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Protection For Consumers In Managed Care Plans: A Comparison Of Medicare, Medicaid and the Private Insurance Market

This policy paper describes key requirements of consumer protection regulation under Medicare, Medicaid and federal and state laws as they apply to private health insurance. These include choice and availability of plans, disclosure of information, marketing, access, quality, and the grievance and appeals process. The discussion highlights differences and similarities…

Trends in Health Plans Serving Medicaid — 2000 Data Update

Trends in Health Plans Serving Medicaid — 2000 Data UpdateAn updated study follows trends in commercial health plan participation in Medicaid managed care and includes new analyses on the performance of Medicaid-dominated and commercial plans on measures of effective care and access to care, and on the extent to which…

Pulling it Together: Teaching An Old Dog New Tricks

Way back in the eighties when I was Human Services Commissioner in New Jersey, I established something called the Garden State Health Plan (GSHP).  It was the first — and I think the only — federally qualified state-run HMO for Medicaid beneficiaries.  One goal of the GSHP was to reallocate…

A Guide to the Medicaid Appeals Process

This background brief provides a comprehensive look at the appeals process for the Medicaid program, which differs significantly from those available through the Medicare program and private health insurance. The Medicaid appeals process provides redress for individual applicants and beneficiaries seeking eligibility for the program or coverage of prescribed services,…

The Growth of Managed Care: Are Women Getting What They Need?

How the Changing Health Care Marketplace Affects Coverage and Access to Reproductive HealthA fact sheet, Q&A and resource list prepared for a media briefing held in New York on March 27, 1996. The purpose of the briefing was to respond to questions about how reproductive health services are currently delivered…