Basics of Medicaid
Iglehart JK. 2007. Medicaid Revisited – The Skirmishes Over a Vast Public Enterprise. The New England Journal of Medicine, 3(7):734-740.
This Health Policy Report reviews the major Medicaid-related provisions under the Deficit Reduction Act of 2005, including those changes that pose new challenges for the declining number of physicians who treat the program’s beneficiaries. The Deficit Reduction Act reflects the policies of the administration of President George W. Bush, a Republican Congress, and governors of both parties who argue that Medicaid must be scaled back to make it sustainable over the long run.
Kaiser Commission on Medicaid and the Uninsured. April 2004. Faces of Medicaid.
This report profiles Medicaid’s role for the low-income population in providing basic health insurance, particularly for children; in supporting services that enable people with disabilities to function and be independent; and in filling gaps in Medicare for seniors, including prescription drugs and long-term care.
Kaiser Commission on Medicaid and the Uninsured. June 2002. Reaching the Uninsured Through Medicaid: If You Build it Right, They Will Come.
This report analyzes enrollment data of recent years and draws on state experiences to outline the key strategies that will lead to successful enrollment in public health coverage programs and finds that improving enrollment in Medicaid drives improved overall enrollment into a state’s public coverage programs.
Kronebusch, K. and B. Elbel. May/June 2004. Simplifying Children’s Medicaid And SCHIP. Health Affairs, 23(3):233–246.
States have implemented the State Children’s Health Insurance Program (SCHIP) in a variety of ways. This article describes these choices and estimates the resulting enrollment impacts. The authors conclude that SCHIP programs administered as Medicaid expansions have been more successful in enrolling children than either separate SCHIP plans or combination programs.
Offner P. Medicaid and the States: A Century Foundation Report. New York: The Century Foundation Press, 1999.
The author explores the impact of decreased federal oversight of Medicaid, the joint federal-state health insurance program for low-income Americans. As Medicaid has increasingly shifted to managed care while financing more community-based health services, the federal government has allotted states greater flexibility in making decisions about the coverage they provide. The author explores the impact of these changes, one of which has been variability among states not only in the amounts they spend per beneficiary, but also in what services they provide and how the services are paid for.
Rosenbaum S. 2002. Medicaid. The New England Journal of Medicine, 346(8):635–640.
This article provides an overview of the Medicaid program including federal and state financing requirements, enrollment and expenditure trends, and reforming options through legislation and demonstration projects.
Rowland D and JR Tallon, Jr. 2003. Medicaid: Lessons from a Decade. Health Affairs, 22(1):138–144.
Drawing from a decade of analysis and examination of the Medicaid program, this paper assesses: Medicaid’s role, its successes and its setbacks.
Rosenbaum S and P Shin, Kaiser Commission on Medicaid and the Uninsured. March 2006. Health Centers Reauthorization: An Overview of Achievements and Challenges.
This report reviews the role of community health centers in the nation's health care safety net. Today, over 1,000 federally funded and “look-alike” health centers serve 14.3 million people, three-quarters of whom are uninsured or covered by Medicaid.
Rosenbaum S and P Shin, Kaiser Commission on Medicaid and the Uninsured. May 2003. Health Center as Safety Net Providers: An Overview and Assessment of Medicaid’s Role.
This policy brief looks at health centers in detail in order to illuminate the role they play as providers of care and to document the important nexus between health centers and Medicaid.
Rowland D, Kaiser Commission on Medicaid and the Uninsured. October 8, 2003. Medicaid: Issues and Challenges, Testimony to the U.S. House Energy and Commerce Committee’s Subcommittee on Health.
This testimony focused on the issues and challenges facing Medicaid in providing health and long-term care coverage for the low-income population.
Weil A. 2003. There’s Something About Medicaid. Health Affairs, 22(1):13–30.
This article outlines the accomplishments of the Medicaid program and the future challenges it faces unless the underlying fiscal pressures and tensions built into it are addressed.
Access and Eligibility
Berk M and C Schur. 1998. Access to Care: How Much Difference Does Medicaid Make? Health Affairs, 17(3):169–180.
Using the 1994 Robert Wood Johnson Foundation National Access to Care Survey, this paper examines the likelihood of having a usual source of care, inability to obtain needed care, and number of physician visits for persons with private insurance, Medicaid coverage, and no insurance.
Cohen-Ross D, Kaiser Commission on Medicaid and the Uninsured. May 2008. Determining Income Eligibility in Children’s Health Coverage Programs: How States Use Disregards in Children’s Medicaid and SCHIP.
This issue brief describes the purpose of income “disregards” (which refer to both income that is excluded and expenses that are deducted from a family’s earnings); how disregards help enable children in working families to obtain health coverage; the types and amounts of disregards currently used in Medicaid for children and SCHIP; and the implications of prohibiting the application of disregards in determining eligibility for children’s health coverage programs.
Cohen-Ross D, A Horn & C Marks, Center on Budget and Policy Priorities for the Kaiser Commission on Medicaid and the Uninsured. Jan 2008. Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts to Face New Hurdles.
This report is a 50-state survey update on eligibility, enrollment, renewal and cost sharing practices in Medicaid and SCHIP.
Coughlin T, S Long & YC Shen. 2005. Assessing Access to Care under Medicaid: Evidence for the Nation and 13 States. Health Affairs, 24(4):1073–1083.
The authors evaluate, for the nation and for thirteen study states, how well the program is providing access for beneficiaries, using the level of access available to low-income privately insured people in the local health care market as the benchmark.
Dubay L and G Kenny. 2001. Health Care Access and Use Among Low-Income Children: Who Fares Best? Health Affairs, 20(1):112–121.
In this paper the authors assess how access to care and use of services among low-income children vary by insurance status.
Howell E. 2001. The Impact of Medicaid Expansions for Pregnant Women: A Synthesis of the Evidence. Medical Care Research and Review, 58(1):3–30.
This article reviews the published literature on the impact of expanding Medicaid for pregnant women to higher income groups of women. Studies show that of new groups of women who received Medicaid some received improved prenatal care services, but evidence is weaker that that expansions led to improved birth outcomes.
Newacheck P, M Pearl, D Hughes et al. 1998. The Role of Medicaid in Ensuring Children's Access to Care. Journal of the American Medical Association, 280(20):1789–1793.
This article assesses the effectiveness of Medicaid in improving access to and use of health care services by poor children. Using data from the 1995 National Health Interview Survey, the authors found Medicaid is associated with improvement in access to care and use of services.
Perry N and J Paradise. May 2007. Enrolling Children in Medicaid and SCHIP: Insights from Focus Groups with Low-Income Parents.
This focus group report explores the perceptions, motivations, and experiences of low-income parents enrolling their children in Medicaid and SCHIP. The 11 focus groups were conducted in Chicago, Houston, Los Angeles and Miami in early 2007.
Budgets and Financing
Boyd D. 2003. The Bursting State Fiscal Bubble and State Medicaid. Health Affairs, 22(1):46–61.
States make policy choices about Medicaid eligibility, benefits, and reimbursement rates in the context of the larger state fiscal environment. This paper reviews the factors that made this environment so favorable in the 1990s and examines the state budget outlook.
Carbaugh A, Kaiser Commission on Medicaid and the Uninsured. April 2004. The Role of Medicaid in State Economies: A Look at the Research.
This policy brief provides an overview of Medicaid financing, explains the methods used to assess economic impact and summarizes the main findings from 17 studies that analyze the role Medicaid plays in state and local economies
Coughlin TA and S Zuckerman. Sept/Oct 2007. Restoring Fiscal Integrity to Medicaid Financing? Health Affairs, 26(5): 1469-1480.
Using state survey data, researchers examined Medicaid supplemental payments, including disproportionate share hospital and upper payment limit payments in 2005 and changes in these payments between 2001 and 2005. The researchers found that states increased their use of general funds in financing Medicaid DSH payments while expanding the size and scope of other supplemental payments considerably. Although the federal government has made some headway in reforming state Medicaid financing in recent years, the paper concludes that problems persist and more work remains.
Coughlin TA, BK Bruen & J King. Mar/April 2004. States’ Use of Medicaid UPL And DSH Financing Mechanisms. Health Affairs, 23(2):245–257.
Using data from a 2002 survey, the authors look at the design and operation of disproportionate-share hospital (DSH) and upper payment limit (UPL) programs in thirty-four states. Findings show that more of the available DSH gains are paid to safety-net hospitals than occurred in the late 1990s. By contrast, survey data suggest that the bulk of available UPL gains are being kept by states and not by providers.
Coughlin T and S Zuckerman. 2003. States’ Strategies for Tapping Federal Revenues: Implications and Consequences of Medicaid Maximization. Chapter 5:145–178. Federalism and Health Policy, John Holahan, Alan Weil and Joshua Wiener (eds), Washington, D.C.: The Urban Institute Press.
The authors provide a brief background on Medicaid financing and program design, and then discuss some of the maximization strategies states have used and how the strategies have affected the Medicaid program
Cunningham P. 2006. Medicaid/SCHIP Cuts and Hospital Emergency Department Use. Health Affairs, 25(1): 237-247.
This article examines the implications of cuts to public coverage programs like Medicaid and SCHIP. The author finds that Medicaid and SCHIP cuts would increase emergency department visits by the uninsured, suggesting that cost containment actions on public coverage programs would shift costs to hospital uncompensated care. The policy brief examines the share of current enrollees in public programs who would have other coverage options if public coverage were no longer available and estimates that no more than 9 percent of currently enrolled low-income adults would have access to an alternative source of insurance.
Dorn S, Garrett B, Holahan, J, & Williams A, The Urban Institute for the Kaiser Commission on Medicaid and the Uninsured. April 2008. Medicaid, SCHIP and Economic Downturn: Policy Challenges and Policy Responses.
This report examines the implications of a downturn for health coverage and state programs and projects the impact of one percentage point rise in the national unemployment rate on Medicaid and SCHIP and the number of uninsured individuals. The analysis also documents how federal fiscal relief during the last economic downturn of 2003-2004 helped to stabilize Medicaid eligibility and let states avoid deeper budget cuts.
Hoadley J, P Cunningham & M McHugh. Mar/April 2004. Popular Medicaid Programs Do Battle With State Budget Pressures: Perspectives From Twelve States. Health Affairs, 23(2):143–154.
This article discusses the impact of serious state budget constraints on state Medicaid and State Children’s Health Insurance Programs (SCHIP) in 2002 to 2003. Based on observations from the Community Tracking Study, authors conclude that states have thus far largely avoided major cuts that would seriously harm beneficiaries’ access, primarily because programs have more support among coalitions of public officials, health care providers, and local advocates than commonly assumed.
Holahan J. Sept 2007. State Variation in Medicaid Spending: Hard to Justify. Health Affairs Web Exclusive.
This article finds that there is great variation among states in Medicaid spending per low-income person. This variation has many determinants, including state discretion and differences in prices and amounts of services used. The author concludes that the current trend toward state-based solutions to health care coverage would likely exacerbate existing variations.
Holahan J and A Ghosh. Jan 2005. Understanding the Recent Growth in Medicaid Spending, 2000– 2003. Health Affairs Web Exclusive.
This article explains what caused Medicaid spending to rise from 2000-2003 and confirms the role Medicaid played in covering people during the recent economic downturn, and that Medicaid per enrollee spending grew at a slower rate than private insurance spending.
Holahan J, M Cohen & D Rousseau. Oct 2007. Why Did Medicaid Spending Decline in 2006?
This issue brief finds that Medicaid spending declined for the first time in the program’s 40-plus year history in Federal Fiscal Year (FY) 2006, falling by 0.2 percent. The two major factors that underlie the 2006 decline, in addition to a more limited effect of the slowdown in per enrollee spending growth for a few key services, were the 2005 Medicare Modernization Act’s creation of a new Medicare drug benefit that shifted the cost of prescription drugs for dual eligibles from Medicaid and a dramatic reduction in enrollment growth.
Kaiser Commission on Medicaid and the Uninsured. April 2008. Medicaid in a Declining Economy: Limited Approaches for States to Control Spending.
This brief analyzes results from its annual 50-state budget surveys of Medicaid directors from 2003 to 2007. The historical results describe how states adopted a wide array of Medicaid cost containment strategies during the last economic downturn and were assisted by the federal government to avoid deeper Medicaid cuts.
Kaiser Commission on Medicaid and the Uninsured. May 2006. An Update on the Clawback: Revised Health Spending Data Change State Financial Obligations for the New Medicare Drug Benefit.
This issue update analyzes the latest data and provides an overview of the state financing of the Medicare drug benefit. Revisions by the federal government due to updated data has resulted in an estimated net decline in the amount states will send to the federal government in 2006 through the clawback of more than $700 million.
Kronick R and D Rousseau. Feb 2007. Is Medicaid Sustainable? Spending Projections for the Program’s Second Forty Years. Health Affairs Web Exclusive.
This article constructed long-term projections of Medicaid spending and compared projected growth in spending with that of state and federal revenues. The authors predict that growth in government revenues is projected to be large enough to sustain both Medicaid spending increases and substantial real growth in spending for other services.
Paradise J and D Rousseau, Kaiser Commission on Medicaid and the Uninsured. March 2004. Medicaid: A Lower-Cost Approach to Serving a High-Cost Population.
This brief brings new analysis to the debate concerning the efficiency of Medicaid versus private health insurance as a mechanism for covering low-income children and adults.
Quinn K. Jan/Feb 2008. New Directions in Medicaid Payment for Hospital Care. Health Affairs, 27(1): 269-280.
This article describes Medicaid’s growing role in purchasing inpatient care, reports Medicaid-specific results from an evaluation of three DRG algorithms, provides a case study of a new payment method designed in Mississippi, and summarizes recent developments in paying for quality.
Rousseau D and A Schneider, Kaiser Commission on Medicaid and the Uninsured. April 2004. Current Issues in Medicaid Financing - An Overview of IGTs, UPLs, and DSH.
This issue brief explains briefly the mechanisms used by states in recent years to finance their share of Medicaid expenditures.
Schneider A, Medicaid Policy, LLC for the Kaiser Commission on Medicaid and the Uninsured. June 2004. The "Clawback": State Financing of Medicare Drug Coverage.
This issue paper describes the origins of the clawback, the formula by which each state’s clawback amount is calculated, and the clawback’s implications for states and for low-income Medicare beneficiaries.
Smith V, K Gifford, E Ellis et al., Kaiser Commission on Medicaid and the Uninsured. Oct 2007. As Tough Times Wane, States Act to Improve Medicaid Coverage and Quality: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2007 and 2008.
This report, based on an annual 50-state survey of state Medicaid officials, identifies changes related to Medicaid spending growth and Medicaid cost containment actions taken in FY2007 and FY2008.
Smith, V, Edwards B & Tolbert J, Kaiser Commission on Medicaid and the Uninsured. Jan 2008. Current Issues in Medicaid: A Mid-FY 2008 Update Based on a Discussion with Medicaid Directors.
This report provides a brief mid-fiscal year 2008 update on current issues in Medicaid, from the perspective of state Medicaid directors who administer the program. Medicaid directors identified a number of key issues, concerns and priorities in mid fiscal year 2008. At the top of the list were the effects of an increase in fiscal stress across states, a number of federal – state issues, including those impacting Medicaid enrollment and access, and their current efforts to address the uninsured.
Thompson P, Kaiser Commission on Medicaid and the Uninsured. Feb 2004. Medicaid's Federal-State Partnership: Alternatives for Improving Financial Integrity.
As the federal government increases its scrutiny of state financing of the Medicaid program, this paper, authored by a former CMS official, evaluates the existing financial management of the Medicaid program.
U.S. Government Accountability Office. June 2005. States’ Efforts to Maximize Federal Reimbursements Highlight Need for Greater Federal Oversight.
Medicaid—the federal-state health care financing program covering almost 54 million low-income people at a cost of $276 billion in fiscal year 2003—is by its size and structure at significant risk of waste and exploitation. Because of challenges inherent in overseeing the program, which is administered federally by the Centers for Medicare & Medicaid Services (CMS), GAO added Medicaid to its list of high-risk federal programs in 2003. Over the years, states have found various ways to maximize federal Medicaid reimbursements, sometimes using consultants paid a contingency fee to help them do so.
Wachino V, A Schneider & D Rousseau, Kaiser Commission on Medicaid and the Uninsured. Jan 2004. Financing the Medicaid Program: the Many Roles of Federal and State Matching Funds.
This paper describes Medicaid’s existing financing structure and examines its implications for the federal government, for states, and for coverage of the low-income populations Medicaid serves.
Zuckerman S, J McFeeters, P Cunningham et al. June 2004. Trends: Changes In Medicaid Physician Fees, 1998– 2003: Implications For Physician Participation. Health Affairs Web Exclusive.
After slow growth during much of the 1990s, Medicaid physician fees increased, on average, by 27.4 percent between 1998 and 2003. Despite recent gains, the relative attractiveness of Medicaid patients has not improved much over the longer term and access for Medicaid recipients may be at increasing risk.
Long Term Care and Medicaid-Medicare Dual Eligibles
Bruen B and J Holohan, Kaiser Commission on Medicaid and the Uninsured. Nov 2003. Shifting the Cost of Dual Eligibles: Implications for States and the Federal Government.
This issue paper provides state-level estimates on spending on dual eligibles and illustrates the fiscal effects of scenarios where the federal government assumes the cost of prescription drugs, Medicare premiums, acute care, and long-term care for this population.
Buchsbaum L, J Varon, E Kagel, RT Boyle & KC McGarvey. May 2007. Perspectives on Medicare Part D and Dual Eligibles: Key Informants’ Views from Three States.
This study provides information on the ongoing successes and challenges that dual eligibles faced in the first eight months of Part D and how different state approaches may affect dual eligibles’ ability to access prescription medications.
Crowley J and M O’Malley. Aug 2007. Medicaid’s Rehabilitation Services Option: Overview and Current Policy Issues.
This policy brief provides an overview of the Medicaid rehab option and explores current policy issues, including the President’s plan to place new restrictions on the types of services allowable under the Medicaid rehabilitation services option (called the rehab option) to yield federal budget savings of $2.29 billion over the next five years. Currently, 47 states plus the District of Columbia provide at least some type of mental health, substance abuse, and physical health services under the rehab option.
Edwards BC, S Kramer & L Elam, Health Management Associations and Kaiser Commission on Medicaid and the Uninsured. April 2007. The Impact of Part D on Dual Eligibles who Spend-Down to Medicaid.
This paper explores the inter-relationship of Medicare prescription drug coverage and Medicaid spend-down for the medically needy. It describes Part D impacts for spend-down individuals and the resulting effects on their eligibility both for Medicaid and the Medicare Low-Income Subsidy assistance.
Kaiser Commission on Medicaid and the Uninsured. April 2004. The Medicare Prescription Drug Discount Care Program: Implications for Low-Income Medicare Beneficiaries.
This issue paper describes the discount card and low-income assistance programs and discusses their implications for low-income Medicare beneficiaries and state Medicaid programs.
Kaiser Commission on Medicaid and the Uninsured. Dec 2007. Medicaid Home and Community-Based Service Programs: Data Update.
This report presents a summary of the main trends to emerge for the three Medicaid HCBS programs and the results of a survey of policies such as eligibility criteria and waiting lists.
Kasper J, Lyons B & M O’Malley, Kaiser Commission on Medicaid and the Uninsured. Sept 2007. Long-Term Services and Supports: The Future Role and Challenges for Medicaid.
This report examines the structure and impact of Medicaid’s role in long-term care. Based on a roundtable discussion of policy makers and experts and drawn from a body of health services research, the report highlights policy challenges facing the Medicaid program today and identifies issues in providing long-term care going forward.
Kasper J, R Elias & B. Lyons, Kaiser Commission on Medicaid and the Uninsured. Mar 2004. Dual Eligibles: Medicaid's Role in Filling Medicare's Gaps.
This paper presents a profile of dual eligible beneficiaries (those qualifying for both Medicare and Medicaid), describes their health care expenditures, and analyzes the distribution of spending on the population.
Kitchener M, T Ng, N Miller et al. 2005. Medicaid Home and Community Based Services: National Program Trends. Health Affairs, 24(1):206– 212.
This paper presents the latest program trends in the three Medicaid home and community-based services programs (waivers, home health, and state-plan personal care) and reports a national survey of cost control policies used on waiver programs in 2002. The findings show slowing annual rates of participation growth on individual programs, widespread use of cost controls on waivers including waiting lists, and the persistence of large interstate variations in Medicaid’s provision of these services.
O’Brien E and R Elias, Georgetown University and the Kaiser Commission on Medicaid and the Uninsured. May 2004. Medicaid and Long-Term Care.
This report examines Medicaid's role in providing long-term care services, including the services provided, the population needing services, and how the services are delivered.
Smith G, J O'Keeffe, L Carpenter et al, Center for Health Policy Research for the U.S. Department of Health and Human Services. Oct 2000. Understanding Medicaid Home and Community Services: A Primer. George Washington University.
This primer explains how Medicaid can be used--and is being used--to expand access to a broad range of home and community services and supports, and to promote consumer choice and control. In addition, the primer presents examples of state programs that have taken advantage of Medicaid’s flexibility to expand home and community services for people of all ages with disabilities.
Smith V, K Gifford, S Kramer et al., Health Management Associates and Kaiser Commission on Medicaid and the Uninsured. Feb 2006. The Transition of Dual Eligibles to Medicare Part D Prescription Drug Coverage: State Actions during Implementation.
This 50-state survey of Medicaid officials assesses states’ early experience relating to the transition of low-income seniors and people with disabilities enrolled in both Medicaid and Medicare (dual eligibles) to the Medicare Part D drug benefit. Conducted by Health Management Associates, the survey covers the types of problems observed by states during the transition of dual eligibles to the Medicare drug benefit, state actions to correct problems and ensure temporary coverage, and specific data on costs incurred by states from these temporary programs.
Sommers AS, M Cohen & M O’Malley, The Urban Institute and Kaiser Commission on Medicaid and the Uninsured. Nov 2006. Medicaid’s Long-Term Beneficiaries: An Analysis of Spending Patterns.
This brief examines Medicaid beneficiaries who receive long-term care services using data from the Medicaid Statistical Information Summary files. Medicaid long-term care users accounted for 7 percent of the Medicaid population in 2002 but over half of total program spending. Three-quarters of these dollars were spent on long-term care and 25 percent were spent on acute care and supportive services. About 55 percent of long-term care spenders were elderly and 34 percent were nonelderly disabled individuals. Children and adults not deemed disabled but using long-term services are a unique population whose medical needs should be assessed in light of recent DRA-related Medicaid changes.
Summer L, The Georgetown University Health Policy Institute, Georgetown University Long-Term Care Financing Project. May 2003. Choice and Consequences: The Availability of Community-Based Long-Term Care Services to the Low-Income Population.
This study uses three hypothetical cases to illustrate the variation across states regarding the manner in which community-based long-term care services are provided, particularly through the Medicaid program.
U.S. General Accounting Office, GAO-03–576. June 2003. Long-Term Care: Federal Oversight of Growing Medicaid Home and Community-Based Waivers Should Be Strengthened.
GAO reviewed the trends in states’ use of Medicaid Home and Community Based Waivers and assessed the quality of care provided and the adequacy of the federal oversight. GAO recommends that the federal oversight of these waivers be increased.
Medicaid Managed Care
Draper DA, RE Hurley & AC Short. Mar/April 2004. Medicaid Managed Care: The Last Bastion Of The HMO? Health Affairs, 23(2):155–167.
States rely on health maintenance organizations (HMOs) for their Medicaid beneficiaries because they offer guaranteed access to comprehensive benefits at a predictable cost. This article examines state Medicaid managed care programs and discusses important policy challenges related to plan participation, mainstreaming, and product design.
Gold M, J Mittler, D Draper et al. 2003. Participation of Plans and Providers in Medicaid and SCHIP Managed Care. Health Affairs, 22(1):230–240.
Findings from a survey of Medicaid and SCHIP managed care programs show that the plans appear supportive of both programs and are largely able to secure providers to participate. While perceptions were positive in 2001, maintaining current plan and provider relationships in a budget-constrained environment will be challenging.
Hurley R and S Somers. 2003. Medicaid Managed Care Payment Methods and Capitation Rates in 2001. Health Affairs, 22(1):204–218.
This article reviews the Medicaid program’s major commitment to managed care during the past decade and discusses the continuing changes in the managed care marketplace and financial distress in state budgets, which present new challenges to the strength and durability of this relationship.
Kaye N, National Academy for State Health Policy. June 2001. Medicaid Managed Care: A Guide for States, 5th Edition.
This report highlights findings from a 2000 survey of state Medicaid managed care programs in all 50 states and the District of Columbia.
Landon BE, EC Schneider, C Tobias et al. July/Aug 2004. The Evolution Of Quality Management In Medicaid Managed Care. Health Affairs, 23(4):245–254.
This paper extends and updates previous evaluations of the use of managed care for the Medicaid population, the extent to which beneficiaries receive care from Medicaid only and from commercial health plans, and the quality management programs that state Medicaid agencies supported during 2001.
Long SK. April 2008. Do For-Profit Health Plans Restrict Access to Care under Medicaid Managed Care? Medical Research and Review E-publication.
Using data from the 2002 National Survey of America’s Families on plan enrollment for a national sample of Medicaid enrollees, this study examines the link between for-profit plan ownership and enrollees’ access to health care. The results suggest that access to care for Medicaid enrollees may be better under nonprofit plans than for-profit plans.
Thompson J, K Ryan, S Pinidiya et al. 2003. Quality of Care for Children in Commercial and Medicaid Managed Care. Journal of the American Medical Association, 290(11):1486–1493.
These authors conclude that commercial health plans do not deliver high quality care on a number of performance indicators for children in Medicaid.
Wooldridge J and S Hoag. 2000. Perils of Pioneering: Monitoring Medicaid Managed Care. Health Care Financing Review, 22(2):61–83.
This article reviews federal and state oversight of section 1115 Medicaid managed care demonstrations in several states. Findings show state and federal monitoring has improved over time, yet monitoring is not at the point of ensuring access and quality.
Medicaid Reform
Bond M, JC Goodman, R Lindsey et al. Feb 2003. Reforming Medicaid. National Center for Policy Analysis.
This paper discusses options for Medicaid reform that focus on approaches regarding choice, competition, and flexibility.
Coughlin TA and S Zuckerman. June 2008. State Responses to New Flexibility in Medicaid. Milbank Quarterly, 86(2):209-240.
This article explores trends in states' Medicaid flexibility and discusses some of the implications for the program and its beneficiaries. Using government databases to identify the policy changes that have been implemented through waivers and state plan amendments, the authors find that since 2001, more than half the states have changed their Medicaid programs, through either Medicaid waivers or provisions in the Deficit Reduction Act of 2005. These changes are in benefit flexibility, cost sharing, enrollment expansions and caps, privatization, and program financing.
Etheredge L and J Moore. Aug 2003. A New Medicaid Program. Health Affairs Web Exclusive.
This paper presents options for a new Medicaid program based on a federal-state partnership that focus on the uninsured and long term care. The authors discuss national eligibility standards based on financial need; buy-ins and reinsurance for high-risk populations; "Medicaid plus tax credits" to cover the uninsured; Medicaid long term care with expanded eligibility, better financial protections and home-community-based benefits; quality initiatives; administration; and new financing sources.
Fishman E, Century Foundation. 2002. Running in Place: How Medicaid Model Falls Short, and What to Do About It.
The author analyzes the various means-tested health insurance initiatives instituted since the 1960s. The author argues that without comprehensive health reform, increasing the effectiveness of existing state-run programs will require the federal government to assume more of the financials costs of these programs.
Frogue J, The Heritage Foundation. Jan 2003. The Future of Medicaid: Consumer-Directed Care.
This paper argues that states should adopt consumer-directed care such as the Cash and Counseling approach to increase quality and control costs.
Holahan J and A Weil, Urban Institute. May 2003. Block Grants are the Wrong Prescription for Medicaid.
This paper analyzes the Bush Administration proposal to reform the Medicaid program.
Holahan J and A Weil. Feb 2007. Toward Real Medicaid Reform. Health Affairs Web Exclusive.
This paper argues that there is a real need for Medicaid reform primarily because of the large differences among states in coverage and benefits and because of the program’s high and rising costs.
Kaiser Commission on Medicaid and the Uninsured. Oct 2005. Medicaid and Budget Reconciliation: Options and Implications of Savings Proposals.
This issue brief examines the context for federal Medicaid savings proposals, emerging themes for savings and the potential impact on Medicaid beneficiaries, states and providers.
Kaiser Commission on Medicaid and the Uninsured. Jan 2005. Medicaid: Issues In Restructuring Federal Financing.
This brief analysis summarizes how the possible restructuring of Medicaid financing could impact states, providers, and beneficiaries.
Ku L, Center on Budget and Policy Priorities. May 2003. Charging the Poor More for Health Care: Cost-Sharing in Medicaid.
This paper reviews the current policies on cost-sharing in Medicaid and SCHIP, reviews the literature regarding the effects of cost-sharing, and discusses the policy implications of increased cost-sharing for Medicaid beneficiaries.
Mann C. 2003. The Flexibility Factor, Finding the Right Balance. Health Affairs, 22(1):62–76.
Rising costs, state fiscal pressures, and new federal waiver policies have prompted some states to seek authority to use Medicaid dollars in ways that do not conform to current federal standards. This article reviews the current financing structure of the Medicaid program and discusses the potential impact changes would have on the program and its beneficiaries.
Mann C, for the Kaiser Commission on Medicaid and the Uninsured. Feb 2004. Medicaid and Block Grant Financing Compared.
This paper compares the current Medicaid financing system to a generic block grant financing system to illustrate the key differences in the structure and incentives of these alternative approaches.
National Governors Association. Aug 2005. Short-Run Medicaid Reform.
This paper focuses specifically on proposals that could be included in the FY 2006 revenue and reconciliation bills.
National Governors Association. June 2005. Medicaid Reform: A Preliminary Report.
Owcharenko N. Oct 2003. A New Direction for Medicaid. The Heritage Foundation Web Memo #355.
The author discusses current issues in the Medicaid program and lays out policy options for states to improve the function of their Medicaid programs and better serve their beneficiaries.
Williams C, Kaiser Commission on Medicaid and the Uninsured. Sept 2004. Medicaid Disease Management: Issues and Promises.
This issue paper presents information from nine states that have developed and implemented disease management programs for adult Medicaid enrollees.
Prescription Drugs
Bruen B and L Miller, Jan/Feb 2008. Changes in Medicaid Prescription Volume and Use in Wake of Medicare Part D Implementation. Health Affairs, 27(1): 197-202.
This article examines the changes in Medicaid prescription volume after the implementation of the Medicare drug benefit. Data indicate that Medicaid programs experienced substantial changes in the volume and types of prescriptions used by enrollees, with Medicaid prescription volume and total payments to pharmacies dropping by almost 50 percent in 2006. The mix of drug classifications also shifted, reflecting the younger makeup of the population that remains eligible for Medicaid prescription drug benefits.
Bruen B and A Ghosh, Urban Institute for the Kaiser Commission on Medicaid and the Uninsured. June 2004. Medicaid Prescription Drug Spending and Use.
This issue paper provides the latest data and trend analysis on Medicaid prescription drug spending and utilization.
Crowley J, Kaiser Commission on Medicaid and the Uninsured. Oct 2005. State Medicaid Outpatient Prescription Drug Policies: Findings from a National Survey 2005 Update.
This survey reports Medicaid prescription drug policies in effect in early 2005. It covers utilization management policies, payment and purchasing policies, utilization review policies, and policies for managed care enrollees and persons residing in institutions.
Crowley J, Health Policy Institute, Georgetown University for Kaiser Commission on Medicaid and the Uninsured. June 2004. The New Medicare Prescription Drug Law: Issues for Dual Eligibles with Disabilities and Serious Conditions.
This issue paper discusses the challenges the new Medicare drug program faces in meeting the needs of dual eligible individuals with disabilities, who tend to have extensive, complex and varying needs.
Kaiser Commission on Medicaid and the Uninsured. Sept 2002. Medicaid and the Prescription Drug Benefit.
This policy brief includes background information on Medicaid and its drug benefit, provides examples of how states are using the cost containment mechanisms at their disposal and addresses issues surrounding beneficiary access to outpatient drugs.
Baugh DK, PL Pine, S Blackwell et al. Spring 2004. Medicaid Prescription Drug Spending in the 1990s: A Decade of Change. Health Care Financing Review, 25(3):5–23.
This article examines Medicaid drug spending from 1990 to 2000. Over that period, Medicaid drug spending increased from $4.4 billion to over $20 billion, an average annual increase of 16.3 percent. Disabled persons experienced an even greater 20 percent average annual increase. Findings in this article provide information on drug spending for dually eligible beneficiaries to policymakers as they seek to target cost-effective coverage and drug therapies.
Population-Specific Research
Bruen B, JM Wiener & S Thomas, Urban Institute for the American Association of Retired Persons Public Policy Institute. Nov 2003. Medicaid Eligibility Policy for Aged, Blind, and Disabled Beneficiaries.
This study provides a description of Medicaid eligibility policies for aged and disabled persons in 50 states and the District of Columbia.
Gold RB, CL Richards, UR Ranji & A Salganicoff. Oct 2007. Medicaid’s Role in Family Planning.
This updated issue brief by the Guttmacher Institute and the Kaiser Family Foundation reviews Medicaid’s part in financing and providing access to family planning services for low-income women across the nation.
Kaiser Commission on Medicaid and the Uninsured. Feb 2005. Medicaid’s Optional Populations: Coverage and Benefits.
This issue brief presents an overview of Medicaid's optional beneficiaries and services and provides examples of who qualifies as "optional" and the services they use.
Kaiser Family Foundation. Nov 2007. Medicaid’s Role for Women.
This issue brief provides an overview of the Medicaid program and its role in providing health and long-term care coverage for low-income women.
Kaiser Commission on Medicaid and the Uninsured. Dec 2003. Medicaid’s Role for People with Disabilities.
This primer is on Medicaid's role as the major provider of health coverage for non-elderly persons with disabilities and on the policy challenges that lie ahead. It also provides short profiles of people with disabilities from across the country.
Rowland D, Kaiser Commission on Medicaid and the Uninsured. Jan 2008. Medicaid’s Role for People with Disabilities, Testimony to the U.S. House Energy and Commerce Committee’s Subcommittee on Health.
This testimony focused Medicaid’s development as a vital source of coverage for people with disabilities and its current role providing coverage and access to health services and supports for this population.
Rowland D, R Garfield & R Elias. 2003. Accomplishments and Challenges in Medicaid and Mental Health. Health Affairs, 22(5):73–83.
This article examines the role Medicaid plays today for the low-income population with mental health needs and then reviews some of the current pressures and challenges in the program that could reshape this role.
Rowland D, A Salganicoff & PS Keenan. 1999. The Key to the Door: Medicaid’s Role in Improving Health Care for Women and Children. Annual Review of Public Health, 20:403–26.
This article assesses Medicaid’s contributions over the last three decades to improving the coverage, access to care, and health of low-income children and women. The article reviews Medicaid’s impact on the low-income population covered by this program, demonstrating both the role insurance plays and its limitations as a strategy for improving the health of vulnerable populations.
Vladeck B. 2003. Where the Action Really Is: Medicaid and the Disabled. Health Affairs, 22(1):90–100.
This article discusses the role Medicaid plays for the nonelderly disabled population. In the past two decades Medicaid has helped finance the deinstitutionalization of the mentally retarded and a growing proportion of the mentally ill, but implementation of the Olmstead decision has deflected advocates' attention from the more important issue of how managed care plans treat Medicaid beneficiaries.
Williams B and J Tolbert. Jan 2007. Aging out of EPSDT: Issues for Young Adults with Disabilities.
This issue brief discusses the challenges and implications for young people with disabilities when they become adults and lose their EPSDT benefits and how recent changes to the Deficit Reduction Act give states an opportunity to increase the availability of services that allow disabled individuals to lead as normal a life as possible as they move into adulthood.
Waivers
Artiga, S. and C. Mann, Kaiser Commission on Medicaid and the Uninsured. Aug 2005. Coverage Gains under Recent Section 1115 Waivers: A Data Update.
This brief assesses the extent to which recent Section 1115 waivers have helped reduce the number of uninsured people and finds that there has been a net gain in coverage of 426,329 people under recent waivers.
Kaiser Commission on Medicaid and the Uninsured. June 2003. Section 1115 Medicaid and SCHIP Waivers: Policy Implications and Recent Activities.
This policy brief provides an overview of recent Section 1115 waivers and a discussion of key issues.
Mann C, Kaiser Commission on Medicaid and the Uninsured. Dec 2003. Assessing the Role of Recent Waivers in Providing New Coverage.
This report analyzes the effect of recent waivers on extending coverage to the uninsured.
Mann C and S Artiga, Kaiser Commission on Medicaid and the Uninsured. June 2004. The Impact of Recent Changes in Health Care Coverage for Low-Income People: A First Look at the Research Following Changes in Oregon’s Medicaid Program.
Oregon recently restructured its Medicaid program through a Section 1115 waiver and other program changes, largely in response to particularly difficult state budget problems. This issue paper summarizes key findings on the impact of Oregon's changes, based on work conducted by a research collaborative within the state.
Reester H, R Missmar & A Tumlinson, Health Strategies Consultancy for the Kaiser Commission on Medicaid and the Uninsured. April 2004. Recent Growth in Medicaid Home and Community-Based Service Waivers.
This paper examines trends in HCBS waiver enrollment and spending in recent years.