The Massachusetts Health Care Landscape May 1, 2012 Fact Sheet This fact sheet summarizes the Massachusetts health care landscape, including data on demographics, population health, the uninsured and the state Medicaid program. Fact Sheet (.pdf)
Quick Take: Medicaid MCOs and Medical Loss Ratio (MLR) Requirements April 13, 2012 Fact Sheet One mechanism for ensuring that health insurance provides value to consumers for the premiums that they pay, or that others pay on their behalf, is to require insurers to meet a minimum “medical loss ratio” or MLR standard. The MLR is the share of premium revenues that an insurer or…
Federal Funding Under the Affordable Care Act April 12, 2012 Fact Sheet This fact sheet provides highlights from an analysis tracking the flow of federal Affordable Care Act funds to states as reporter in the Department of Health and Human Services grant database as well as periodic reports from HHS and the Internal Revenue Service. The analysis distinguishes between funds awarded to…
Medicare’s Role for Dual Eligible Beneficiaries April 4, 2012 Issue Brief About 9 million low-income seniors and younger people with disabilities in the United States are covered by both Medicare and Medicaid. This brief examines the role of Medicare in providing health coverage for these beneficiaries. Medicare is the primary source of health insurance, while Medicaid provides supplemental coverage, helping with…
States Getting a Jump Start on Health Reform’s Medicaid Expansion April 2, 2012 Issue Brief One of the primary goals of the Affordable Care Act (ACA) is to decrease the number of uninsured through a Medicaid expansion to nearly all individuals with incomes up to 133 percent of the federal poverty level (FPL) ($14,856 for an individual or $25,390 for a family of three in…
The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare April 1, 2012 Issue Brief This issue brief analyzes linked Medicare and Medicaid data to examine dual eligibles’ utilization and spending in both programs in 2007. As a group, dual eligibles are costly—with per capita Medicare and Medicaid spending over four times Medicare spending for other beneficiaries. However, a small share of dual eligibles account…
Among Dual Eligibles, Identifying The Highest Cost Individuals Could Help In Crafting More Targeted And Effective Responses April 1, 2012 Report This Health Affairs article by researchers at the Urban Institute analyzes linked Medicare and Medicaid data to examine dual eligibles’ utilization and spending in both programs in 2007. It finds that while the population of people dually eligible for Medicare and Medicaid is indeed costly, it is not monolithic. For…
An Update on CMS’s Capitated Financial Alignment Demonstration Model For Medicare-Medicaid Enrollees April 1, 2012 Issue Brief 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…
Using Data and Technology to Drive Process Improvement in Medicaid and CHIP: Lessons From South Carolina March 30, 2012 Fact Sheet In the past year, there has been a notable trend of states increasingly utilizing data and technology to modernize, streamline, and gain efficiencies in their Medicaid and CHIP programs. The expanded use of data and technology is not only helping states deal with current budget pressures and decreased administrative resources,…
A Guide to the Medicaid Appeals Process March 29, 2012 Issue Brief 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,…