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Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries: What Prior Experience Did Health Plans and States Have with Capitated Arrangements?

This report examines the Center for Medicare and Medicaid Services (CMS) financial alignment demonstration for beneficiaries dually eligible for Medicare and Medicaid, with a focus on the extent to which participating states and health plans have prior experience with capitated managed care arrangements under Medicare or Medicaid, and specifically for this population. Under these capitated financial alignment demonstrations, health plans contract with the state and CMS (a three-way contract) to provide both Medicare and Medicaid benefits to dually eligible beneficiaries. These demonstrations aim to improve the quality of care and the coordination of benefits for people dually eligible for Medicare and Medicaid. The report finds considerable variation in the experience of states and health plans participating in these demonstrations, and discusses the potential implications for beneficiaries and plan oversight.

Awaiting New Medicaid Managed Care Rules: Key Issues to Watch

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.

Comparison of Consumer Protections in Three Health Insurance Markets: Medicare Advantage, Qualified Health Plans and Medicaid Managed Care Organizations

This report examines similarities and differences in federal consumer protection standards for Medicare Advantage (MA) plans, Qualified Health Plans (QHPs), and Medicaid Managed Care Organizations (MCOs). It focuses on rules established at the federal level, though some states have chosen to go above the federal minimums and impose additional requirements for QHPs and Medicaid MCOs.

Tapping Nurse Practitioners to Meet Rising Demand for Primary Care

More than 58 million Americans, or nearly 1 in 5, live in primary care shortage areas, where the supply of primary care physicians is not sufficient to meet the needs of the population. Particularly as the demand for primary care increases due to population growth, aging, and expanded insurance coverage, strategies to mitigate already sharp strains on primary care capacity are needed. This brief focuses on the opportunity to more fully tap the potential of nurse practitioners to increase access to primary care.

Web Briefing: The Medicaid Managed Care Market Tracker

More than half of the nation’s 67.9 million Medicaid beneficiaries now receive their health care in comprehensive managed care organizations (MCOs) – and the number and share are growing. As states expand their use of Medicaid managed care, the Kaiser Family Foundation has launched a new interactive tool to enhance…

New Interactive Data Tool Tracks Medicaid Managed Care Market

The Medicaid Managed Care Market Tracker, a new feature of the Foundation’s State Health Facts data center, provides the latest data on key dimensions of risk-based Medicaid managed care for the 39 states that contract with MCOs – these states are home to more than 90 percent of all Medicaid beneficiaries nationwide. On Thursday, December 11 at 12:30 p.m. ET, the Foundation will host an interactive web briefing with Medicaid managed care expert Julia Paradise, an Associate Director of the Foundation’s Kaiser Commission on Medicaid and the Uninsured.

Key Findings on Medicaid Managed Care: Highlights from the Medicaid Managed Care Market Tracker

This report highlights 10 key findings on the Medicaid managed care market, based on analysis of data included in the Kaiser Family Foundation’s Medicaid Managed Care Market Tracker. The findings provide a partial profile of the Medicaid MCO market nationally and by state. They also illuminate the involvement of large, multi-state health insurance companies in the Medicaid market and the participation of these firms in other markets as well, including the managed long-term services and supports market, the new ACA marketplaces, and the Medicare Advantage market. Finally, these selected highlights serve to illustrate the array of ways the Tracker can be used to understand more about the Medicaid managed care market and its place in the broader market.

Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers

This issue brief analyzes key themes in 19 capitated § 1115 and § 1915(b)/(c) Medicaid managed long-term services and supports (MLTSS) waivers approved to date by the Centers for Medicare and Medicaid Services (CMS) with a focus on covered populations and services, provisions aimed at expanding beneficiary access to HCBS, beneficiary protections, and quality measurement and oversight.