Kip Piper's Health Care Blog
Medicare, Medicaid, Health Reform

State Partnership Exchanges are a hybrid model for operation of a Health Insurance Exchange (HIX) under the Affordable Care Act.  In this model, responsibility for Exchange functions is shared between the state and Centers for Medicare and Medicaid Services (CMS).  The other two models are a Federally Facilitated Exchange...
Medicaid accounts for the largest share of state budgets and is growing still. Since fiscal year 2010, state Medicaid spending nationwide grew from 22.2 percent to about 24 percent of the average state budget, according to the National Association of State Budget Officers (NASBO). Since the recession began in...
The Employer Mandate is one of the many complex new requirements of the Affordable Care Act (ACA) health reform law.  Under the Employer Mandate - decorously called Employer Shared Responsibility in the law - most employers must provide health insurance coverage to all full-time employees or pay a penalty...
Medicaid eligibility and enrollment is being substantially streamlined.  State Medicaid agencies and their contractors are busy adapting eligibility systems and processes to a dramatically new set of federal standards, all required under the Affordable Care Act.  Starting in January 2014, the new framework for Medicaid eligibility and enrollment will...
State Medicaid programs must increase primary care physician payment rates in 2013 and 2014 to at least 100 percent of Medicare rates.  The Medicaid-Medicare payment parity mandate is part of the Affordable Care Act (ACA). For the difference between prior rates and the necessary rate increase, states will receive a 100...
Enrollees in both Medicare and Medicaid, called dual eligibles, are the most expensive and vulnerable group of beneficiaries. More than 40 percent of dual eligibles have severe cognitive disabilities, are likely to have severe physical disabilities, and have higher rates of chronic disease, such as diabetes and Alzheimer’s. All...
Much of the nation's long-term care is paid for with Medicaid funding. Medicaid pays 43 percent of all long-term care, while Medicare pays 24 percent and a mix of private health plans and consumers funds the rest, according to the Kaiser Family Foundation. Only half of people who need...
Somewhere between 11 million and 21 million will become newly insured under Medicaid thanks to the Affordable Care Act (ACA), depending on whether you subscribe to the latest estimates from the Congressional Budget Office (CBO) or the Urban Institute. The Supreme Court’s decision in NFIB v. Sebelius gave states...
Essential health benefits (EHB) will play a fundamental role in shaping health plans after 2014. Part of the Affordable Care Act (ACA), EHBs define a baseline of 10 types of services those plans must cover, including prescription drugs, hospital services, preventive or wellness services, and chronic disease management. Qualified...
Two thirds of people who become newly insured on state health insurance exchanges (HIX) under the Affordable Care Act (ACA) will not have had coverage. More than one third of them will have had no usual health care provider and no recent checkup. Such estimates suggest the people who...

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