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

When the Medicare prescription drug benefit begins on January 1, 2006, about seven million beneficiaries face more restricted drug formularies. Currently, these "dual eligible" individuals receive their drug benefit through state Medicaid programs, which offer more liberal formularies than what will be expected of the new Medicare drug plans. In...
Some legal gurus are questioning the constitutionality of a key provision of the Medicare prescription drug benefit: the so-called "clawback" provision that requires states to send the federal government cash to help cover the cost of drugs for dual eligibles. The mandatory payments are enormous - $6 billion in...
Under President Bush's FY 2006 budget, state Medicaid programs face the prospect of significant changes, including funding cuts of $60 billion, some new expansions, and additional flexibility. Now costing taxpayers over $300 billion a year and growing at 8-12 percent in most states, Medicaid is a hot topic inside...
From 2000 to 2003, a sharp rise in enrollment during the economic downturn triggered Medicaid budgets to increase by a third - an average annual increase of 10.2 percent. A new analysis in Health Affairs found that during this four-year period: ● In per capita terms, average annual Medicaid costs...
As a tool to control costs and improve care for vulnerable patients, disease management is now used in some form by over half of all state Medicaid programs. To help states craft their disease management programs, a variety of technical resources are now available. The National Pharmaceutical Council offers a...
Prescription drug utilization varies dramatically among individuals. To make sure Medicare payments to Prescription Drug Plans (PDPs) reflect the health status of enrollees, the Centers for Medicare & Medicaid Services (CMS) is developing a risk adjustment methodology. Risk adjustment is a statistical process used to identify and adjust for...
Under the new Medicare prescription drug benefit, drug plans will have a fair amount of discretion in setting formularies. The idea is to encourage competition among drug plans and offer Medicare beneficiaries choice. The Centers for Medicare & Medicaid Services (CMS) will review the benefit designs of drug plan...
Medicaid health plans are the Ginger Rogers of managed care. They have to do everything commercial and Medicare health plans do but have to do it backwards and in high heels. Despite dealing with more complex requirements and the toughest, most vulnerable patient populations, Medicaid health plans often provide...

Stay Connected

4,868FansLike
7,209FollowersFollow
15,517FollowersFollow

WEATHER

Latest Articles