible for both Medicare and Medicaid benefits, this brief examines how insurers now serving these markets view the opportunities and challenges, including a look at Medicare Advantage Special Needs Plans.
A Review of the Waiver Applications, Letters of Approval and Special Terms and Conditions This background paper provides a summary of the key features of the Medicaid 1115 waivers that have been approved, proposed, implemented and conditionally rejected.
Native Americans and Medicaid:Coverage and Financing Issues Medicaid as Medicare Premium Assistance The Medicare program provides health insurance coverage for the nation's elderly and disabled.
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.
Today, one out of every four disabled Medicaid beneficiaries receives health care through managed care. This Background Paper provides insights into how Medicaid managed care is working for individuals with disabilities, based on the findings from seven focus groups held in Florida and New Mexico.
This issue brief describes the Centers for Medicare and Medicaid Services’ plan to evaluate the financial alignment demonstrations, for beneficiaries dually eligible for Medicare and Medicaid via its contract with RTI International.
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work and age. While there are limits, states can use Medicaid – which, by design, serves a primarily low-income population with greater social needs – to address social determinants of health. This brief outlines the range of Medicaid authorities and flexibilities that can be used to add benefits and design programs to address the social determinants of health.
On November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized revisions to the Medicaid managed care regulations which were proposed in November 2018. CMS previously finalized a major revision to these regulations in 2016. The November 2020 final rule is not a wholesale revision of the 2016 regulations but adopts changes in areas including network adequacy, beneficiary protections, quality oversight, and rates and payment.
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