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  • Papers on Issues For People With Medicare Raised By Proposed Drug Benefit Regulations

    Issue Brief

    Papers on Issues For People With Medicare Raised By Proposed Drug Benefit Regulations The Kaiser Family Foundation has commissioned a series of papers to explore key issues that may be of concern for Medicare beneficiaries as the new Medicare drug benefit is implemented. These papers focus on specific areas of potential concern for people with Medicare. In addition, the Foundation also has produced a timeline of upcoming important dates leading up to the implementation of…

  • Current and Emerging Issues in Medicaid Risk-Based Managed Care: Insights from an Expert Roundtable

    Issue Brief

    Half of all Medicaid enrollees receive care through comprehensive risk-based managed care organizations (MCOs). Most Medicaid MCO enrollees today are low-income children and parents, but states are increasingly moving beneficiaries with more complex needs into MCOs. Managed care enrollment may grow more rapidly as states work with the Centers for Medicare & Medicare Services (CMS) to implement initiatives to better integrate Medicare and Medicaid benefits and care for dual eligibles. The Foundation’s Kaiser Commission on…

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

    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 that seek to integrate benefits and align financial incentives between the two programs. On January 25, 2012, CMS issued a memorandum providing additional guidance for…

  • Federal Core Requirements And State Options In Medicaid: Current Policies And Key Issues

    Fact Sheet

    Medicaid is a jointly financed partnership between the federal government and states. The federal-state financing and administrative structure of Medicaid provides a framework of federal core requirements along with broad state options for program design and administration. This issue brief presents an overview of the current Medicaid program framework, with a focus on eligibility, benefits and cost sharing, care delivery and provider payment, long-term services and supports, and dual eligibles, as well as key issues…

  • Increasing Medicaid Payments for Certain Primary Care Physicians in 2013 and 2014: A Primer on the Health Reform Provision and Final Rule

    Issue Brief

    To help ensure that access in Medicaid expands to meet anticipated higher demand for care, the health reform law requires states to pay certain physicians Medicaid fees that are at least equal to Medicare’s for a list of 146 primary care services in 2013 and 2014. The idea is to attract new physicians to Medicaid and provide greater support for physicians who already participate. As a result, Medicaid fees paid to certain physicians for primary…

  • Medicaid’s New “Health Home” Option

    Issue Brief

    This brief provides key information about the new option for state Medicaid programs to provide "health home" services for enrollees with chronic conditions. The option, established under the new health reform law, took effect on Jan. 1, 2011. Health homes are designed to facilitate access to and coordination of the full array of primary and acute physical health services, behavioral health care and long-term community-based services and supports. Brief (.pdf)

  • Prescription Drug Spending Under The MMA: Modeling The Impact On Out-of-Pocket Costs

    Event Date:
    Event

    This report projects the impact of the new Medicare drug benefit on out-of-pocket spending for people who enroll in 2006. The analysis is based on a model developed by the Actuarial Research Corporation for the Kaiser Family Foundation. The model generally conforms to the Congressional Budget Office’s assumptions and projections about Medicare drug benefit spending and participation rates for the new benefit and for the low-income subsidy. The report was released at a briefing in…

  • Chronic Disease and Co-Morbidity Among Dual Eligibles: Implications for Patterns of Medicaid and Medicare Service Use and Spending

    Report

    The health reform law contains provisions that aim to improve the delivery and coordination of services for persons enrolled in both Medicaid and Medicare, known as the dual eligibles. This population includes individuals with some of the most severely disabling chronic conditions. While the higher costs associated with services to dual eligibles is well-known, information on how spending is distributed across these programs is less understood. This study uses linked Medicare and Medicaid data to…

  • Washington’s Managed FFS Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

    Issue Brief

    Washington is the first state to sign a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test a managed fee-for-service (FFS) financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid, beginning on April 1, 2013. Washington’s managed FFS demonstration uses Medicaid health home services to coordinate care for high risk/high cost dual eligible beneficiaries with chronic conditions. This policy brief summarizes key aspects of the…