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The Henry J. Kaiser Family Foundation

An Update on CMS’s Capitated Financial Alignment Demonstration Model For Medicare-Medicaid Enrollees

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. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans…

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The Henry J. Kaiser Family Foundation

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,…

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The Henry J. Kaiser Family Foundation

Medicaid and Managed Care: Key Data, Trends, and Issues

This brief provides a snapshot of the Medicaid program’s use of managed care to deliver services to beneficiaries. It examines the prevalence of managed care in state Medicaid programs; the various approaches states have used, including primary-care case management; managed care for long-term services and for beneficiaries dually eligible for…

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The Henry J. Kaiser Family Foundation

People with Disabilities and Medicaid Managed Care: Key Issues to Consider

As many states expand their use of managed care in Medicaid, a growing number of beneficiaries with disabilities are being enrolled in risk-based managed care arrangements for at least some of their care. Further growth in managed care is expected in 2014, when the Affordable Care Act expands Medicaid eligibility…

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The Henry J. Kaiser Family Foundation

California and Texas: Section 1115 Medicaid Demonstration Waivers Compared

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. Both waivers affect hundreds of thousands of…

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The Henry J. Kaiser Family Foundation

Financial Alignment Models for Dual Eligibles: An Update

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. In April 2011, the Centers for Medicare and Medicaid Services (CMS) announced the award of design…

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The Henry J. Kaiser Family Foundation

Medicaid Innovations: Can Managed Care Cut Costs and Improve Value?

A number of states have expressed interest in expanding managed care approaches within their Medicaid programs. While managed care may present an opportunity for better delivery of care, it presents challenges within certain populations and geographic areas. How many states are planning Medicaid managed care expansions? What impact would these…

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The Henry J. Kaiser Family Foundation

States Focus on Cost Containment as a Loss of Federal Stimulus Funds Means State Costs for Medicaid Will Jump in FY 2012

NEWS RELEASE Thursday, October 27, 2011 New 50-State Survey Finds Cuts In Provider Payments And Changes In Delivery Of Services WASHINGTON, D.C. – Faced with the end of stimulus money and a continuing weak economy, Medicaid officials in virtually every state are enacting a variety of cost cutting measures as states’…

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The Henry J. Kaiser Family Foundation

California's "Bridge to Reform" Medicaid Demonstration Waiver

This issue brief provides an overview of California’s “Bridge to Reform” Medicaid Demonstration Waiver, which was approved in 2010 and will make up to roughly $8 billion in federal Medicaid matching funds available to California over a five-year period to expand coverage to low-income uninsured adults and preserve and improve…

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The Henry J. Kaiser Family Foundation

Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues To Consider

There is increased interest among states in operating Medicaid managed long-term services and support (MLTSS) programs rather than paying for long-term services and supports (LTSS) on a fee-for-service basis, as has been the general practice. This issue brief examines key issues for states to consider if they are contemplating a…

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