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Payment and Delivery System Reform in Medicare: A Primer on Medical Homes, Accountable Care Organizations, and Bundled Payments

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.

Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings in this report are drawn from the 16th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2016 and those implemented or planned for FY 2017 based on information provided by the nation’s state Medicaid directors. Key areas covered include changes in eligibility and enrollment, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, and covered benefits (including prescription drug policies).

Trends in State Medicaid Programs: Looking Back and Looking Ahead

For 15 years, KCMU and HMA have conducted annual surveys of Medicaid programs across the country. The NAMD has formally collaborated on this project since 2014. This brief provides a look back at the enrollment and spending trends as well as the multitude of policy actions taken by states across key areas: eligibility and application processes; provider rates and taxes; benefits, pharmacy and long-term care since as well as highlighting more recent data on managed care and delivery system reforms collected as part of this annual survey. Looking ahead, the survey will continue to capture the evolution of the Medicaid program with a focus program changes during economic cycles as well as innovations in payment and delivery system reform.

CMS’s Final Rule on Medicaid Managed Care: A Summary of Major Provisions

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued final regulations that revise and significantly strengthen existing Medicaid managed care rules. In keeping with states’ increasingly heavy reliance on managed care programs to deliver services to Medicaid beneficiaries, including many with complex care needs, the regulatory framework and new requirements established by the final rule reflect increased federal expectations regarding fundamental aspects of states’ Medicaid managed care programs.

Medi-Cal Managed Care: An Overview and Key Issues

California’s Medicaid program, Medi-Cal, is the largest state Medicaid program in the nation, insuring almost one-third of Californians. For several decades, Medi-Cal has been transitioning from a fee-for-service (FFS) system to risk-based managed care, and more than three-quarters of all Medi-Cal beneficiaries, including low-income children, adults, seniors, and people with disabilities, are now enrolled in managed care plans. As other state Medicaid programs increase their reliance on risk-based managed care, a review of California’s transition is both timely and illustrative. This issue brief provides an overview of the evolution of Medi-Cal managed care, key issues, and lessons for managed care programs in other states.

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity

Research demonstrates that improving population health and achieving health equity will require broad approaches that address social, economic, and environmental factors that influence health. Recently there has been increased recognition of the importance of these factors to health. Moreover, the ACA includes provisions to help bridge health care and community health. Reflecting the increased focus and new opportunities provided under the ACA, a growing number of initiatives are emerging at the national, state, and local level to address broader determinants of health. Given Medicaid’s longstanding role serving a diverse population with complex health, behavioral, and social needs, efforts to address social determinants of health are emerging through many Medicaid delivery and payment initiatives. This brief provides an overview of the broad factors that influence health and describes emerging efforts to address them, including initiatives within Medicaid.

The Affordable Care Act Drove Record Annual Increases in Enrollment and Total Medicaid Spending Nationally in FY 2015, As Newly Eligible Adults gained Coverage in Expansion States

High Federal Match for Adult Expansion Group Contributed to Substantially Slower State Medicaid Spending Growth in Expansion States Compared to Non-Expansion States Survey Also Finds States Relying More on Managed Care, Undertaking Delivery System Reforms The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending…

Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016

This report provides an in depth examination of the changes taking place in state Medicaid programs across the country. The findings in this report are drawn from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2015 and those planned for implementation in FY 2016 based on information provided by the nation’s state Medicaid Directors. Key areas covered include changes in eligibility and enrollment, delivery and payment system reforms, provider payment rates, and covered benefits (including prescription drug policies).

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.