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Medicaid Operations

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Webinar & Presentations

This webinar walks through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization.

Commentary

This commentary tells the story of Jim, who overcomes the challenges of living with cerebral palsy through services covered by Medicaid.

Commentary

Espri is a self-employed farmer whose family is covered by Medicaid in Indiana.

Commentary

This commentary explores how states have been required to make numerous changes to their eligibility and enrollment systems, operations, and policies, in order to comply with the enhanced Federal Medicaid Assistance Percentages.

Commentary

This commentary recommends specific steps for state Medicaid programs to ensure state residents receive needed services during the COVID-19 pandemic, with a specific focus on Medicaid managed care organization (MCO) enrollees.

Commentary

This commentary discusses how state Medicaid, children’s health insurance programs, and health insurance marketplaces prepare for an expected increase in demand due to COVID-19, an economic downturn and ensuing budget crises, and unpredictable federal relief efforts.

Commentary

In this podcast, Medicaid experts share five tips for leaders to address today’s VUCA (volatility, uncertainty, complexity, and ambiguity) challenges within their organizations.

Commentary

In this podcast, Medicaid experts discuss how vision coherence is important for effective leadership.

Webinar & Presentations

In this webinar, experts present key findings from a new COVID-19 state resource guide on federal and state Medicaid flexibilities and how they are being deployed to help ensure access to long-term services and supports.

Commentary

This commentary provides a snapshot of how states are navigating fiscal challenges of the COVID-19 pandemic, given declining revenues and rising spending demands.

Dataset

This dataset examines projected changes in federal and state Medicaid and CHIP expenditures for scenarios during the COVID-19 pandemic.

Report

This report provides excerpts of health disparities and health equity contract language from Medicaid Managed Care contracts from five states, Washington, D.C., and the contract for California’s Health Exchange, Covered California.

Report

Stakeholders in six states assess the impact of Medicaid insurers increasing dominance in the ACA marketplaces.

Brief

This brief provides an overview of New Hampshire’s recent directed payment to six types of essential Medicaid providers in order to help them keep their doors open during the COVID-19 pandemic.

Brief

This brief provides a chart describing the effective dates of various federal provisions to allow for temporary flexibilities in the Medicaid and Children's Health Insurance Program programs.

Brief

This toolkit is intended to serve as a resource for states as they begin to strategize about reopening and plan for the next phase of the COVID-19 pandemic.

Commentary

This commentary outlines three key policy steps to help health centers survive in the short term and thrive beyond the COVID-19 crisis.

Webinar & Presentations

In this webinar, experts reviewed the current telehealth policy landscape and considerations for states as they design their post-apex telehealth policies.

Report

This report uses new enrollment data to examine insurer type enrollment trends from 2016-2018.

Commentary

This commentary provides an overview of CMS relief guidance and flexibility to state hospitals, facilities, and providers on reporting measures for value-based purchasing and quality reporting programs.

Commentary

This commentary explains how, due to the loss of employer-sponsored insurance from the economic fallout of COVID-19, states may continue to see an increase in Medicaid enrollment.

Webinar & Presentations

This webinar presented results from a financial model examining the Medicaid fiscal implications of the interaction between the COVID-19 pandemic, the emerging economic downturn, and recent policy changes.

Report

This report documents access and affordability challenges facing uninsured new mothers using 2015–18 data from the National Health Interview Survey (NHIS). It also uses 2015–17 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to describe the health status of women who lost Medicaid coverage following their pregnancies.

Report

This report shows how the additional levels of unemployment insurance provided through the Federal Pandemic Unemployment Compensation program affects eligibility for subsidized coverage in expansion and nonexpansion states.

Commentary

In this podcast episode, Ed O’Neil, PhD, MPA, a leadership development expert, speaks with Hilary Kennedy, program director for Medicaid leadership at the National Association of Medicaid Directors, about strategies Medicaid leaders can use to continue developing their staff at a distance.

Commentary

This commentary identifies actions federal and state policymakers have taken to address the impact of COVID-19 on their managed care performance incentive programs.

Report

This report outlines potential IT investments in responding to COVID-19 and strategies for states to support these investments, and to secure current and future IT investments that enable ongoing Medicaid program operations and advance health information exchange.

Webinar & Presentations

This webinar reviews potential information technology (IT) investments in responding to COVID-19 and strategies for states to support these investments to secure current and potential IT investments that enable ongoing Medicaid program operations and advance health information exchange.

Commentary

This commentary provides an overview of strategies that states can consider to help address gaps in coverage to ensure as many people as possible get access to comprehensive care as the country continues to respond and recover from the COVID-19 health and economic crisis.

Webinar & Presentations

In this webinar, experts review strategies states can use to manage and process an increased number of Medicaid applications, and the federal authorities that permit states to do so.

Brief

This document provides examples of potential Medicaid messaging states can use during the COVID-19 pandemic.

Graphic

This infographic highlights what states need to consider when providing pregnancy-related services to Medicaid enrollees through telehealth during the pandemic.

Commentary

This commentary discusses the 1115 waiver applications submitted by states that have the potential to safeguard access to care and increase support for children during the COVID-19 pandemic.

Brief

This Q&A responds to questions received regarding the April 9 Targeted Options for Increasing Medicaid Payments to Providers During COVID-19 Crisis Webinar and corresponding Toolkit.

Report

In this report, researchers estimate the fiscal impacts of several approaches for increasing federal Medicaid matching rates, providing state-level estimates for each approach.

Commentary

This commentary discusses the states that have rapidly amended their Medicaid home- and community-based services for older adults and their family caregivers to ensure access to long-term services and supports during the COVID-19 crisis.

Commentary

This commentary discusses the steps states are taking during the COVID-19 pandemic to protect pregnant women and their infants during delivery.

Commentary

Valerie and her husband Christopher wanted to adopt two sons from foster care, both with challenging health conditions, but were not sure if they could afford the medical bills. Valerie learned both children were automatically covered by South Dakota Medicaid because of their time in foster care.

Commentary

April was born with sickle cell anemia, a genetic blood disorder that is deeply painful and must be managed with proper medication. Medicaid covered April’s treatment and her electric wheelchair, which empowers her in her new everyday life.

Brief

This brief addresses how Medicaid Managed Care Organizations (MCOs) and states can individually and collectively play a role in responding to the COVID-19 pandemic.

Commentary

This commentary discusses the Coronavirus Aid, Relief and Economic Security Act (CARES) and how policymakers can make informed decisions about how best to target these resources.

Commentary

This commentary includes some of the options available to states to ensure that individuals with complex medical conditions and their families have access to necessary home- and community-based services during the coronavirus (COVID-19) crisis through waiver and state plan amendment applications.

Report , Webinar & Presentations

This webinar walks through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization. An accompanying toolkit is included that identifies the immediately available tools for states.

Report

This report assesses the cost of Medicaid relative to private insurance in the health insurance landscape under the Affordable Care Act (ACA).

Commentary

This perspective discusses strategies state Medicaid and CHIP agencies can pursue as part of their emergency preparedness planning for, and response to, COVID-19.

Webinar & Presentations

In this webinar, experts explore the key health care provisions in the Families First Coronavirus Response Act and the implications for states.

Brief

This brief is a compilation of communication examples from state departments and agencies during the COVID-19 pandemic.

Report

This report examines the kinds of health insurance unemployed workers have and how coverage patterns have shifted under the Affordable Care Act (ACA).

Commentary

This commentary reviews key information for states about the recent federal medical assistance percentage (FMAP) increase and conditions states must meet to qualify for it.

Commentary

The federal government has offered Medicaid waivers to give states flexibility to quickly increase their health care workforces in response to the COVID-19 pandemic.

Report

This brief examines the effect of a recently announced federal program allowing states to apply for Medicaid block grants or per capita caps in exchange for new flexibility to limit enrollment and benefits.

Report

This report examines the Families First Coronavirus Response Act and its implications for Medicaid and the Children's Health Insurance Program (CHIP).

Commentary

This podcast discusses the many ways that states are working to address the challenges surrounding maternal and infant mortality, specifically the significant disparity experienced by black women,

Report

This report describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement.

Report

This FAQ answers questions about whom the Department of Homeland Security (DHS) public charge rule will impact, what benefits are implicated by the rule, and how the rule might be administered.

Commentary

This podcast discusses the strategies and challenges faced while developing meaningful consumer engagement strategies for Colorado and Washington State Medicaid.

Commentary

Carolyn was working two jobs without health insurance when she fell in her home and cracked her hip. Unable to afford out-of-pocket expenses, Carolyn received disability coverage through Medicaid.

Commentary

Alecia was born with Down Syndrome, a lifelong condition that comes with physical and developmental challenges. Iowa’s Medicaid coverage empowers her to live independently.

Report

This report focuses on how Medicaid programs can use data from the American Community Survey (ACS), to inform and target interventions that seek to address social determinants of health and advance health equity.

Report

02.2020 / By Urban Institute

This report studies New Hampshire’s Medicaid work requirement program to understand how it was implemented and why it appears to fail to protect coverage and promote work.

Report , Webinar & Presentations

This report reviews the key features of the proposed capped funding demonstrations and highlights the considerations for states. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) inviting states to apply for Section 1115 demonstration projects that would impose caps on federal Medicaid funding for the adult expansion and some other adult populations in exchange for new programmatic flexibility.

Commentary

In this podcast, three individuals from the Wisconsin Department of Health Services discuss how they have created an environment that values transparency and staff well-being.

Report

This report gives an overview of the federal authorities under which states are able to cover nonclinical housing-related services for high-need Medicaid enrollees, and also details how states are using these authorities to invest in supportive housing for diverse high-need Medicaid populations.

Commentary

In this podcast, Connecticut’s Medicaid director Kate McEvoy and chief financial officer Mike Gilbert discuss their experiences working with partners in the executive and legislative branches to build trust and a shared vision for sustaining critical programs.

Brief

This blog from the Delta Center illustrates five key insights related to program design and evaluation from the productive partnership between the Partnership HealthPlan of California (PHC) and local community health centers (CHCs) to create a care coordination (CCM) program.

Report

This issue brief draws from the experiences of states that were among the first to implement their substance use disorder waivers to profile how the American Society for Addiction Medicine (ASAM) Criteria is used within the context of managed care and utilization review, and the challenges and best practices associated with its use.

Report

10.2019 / By Urban Institute

This report analyzes commercial insurers’ experiences competing in marketplaces with managed care organizations, which only offered coverage within public programs prior to ACA implementation.

Commentary

Paul needed a kidney transplant to save his life, and couldn't have afforded the costs without Medicaid.

Commentary

When Stacia needed treatment for substance use and mental health, Medicaid covered her care.

Commentary

When Sheila's daughter was born with birth defects, Sheila couldn't afford her care. Then she found Medicaid.

Report

10.2019 / By Manatt Health

This issue brief examines how state Medicaid agencies, families, advocates, providers and other stakeholders can partner to improve access to services for Medicaid-enrolled children with special health care needs.

Report

This report provides an overview of the behavioral health system’s engagement in Medicaid value-based payment (VBP) models and provides policy recommendations to support VBP adoption.

Commentary

09.2019 / By That's Medicaid

When Jennifer and Jerry welcomed their daughter into the family, Medicaid gave her a healthy start.

Commentary

09.2019 / By That's Medicaid

When Hannah and Martin's son was born, he needed immediate open-heart surgery. Medicaid covered their son’s birth, surgery, and follow-up care.

Commentary

09.2019 / By That's Medicaid

Soon after Gail was diagnosed with breast cancer, she lost her job and her health insurance. Medicaid was a lifeline.

Commentary

08.2019 / By That's Medicaid

To stay alive, Bridget must receive dialysis for four hours a day, three times each week. Medicaid is an essential part of her health care coverage, and helps her to lead a normal life.

Commentary

08.2019 / By That's Medicaid

LaVerne was covered by Medicaid while she earned her bachelor's degree in nursing, opening the door for her service in the U.S. Army Nurse Corps.

Commentary

08.2019 / By That's Medicaid

Laura's high-risk pregnancy, and a car accident that left her husband Jed permanently disabled, threw her family's life off course. Learn how Medicaid helped Laura and Jed get it back on track.

Report

This report describes preliminary observations regarding implementation of Medicaid housing support demonstrations in California, Maryland, and Washington.

Commentary

08.2019 / By That's Medicaid

When Shari's disease worsened, she knew she needed more assistance. Learn how Medicaid helped her maintain her independence, so she could help others in need.

Commentary

07.2019 / By That's Medicaid

Tom was a successful insurance agent with a college degree and a six-figure salary, when personal tragedy sent him spiraling. Learn how Medicaid helped him get back on his feet.

Webinar & Presentations

07.2019 / By Vox

This short video explains what Medicaid expansion is.

Webinar & Presentations

07.2019 / By Vox

This short video explains the difference between Medicaid and Medicare.

Webinar & Presentations

07.2019 / By Vox

This short video explains how Medicaid has expanded its coverage to cover roughly 1 in 5 Americans.

Webinar & Presentations

07.2019 / By Vox

This short video explains the effect of Medicaid on children's health.

Commentary

These tip sheets provide general guidance to help state agency leadership develop and refine the necessary skills and expertise to successfully lead their state programs.

Brief

These resources describe the core roles of state Medicaid and public health agency staff when partnering to implement evidence-based prevention interventions.

This blog reflects on the value of Medicaid and the critical role of Medicaid directors since the program's inception more than 50 years ago.

Brief

06.2019 /

In this blog, two former state medicaid directors demystify the distinct yet complementary roles of public health and health care — and how these state agencies can align efforts around prevention strategies to impact health and costs.

Brief

06.2019 / By Urban Institute

This brief examines the prevalence of precarious work schedules among working adults whose families participate in federal safety net programs, using data from the December 2018 Well-Being and Basic Needs Survey.

Report

This issue brief provides examples from a handful of states that have begun the work of identifying, evaluating, and reducing health disparities within their Medicaid managed care programs.

Report

06.2019 / By Urban Institute

This study assesses potential barriers facing Medicaid enrollees in meeting work requirements through employment on a sustained basis, using pooled data from the September 2018 and March 2019 Health Reform Monitoring Survey.

Commentary

A new podcast series, Medicaid Leadership Exchange, is launching to help Medicaid directors and their senior management teams steer the course.

Webinar & Presentations

The webinar highlights six key questions that state policymakers need to consider when choosing a buy-in model, designing its features, and introducing a Medicaid buy-in program.

Commentary

State policymakers have more flexibility than ever to advance health-promoting policies and programs, and showcase effective strategies from which other states—and the nation as a whole—might learn. RWJF helps inform these efforts through research and analysis, technical assistance and training, and advocacy.

Brief

The issue brief identifies the key questions for states pursuing Medicaid buy-in programs to consider as they seek to design and implement their proposals.

Report

This issue brief explores the “next generation” practices that states are deploying to address social factors using Medicaid 1115 waivers and managed care contracts.

Report

03.2019 / By Manatt Health

This report examines monitoring and evaluation of work/CE demonstrations and reviews the data assets and infrastructure necessary to support states and their researcher partners in robust monitoring and evaluation efforts.

Commentary

In this interview with Louisiana's Medicaid Director Jen Steele, she shares her approach to leveraging Medicaid’s role to improve health outcomes and health equity.

Brief

This brief reviews considerations for policymakers assessing their state Medicaid managed care programs and exploring strategies for advancing cost, quality, and accountability goals.

Brief

This brief reviews a number of Medicaid strategies states are implementing to prevent and treat substance use disorder and support long-term recovery.

Brief

This brief reviews the role that social and economic factors--such as housing, healthy food, and income--play in a “whole person” approach to health care, especially among Medicaid’s low-income enrollees.

Brief

This brief reviews the opportunities state policymakers have to affect the health—and future well-being and productivity—of their youngest residents through their Medicaid programs.

Brief

This brief reviews the growing body of research on Medicaid's health and economic impacts, including access to care; self-reported health status; preventive health screenings; delaying care because of costs; hospital and ED utilization; and mortality rates.

Brief

This brief outlines the basics of the Medicaid program, including financing and eligibility, for new state policymakers in order to lay the groundwork for considering the challenges and opportunities that lie ahead. 

Brief

This brief highlights priority issues for consideration and potential action, including: the structure of the Medicaid agency; enabling coverage and access; addressing the needs of special populations; and value-based payment policies.

Report

02.2019 / By Urban Institute

This report finds between 2006 and 2017, growth in spending per enrollee in Medicare and Medicaid was much slower than in private insurance.

Dataset

02.2019 / By LawAtlas

This tool facilitates use of policy surveillance and legal mapping for improving the nation’s health.

Dataset , Report

02.2019 / By Health Impact Project

This project encourages state, local, and national level organizations to include health considerations in policy decisions across multiple sectors, such as housing, transportation, and education. Research shows that the conditions in which people live, learn, work, and play influence their health, so the project also works to create cross-sector partnerships that include the expertise of health care and public health systems.

Dataset

This tool helps identify policies and programs that are a good fit for community priorities. Analysts review and assess research to rate the effectiveness of a broad variety of strategies (i.e., policies, programs, systems & environmental changes) that can affect health through changes to: health behaviors, clinical care, social and economic factors, and the physical environment.

Report

The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.

Webinar & Presentations

This webinar examines the complexities of state Medicaid oversight of the pharmacy benefit in the managed care environment.

Webinar & Presentations

This webinar walked through key components of the proposed annual Notice of Benefit and Payment Parameters for 2020, and discussed potential state considerations for states.

Journal Article

01.2019 / By Urban Institute

This study analyzed linked maternal and infant Medicaid claims data and infant birth records in three states to assess treatments and outcomes on maternal and infant health.

Report

MACPAC's 2018 Medicaid and CHIP Data Book is a collection of federal and state statistics regarding the Medicaid and CHIP programs.

Report

This report outlines the activities of three pilot sites pursuing Medicaid-driven strategies to support young children and their families, to help inform other cross-sector partnerships at varying stages of development.

Webinar & Presentations

This webinar discusses state considerations for developing a Medicaid buy-in proposal, as well as evolving models.

Brief

This case study explores how Indiana’s Family and Social Services Administration is working to rethink how to optimize the integration and delivery of health and social services for Medicaid beneficiaries.

Commentary

This national scan summarizes the health care reforms and innovations that newly-elected governors promoted in their campaigns and may become policy in 2019.

Webinar & Presentations

The Senate passed H.R. 6, The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the “SUPPORT Act”) on October 3, 2018. This reviews major health provisions of the new law and implications for states.

Report

This resource highlights articles published since January 2018 that report on the impact of Medicaid expansion in 33 states and DC, organized by health access and outcomes, economic impacts, and coverage impacts.

Brief

This State Health Policy Highlight profiles three State Health and Value Strategies issue briefs that provide states with practical approaches to improve individual and population health and create joint accountability across health care and other sectors.

Brief

This State Health Policy Highlight profiles two issue briefs and a webinar on how state Medicaid programs can address social determinants of health.

Report

The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.

Report

10.2018 / By Urban Institute

This report explores changes in coverage type between 2013 and 2016 overall and for key demographic and income subgroups. Between 2013 and 2016, the share of Americans ages 64 and younger without health insurance fell from 17 percent to 10 percent.

Brief

10.2018 / By Urban Institute

This brief examines changes in health insurance coverage and health care access and affordability for parents and their children between 2013 and 2018 using data from the Health Reform Monitoring Survey.

Graphic

This chart compares the social determinants 11 states targeted in their Medicaid contracts and contract guidance documents to enhance population health, as well as how states monitored outcomes and funded these efforts.

Report

CMS approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire; and additional states have submitted or are poised to submit similar waivers. This series of charts outlines the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program.

Report

08.2018 / By Urban Institute

This report investigates the work patterns of Medicaid beneficiaries in Kentucky who are are potentially subject to Medicaid work requirements. It finds that the structure of Kentucky’s Medicaid waiver does not seem to align with the reality of some working enrollees’ lives, and that working enrollees losing coverage may not have access to an employer plan.

Webinar & Presentations

This webinar reviews the Stewart v. Azar decision and potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. The court’s findings may shape what analysis will be necessary to demonstrate that future waivers advance the Medicaid statute's objectives.

Brief

State officials can align prevention strategies with value-based payment goals through a variety of mechanisms outlined in this brief, which draws from state-based 6|18 Initiative implementation efforts to help Medicaid and public health officials make the case for investing in prevention strategies and aligning these efforts to achieve state VBP goals.

Webinar & Presentations

Webinar discusses the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD), including the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver.

Graphic

This map tracks state Medicaid expansion decisions and approaches states are taking for expanding eligibility to 138 percent of the Federal Poverty Level. It also includes information on state legislative activity around Medicaid expansion, governors’ stances on the issue, and fiscal and demographic analyses from the state or other institutions. For states that are expanding Medicaid, but using an alternative to traditional expansion, the map also contains brief descriptions of these demonstration waivers.

Graphic

In January 2018, the Centers for Medicare & Medicaid Services issued a new policy allowing states to implement work and community engagement requirements for certain Medicaid enrollees. States are permitted to seek federal approval to require non-elderly, non-pregnant, and non-disabled adults to participate in these types of activities to qualify for Medicaid or certain aspects of Medicaid coverage. This chart summarizes states’ pending and approved Section 1115 waivers, waiver renewals, and waiver amendments to implement work and community engagement requirements.

Webinar & Presentations

This webinar untangles HHS's annual Notice of Benefit and Payment Parameters and its many implications for states. The rule is a collection of policies governing the ACA’s marketplaces, insurance reforms, and premium stabilization programs. Speakers include Sabrina Corlette and Justin Giovannelli from Georgetown’s Center on Health Insurance Reforms, Joel Ario from Manatt Health, and Jason Levitis.

Report

04.2018 / By Urban Institute

In this brief, we provide an overview of the lessons learned from work requirements for Temporary Assistance for Needy Families (TANF, or cash assistance) and Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) and discuss the implications of introducing or expanding work requirements.

Report

04.2018 / By Urban Institute

The Profile of Virginia’s Uninsured provides a detailed picture of the Commonwealth’s uninsured using the 2016 American Community Survey. In 2016, 10.3 percent of Virginians under age 65 were uninsured. Most of these uninsured nonelderly Virginians had family incomes at or below 200 percent of the Federal Poverty Level (FPL), and more than three-quarters were part of working families.

Journal Article

This article analyzes the impact of the Affordable Care Act on health insurance coverage for verterans in states that chose to expand Medicaid and in non-expansion states using data from the 2013 and 2014 American Community Survey. The analysis found a substantial 24 percent relative decline in the rate of uninsurance for U.S. veterans between 2013 and 2014. Coverage gains in rural areas were due to gains in Medicaid and individual market coverage. The increase in the insured rate was three times larger in Medicaid expansion states versus non-expansion states.

Report

03.2018 / By Urban Institute

In January 2018, CMS approved Kentucky’s Section 1115 Medicaid demonstration waiver, which allows the state to require some beneficiaries to participate in “community engagement” activities for at least 80 hours a month to retain their Medicaid coverage. This brief revises an earlier analysis on who could be affected by Kentucky’s Medicaid work requirements based on new information posted on Kentucky’s website.

Brief

The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet, only 1 in 5 people suffering from an OUD receive treatment. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.

Report

State Medicaid programs are increasingly requiring their Medicaid managed care organizations (MCO) to implement APMs. It is important for states to develop ways to ensure that their MCOs are complying with the APM requirements within their contract, and monitoring the progress and challenges with the implementation of APM strategies with Medicaid providers. This report focuses on different ways in which states may set standard APM definitions to track MCO progress toward meeting state APM goals, and support comparison of APM implementation within a state and nationally.

Report

The Health Care Payment Learning and Action Network Alternative Payment Models Framework (the LAN APM Framework) is an increasingly common method being used by states to measure plan progress toward implementation of APMs. This report provides real-world examples of APMs within the LAN categories and can help states and other interested purchasers develop a common understanding of what types of payment models fit within the framework categories.

Brief

01.2018 / By Urban Institute

This brief provides an analysis of legislation recently introduced in the U.S. Senate that would create a mechanism for states to offer their residents the opportunity to buy a Medicaid-based public insurance option.

Webinar & Presentations

On January 11, 2018, CMS released guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represent a significant departure from past Administrations’ positions. This webinar reviews the new guidance and discusses state legal, policy, and operational considerations.

Webinar & Presentations

RWJF’s SHVS together with experts from Manatt Health, host this webinar that highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. Conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states are discussed.

Brief

Uncertainty about the future of health insurance options and concern about the ability of Affordable Care Act (ACA) marketplaces to offer adequate competition and choice have spurred states to look for new coverage approaches. Innovative strategies states are proposing include allowing consumers to buy into state Medicaid programs and developing state-specific coverage options within the ACA’s framework.

Webinar & Presentations

This webinar features the Urban Institute's Dr. Fred Blavin, whose SHARE-funded research asks how medical spending burdens for near-poor families in non-expansion states would change if the states were to expand Medicaid.

Report

This report provides an overview of three areas of value-based innovation and then affords a deeper examination into specific examples of state employee purchaser activity in California, Connecticut, Massachusetts, Minnesota, Tennessee, and Washington.

Webinar & Presentations

The research included in this panel illustrates both the intended and unintended consequences of state policy decisions on a range of health systems outcomes and highlights the necessity of access to different types of federal surveys for the purposes of health policy evaluation. Federal survey data is especially critical when analyzing variation between states, as when comparing outcomes by Medicaid expansion status. As policy flexibility for states continues to grow, this ability to compare states to one another will continue to be essential.

Report

This toolkit is designed to assist states interested in implementing value-based purchasing approaches with their Medicaid managed care organizations (MCOs). Using a value-based purchasing approach can mean significant and ongoing changes for a state Medicaid agency and its MCOs.

Brief

The Administration signaled a willingness to give states more flexibility to address health and prevention in new and innovative ways under Section 1115 of the Social Security Act, allowing the Department of Health and Human Services to approve experimental and innovative projects that promote the goals of Medicaid. This comes at a pivotal time when many states are developing new ways to improve health care, reduce costs, and address health-related social needs such as housing.

Report

State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. This report digs into opportunities that states have to account for SDOH in Medicaid programs.

Brief

The Senate released two bills as part of its efforts to repeal the Affordable Care Act (ACA): A revision to the Better Care Reconciliation Act (BCRA) eliminating the “Ted Cruz Amendment,” which provided funding to create coverage alternatives for high-risk individuals, and the Obamacare Repeal Reconciliation Act (ORRA), which would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions.

Brief

CMS has signaled a willingness to evaluate new types of Medicaid proposals from states, such as Medicaid waiver applications that include programs to connect individuals to employment or incorporate features of private market coverage. In response to CMS’ letter, some states have developed proposals that include these types of requirements for certain individuals covered by the Affordable Care Act’s Medicaid expansion—and a few states are seeking similar changes for their non-Medicaid expansion populations.

Brief

Under the authority of Section 1115 demonstrations, some states have implemented DSRIP programs to improve care, improve health, and lower costs. DSRIP programs restructure Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals, which are used to measure success.

Report

This report explores Louisiana’s permanent supportive housing program. The program, administered jointly by the state’s Medicaid agency and housing authority, is a cross-agency partnership that braids funding to serve vulnerable cross-disability populations, address homelessness, reduce institutionalizations, and save money for the state.

Brief

Medicaid can play a unique and critical role in responding to public health emergencies and health crises. This brief explores the role Medicaid has played in responding to events such as the opioid and HIV/AIDS epidemics, the 2001 World Trade Center attacks, the Flint, Michigan lead contamination crisis, and Hurricane Katrina.

Report

Driven to improve care coordination and contain costs by moving away from a volume-based payment model, an increasing number of states are implementing risk-based managed care programs to deliver long-term services and supports (LTSS). As the primary payer for LTSS, state Medicaid programs have a significant interest in ensuring that entities with which they contract deliver high quality and cost-effective care to members. This report identifies ways states can learn from value-based payment models being applied elsewhere to create more accountability for the quality and cost of LTSS.

Report

04.2017 / By Urban Institute

In this report, researchers estimate the impact of the ACA Medicaid expansion on uninsured rates of poor, childless adult citizens, by age, gender, race, income, education, and health.

Brief

While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.

Webinar & Presentations

In order to assist states in the facilitation of Medicaid enrollment and renewal for eligible SNAP participants, this webinar presents some of the necessary considerations for leveraging these data for enrollment purposes.

Brief

In this brief, we explore two revenue sources states may deploy to fund the non-federal share of expansion: provider assessments and provider donations. Both are authorized by federal law and both have been used by states in connection with expansion.

Brief

This issue brief examines seven safety-net ACOs across five states to understand their origins, organization, characteristics and functions and to identify federal and state policy questions associated with their emergence. The issue brief identifies both challenges facing safety-net provider ACO aspirants and state strategies to support safety-net provider development of ACOs.

Brief

As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. Through their focus on improved health outcomes, patient satisfaction, and access to appropriate care, alternative payment methodologies can benefit FQHCs, the state purchaser, and most importantly Medicaid beneficiaries. This brief describes a number of state-level payment reform strategies that include FQHCs and offers strategies and considerations for states and FQHCs alike.

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