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:

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.

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.

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.

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.   

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.