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

The nation’s 9 million Medicare-Medicaid dual eligibles - low-income frail seniors and persons of all ages with severe disabilities - now use about $350 billion in healthcare annually.  States and CMS are rolling out models to integrate Medicare and Medicaid financing and care delivery for dual eligibles.  These reforms are of...
Medicaid financing is extremely complex.  Federal upper payment limits on hospitals, nursing facilities, and other healthcare providers are a case in point.  Here is a quick primer. Origins of Upper Payment Limit: The Upper Payment Limit (UPL) is a federal limit placed on fee-for-service reimbursement of Medicaid providers.  Specifically, the Upper...
Medicaid enrollment is expected to increase dramatically starting in 2014 under the Affordable Care Act (ACA).  New final and interim final rules from the Centers for Medicare and Medicaid Services (CMS) significantly expand Medicaid eligibility for adults under age 65 and streamline existing Medicaid eligibility and enrollment processes. These new...
A new federally mandated tax on health insurers will increase costs for state Medicaid programs and Medicaid health plans. In an excellent new report, PPACA Health Insurer Fee Estimated Impact on State Medicaid Programs and Medicaid Health Plans, Milliman, retained by the Medicaid Health Plans of America (MHPA), conducted an independent...
As part of the Affordable Care Act (ACA), Medicaid coverage could be expanded to cover nearly 400,000 currently uninsured American Indians and Alaska Natives (AI/AN). This population, particularly sensitive to health disparities, suffers from elevated disease burdens and poorer overall health than that of the general population. The AI/AN...
The AHRQ released its background report, National Advisory Council Subcommittee: Identifying Health Care Quality Measures for Medicaid-Eligible Adults. Required by the Affordable Care Act, this report identified a recommended core set of quality measures for Medicaid-eligible adults. Also aimed at providing states with insight into health care quality for...
As part of the Health Reform Toolkit Series, the Blue Cross Blue Shield of Massachusetts Foundation, the Robert Wood Johnson Foundation, and the Commonwealth Health Insurance Connector Authority have published Effective Education, Outreach, and Enrollment Approaches for Populations Newly Eligible for Health Coverage. The series offers resources for health...
Following a five-year demonstration, a new report examines the Health Opportunity Accounts Demonstration Program created by the Deficit Reduction Act (DRA).  The law allowed up to 10 states to test the use of Health Opportunity Accounts as an alternative health benefit design in Medicaid. Participating states were allowed to establish Health Opportunity...
The $350 billion Medicare-Medicaid dual eligible market is an extraordinary new business opportunity for health insurers, as well as a way for state Medicaid programs to generate significant budget savings and improve access and quality of care for frail seniors and persons with severe disabilities.  A dozen states are now looking...
As part of health reform implementation, states will create a large and complex new marketplace for the buying and selling of health insurance coverage. Through State Exchanges, individuals and small businesses may buy federally defined benefit packages from state licensed and certified Qualified Health Plans. For health plans, this is...

Stay Connected

4,834FansLike
6,955FollowersFollow
17,150FollowersFollow

WEATHER

Latest Articles