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.
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The Balancing Incentive Program provides enhanced federal matching funds, allowing states to advance their efforts to rebalance Medicaid long-term services and supports (LTSS) spending and expand access to home and community-based services as an alternative to institutional care. This report highlights participating states’ efforts to implement the program’s three structural requirements and use the enhanced federal funds in support of other Medicaid LTSS rebalancing efforts.
More than one third of the nation’s 15,500 nursing homes, accounting for 39 percent of all nursing home residents, received relatively low ratings of 1 or 2 stars under the federal government’s recently revamped Five-star Quality Rating System, according to a new analysis by the Kaiser Family Foundation. The rating…
This issue brief presents national and state-level analysis of nursing homes based on the Five-Star Quality Rating System, recently updated by the Centers for Medicare and Medicaid Services (CMS) to help consumers compare nursing homes when selecting one for themselves or their family members. The issue brief finds that more than one-third (36%) of the nation’s 15,500 nursing homes certified by Medicare or Medicaid received relatively low ratings of 1 or 2 stars (out of a possible 5 stars). In 11 states, at least 40 percent of nursing homes in the state have 1- or 2-star ratings. In 23 states, however, at least half of the nursing homes have 4- or 5- star ratings. This issue brief discusses relevant policy considerations regarding nursing home quality—a serious issue in light of the vulnerability of the nursing home population and recent reports of problems arising from inadequate staffing, fire safety hazards, and substandard care.
Medicaid, the main health insurance program for low-income people and the single largest source of public coverage in the U.S., turns 50 this year. In that time, it has grown to cover nearly 70 million Americans and become a key source of financing for safety net hospitals and health centers,…
The Medicaid program, signed into law by President Lyndon B. Johnson on July 30, 1965, will reach its 50th anniversary this year, a historic milestone. This report reflects on Medicaid’s accomplishments and challenges and considers the issues on the horizon that will influence the course of this major health coverage and financing program moving forward.
More than half of all Medicaid beneficiaries now receive their services in risk-based managed care plans, and states’ use of managed care is expanding. States operate their own Medicaid managed care programs within federal rules and requirements. The federal regulations were last updated in 2002 and a new proposed rule is expected in Spring 2015. This brief identifies key issues in the regulation and discusses how CMS might address them.
This fact sheet provides a brief overview of quality measures related to long-term services and supports rebalancing.
Rebalancing in Capitated Medicaid Managed Long-Term Services and Supports Programs: Key Issues from a Roundtable Discussion on Measuring Performance
This issue brief summarizes the key issues related to measuring performance in LTSS rebalancing identified and discussed by participants in an expert roundtable meeting on November 13, 2014.
A new report, The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare, from the Kaiser Family Foundation takes a detailed look at per person Medicare spending by age and by service among the nearly 30 million people covered by traditional Medicare in 2011