Posted on August 29, 2011 15:02
Categories: Medicaid | Special Populations | Treatment and Recovery
Topics: Access/Barriers | CHIP | Medicaid | Mental Health | Treatment
On June 30, the U.S. Government Accountability Office (GAO) released a report examining children’s access to health coverage under Medicaid and the Children’s Health Insurance Program (CHIP). The GAO studied physicians’ willingness to care for children enrolled in the programs and physicians’ willingness to accept new children insured through them. The authors also examined the difficulty physicians face in referring children enrolled in Medicaid and CHIP to specialty care. The report found that 83 percent of primary care physicians and 71 percent of specialty physicians serve children enrolled in Medicaid and CHIP. Among physicians participating in the government programs, the authors found that 79 percent are accepting new privately insured children while only 47 percent are accepting children enrolled in Medicaid or CHIP. The report also found that non-participating physicians most commonly cite administrative issues as barriers to participation, including low and delayed reimbursements. The GAO concluded that physicians face significant difficulty in referring Medicaid and CHIP-enrolled children to specialty care, including mental health.
From the report:
Most physicians are enrolled in Medicaid and CHIP and serving children covered by these programs. On the basis of its 2010 national survey of physicians, GAO estimates that more than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs. A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent). Further, a larger share of rural primary care physicians (94 percent) are participating in the programs than urban primary care physicians (81 percent). Nationwide, physicians participating in Medicaid and CHIP are generally more willing to accept privately insured children as new patients than Medicaid and CHIP children.
Full report: Most Physicians Serve Covered Children but Have Difficulty Referring Them for Specialty Care (PDF | 1.41 MB)
Government Accountability Office. (2011). Most physicians serve covered children but have difficulty referring them for specialty care.
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Posted on August 29, 2011 14:34
Categories: Medicare | Special Populations
Topics: Dual Eligibles | Managed Care | Medicare
Mathematica Policy Research has released a brief examining managed long-term care. Focusing on options for New York State, the brief also offers general options available to all states. The authors also offer options for improving dual eligibles' care.
From the report:
The Federal Coordinated Health Care
Office (renamed the Medicare-Medicaid Coordination Office) and the Center for
Medicare and Medicaid Innovation are partnering to help states develop
integrated care programs for dual eligibles. CMS selected 15 states on April 14, 2011 to receive
contracts of up to $1 million each to help them plan dual eligible
demonstration projects. States selected
were CA, CO, CT, MA, MI, MN, NY, NC, OK, OR, SC, TN, VT, WA, and WI. Planning
contracts will be for 18 months, and demonstrations will start in 2012.
Full report: Managed Long Term Care: Options for New York and Examples From Other States (PDF | 197.47 KB)
Mathematica Policy Research. (2011). Managed long term care: options for New York and examples from other states. Verdier, J.
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Posted on August 29, 2011 14:26
Categories: Special Populations | Medicaid
Topics: Health Care Reform | Managed Care | Medicaid
Mathematica Policy Research has released a brief examing managed care opportunities for childless adults under the national health care reform law's Medicaid expansion. The law explains how the Medicaid expansion will work and who it will make eligible for Medicaid coverage. The authors also examine opportunities and challenges for managed care under the expansion.
From the report:
Health care reform Medicaid expansion
will result in many potential new enrollees for Medicaid MCOs. High
health care needs and costs for low-income childless adults will present
significant challenges in terms of outreach, network development, care
management, capitated rate setting, and quality monitoring.
Full report: Extending Medicaid Coverage to Low-Income Childless Adults: Opportunities and Cautions for Managed Care Plans (PDF | 149.96 KB)
Mathematica Policy Research. (2011). Extending Medicaid coverage to low-income childless adults: opportunities and cautions for managed care plans. Verdier, J.
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Posted on August 29, 2011 14:20
Categories: Medicaid | Medicare | Special Populations
Topics: Dual Eligibles | Quality | Spending
Mathematica Policy Research has released a brief examining opportunities to improve dual eligibles' care through managed care plans in Medicare. The authors offer background on dual eligibles and state efforts to manage their care. The brief also examines opportunities for expanding managed care for dual eligibles under the national health care reform law.
From the report:
Only
July 8, 2011, CMS announced three new initiatives to assist states in improving
care for dual eligibles. Two new financial models to support state efforts to
coordinate care for dual eligibles.
A capitated model in which a state, CMS, and a health plan enter
into a three-way contract, and the plan receives a prospective blended payment
to provide comprehensive, coordinated care.
A managed fee-for-service model in which a state and CMS enter
into an agreement that would permit the state to share in Medicare savings for
care coordination initiatives.
Full report: Improving Care for Dual Eligibles: Opportunities for Medicare Managed Care Plans (PDF | 183.71 KB)
Mathematica Policy Research. (2011). Improving care for dual eligibles: opportunities for Medicare managed care plans. Verdier, J.
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Posted on August 29, 2011 13:54
Categories: Special Populations
Topics: Access/Barriers | CHIP | Health Care Reform
The Journal of Health Politics, Policy and Law has published a study examining relative affordability of health coverage premiums under the national health care reform law and the expansion of the Children's Health Insurance Program (CHIP). The authors compare the cost of covering a family in Illinois, Pennsylvania, and Washingon through a combination of CHIP and employer-sponsored coverage to that of a family obtaining coverage through one of the law's health exchanges.
Gresenz, C., Laugesen, M., Yesus, A. and Escarce J. (2011). Relative affordability of health insurance premiums under CHIP expansion programs and the ACA. The Journal of Health Politics, Policy and Law, 36 (3): 859-877. doi:
10.1215/03616878-1407658. http://jhppl.dukejournals.org/content/early/2011/07/22/03616878-1407658.full.pdf+html
Authors: Carole Gresenz, Miriam Laugensen, Ambeshie, Yesus and Jose Escarce.
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Posted on August 26, 2011 15:28
Categories: Mental Health | Special Populations | Legislative and Regulatory Issues
Topics: Health Care Reform | Integrated Health | Mental Health | Spending
The National Association of State Mental Health Program Directors has released a presentation examining care integrationg efforts for individuals with serious mental illnesses (SMIs) in Missouri. The presentation outlines the state's activities under the initiative and highlights care integration and cost savings achieved as a result of those efforts. The authors assert that Missouri serves as a model for other states to follow.
From the report:
The webinar focused on Missouri’s initiative to integrate behavioral
health and primary care, including the state’s application for a health
home state plan amendment under Section 2703 of the Affordable Care
Act. Dr. Joe Parks, with Missouri’s Department of Mental Health, gave
an overview of the state’s health home initiative highlighting their
definition of health homes, services implemented, outcomes achieved
such as cost savings, and recommendations for integrating health care.
Full report: Missouri’s Efforts to Integrate Care for Individuals with Serious Mental Illness: A Catalyst for Other States (PDF | 10.61 MB)
National Association of State Mental Health Program Directors. (2011). Missouri's efforts to integrate care for individuals with serious mental illness: a catalyst for other states. Parks, J.
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