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This report is based on a focus group discussion in May 2012 with the Executive Board of the National Association of Medicaid Directors (NAMD) and other leading Medicaid directors. The group of nine directors reflected perspectives from various regions of the country.
Beginning in January, 2013, the Centers for Medicare and Medicaid Services (CMS) will implement a three year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid.
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.
TennCare represents one of the most ambitious state-level efforts to restructure Medicaid and expand insurance coverage to the uninsured. The case study shows that the rapid change caused considerable confusion for patients, providers, and health plans. The TennCare experience provides early insights into the issues that states will face as they move to enroll more of their low-income populations into managed care arrangements.
The Centers for Medicare and Medicaid Services (CMS) has proposed two models to align Medicare and Medicaid benefits and financing for dual eligible beneficiaries, one capitated model and one managed fee-for-service model. In the spring of 2012, 26 states submitted proposals to CMS seeking to test one or both of these models.
The nearly nine million dual eligibles who receive both Medicare and Medicaid benefits are a high cost, high need population, accounting for a disproportionate share of expenditures relative to their enrollment in both programs.
This report provides an overview of the Arizona Medicaid experience and contains valuable insights into the evolution and experience of a mandatory statewide Medicaid managed care program covering both acute care and long-term care services. Note: This publication is no longer in circulation.
One mechanism for ensuring that health insurance provides value to consumers for the premiums that they pay, or that others pay on their behalf, is to require insurers to meet a minimum “medical loss ratio” or MLR standard.
This fact sheet compares and contrasts key provisions of the California and Texas Section 1115 Medicaid demonstration waivers. The Texas waiver, approved in December 2011, is modeled, in part, on the California waiver, which has been underway in that state since November 2010.
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.
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