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...
Medicare and Medicaid spending will exceed $1 trillion in FY 2013. Together, the two programs now serve about 113 million Americans - over a third of the population. Policymakers in Washington and the states face a daunting challenge to containing costs in Medicare and Medicaid – both health programs are...
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...
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...
Thanks to the Supreme Court’s ruling in NFIB v. Sebelius, states have a choice about whether to expand Medicaid eligibility as part of the Affordable Care Act (ACA). State Medicaid directors currently oversee a patchwork of eligibility standards, which for the most part cover low-income families and disabled people....
Special Needs Plans for dual eligibles (D-SNPs) account for a large and growing category of Medicare Advantage Special Needs Plans (SNPs), reaching 1.2 million or 83 percent of SNP enrollees in 2012.
Medicare Advantage Special Needs Plans for dual eligibles, commonly an HMO, are often key players in new integrated Medicare-Medicaid health plan...
Leading-edge state Medicaid agencies across the country are exploring the potential of accountable care organizations (ACOs) to drive improvements in quality, delivery, and cost-effectiveness for Medicaid beneficiaries. Seven states in particular – Maine, Massachusetts, Minnesota, New Jersey, Oregon, Texas, and Vermont – are creating ACO models for Medicaid.
The Center...
Opaque prices – the norm in U.S. health care – in a key driver of inefficient, ineffective medical care and rapid cost increases. Transparency of health care prices - public reporting of prices - is an essential ingredient for a high-value, cost effective health care system.
In recent years, rising...
The rise of uninsurance in the South and West over the past decade means those regions have the most to gain from the Affordable Care Act’s (ACA) coverage expansions, says a brief by the Urban Institute sponsored the Robert Wood Johnson Foundation. However, new taxpayer-financed health insurance coverage in the ACA...
