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

Health Insurance Exchanges, new health insurance market rules, and Medicaid expansion under the Affordable Care Act (ACA) presents states with a massive array of policy, fiscal, and technical challenges.  In sheer complexity, magnitude of change, and impact on consumers, employers, health care providers, government programs, and taxpayers, ACA is...
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...
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...
Sellers Dorsey announced key leadership changes aimed at business expansion at its annual meeting on October 23. Harvey Hurdle became the Chief Executive Officer and Sellers Dorsey's founder and current Chief Executive Officer, Martin Sellers, will now serve as Founder and Chairman. "I am honored to lead Sellers Dorsey and...
In deciding whether to expand Medicaid eligibility under the Affordable Care Act (ACA), governors and state legislatures face a complex, politically and fiscally challenging choice.  The decision on Medicaid eligibility expansion is already a hot topic in state capitals and state election campaigns.  Expect the politics and policy of...
State Medicaid directors need greater flexibility and faster federal approval to maintain or establish new managed long-term supports and services (MLTSS) programs in Medicaid. A growing number of states are implementing such programs, from 8 states in 2004 to 16 states in 2012. “A strong and effective federal-state partnership with clearly aligned...
Medicaid directors have been pushed to find cost savings in their programs in the midst of recent budget shortfalls, often using blunt instruments such as cuts in benefits, provider rates, and eligibility. But Medicaid directors are also evaluating and implementing more sustainable reforms to ensure Medicaid continues to provide...
In the Medicaid managed care market, health plans that specialize in Medicaid are more likely to be profitable.  Health plans that also offer commercial and Medicare products tend to operate at a loss for their Medicaid line of business. An interesting new study by Mike McCue, DBA, at Virginia Commonwealth...

Stay Connected

4,901FansLike
7,208FollowersFollow
14,829FollowersFollow

WEATHER

Latest Articles