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In States That Don't Expand Medicaid, Who Gets New Coverage Assistance Under the ACA and Who Doesn't? (Policy Briefs/Timely Analysis of Health Policy Issues)
Stan Dorn, Matthew Buettgens, Jay Dev

This research provides more evidence that state officials' decisions against expansion adversely affect already disadvantaged residents. While 5.9 million adults with moderate incomes in nonexpanding states qualify for financial assistance to purchase insurance through the new marketplaces, nearly 6.3 million uninsured residents with lower incomes remain ineligible for help because the state's Medicaid program was not expanded. The median income of those ineligible for coverage assistance is less than $800 a month, compared to more than $2,000 a month for those eligible to receive subsidies.

Posted to Web: October 09, 2014Publication Date: October 09, 2014

Structuring Payment to Medical Homes After the Affordable Care Act (Article)
Robert A. Berenson, Additional Authors

The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models.

Posted to Web: October 02, 2014Publication Date: October 02, 2014

How Local Context Affects Providers' Adoption and Use of Interoperable Health Information Technology: Case Study Evidence from Four Communities in 2012 (Round One) (Research Report)
Kelly J. Devers, Arnav Shah, Fredric Blavin

These issue briefs explore how local context affects HITECH program implementation as well as providers' incentives and ability to achieve Meaningful Use. These briefs identify the influence that state governments and policies, local grantees charged with implementing particular HITECH programs, health care market and community characteristics, and current health care reform efforts are having on providers' incentives and ability to meaningfully use EHRs and qualify for Medicare and Medicaid incentive payments.

Posted to Web: October 02, 2014Publication Date: August 22, 2014

How Local Context Affects Providers' Adoption and Use of Interoperable Health Information Technology: Case Study Evidence from Four Communities in 2013 (Round Two) (Research Report)
Fredric Blavin, Arnav Shah, Nicole Cafarella Lallemand, Kelly J. Devers, Christal Ramos

These issue briefs explore how local context affects HITECH program implementation as well as providers' incentives and ability to achieve Meaningful Use. These briefs identify the influence that state governments and policies, local grantees charged with implementing particular HITECH programs, health care market and community characteristics, and current health care reform efforts are having on providers' incentives and ability to meaningfully use EHRs and qualify for Medicare and Medicaid incentive payments.

Posted to Web: October 02, 2014Publication Date: August 22, 2014

Joint SNAP and Medicaid/CHIP Program Eligibility and Participation in 2011 (Research Report)
Laura Wheaton, Victoria Lynch, Pamela J. Loprest, Erika Huber

More than one-third of all children were eligible for both Supplemental Nutrition Assistance Program (SNAP) and Medicaid/Children’s Health Insurance Program (CHIP) benefits in 2011, the most recent year of data available. Far fewer adults were jointly eligible. Reasons for the difference include children’s high poverty rates and state eligibility policies. However, joint participation rates (the percent of eligibles receiving benefits) suggest that many eligibles were not participating. In four out of five of states with available data, less than three-quarters of those jointly eligible (adults and children) were receiving both benefits. Efforts to streamline and integrate application systems have the potential to improve program reach to families in need.

Posted to Web: September 29, 2014Publication Date: September 29, 2014

Disability and Care Needs Among Older Americans (Article)
Vicki Freedman, Brenda Spillman

Estimates from the new National Health and Aging Trends Study indicate that nearly half of Medicare enrollees age 65 or older had difficulty or received help in the last month with daily activities in 2011. Of those receiving help, 10% were in a nursing homes, 15% were in alternative supportive care settings, and the rest lived in the community (75%). Persons with low incomes were a disproportionate share of those receiving help with at least 3 self-care or mobility activities in settings other than nursing homes. Informal care, primarily from family members, was substantial—164 hours monthly for older persons receiving help in the community and 50 for those in alternative supportive settings. Adverse consequences related to unmet need affected nearly a third of persons with difficulty or help in all settings other than nursing homes and nearly twice that proportion of persons receiving paid help in the community. Results suggest that policies to improve services and supports and reduce unmet need could benefit both older adults and those who care for them.

Posted to Web: September 25, 2014Publication Date: September 09, 2014

Implementation of the Affordable Care Act: Cross-Cutting Issues : Six-State Case Study on Network Adequacy (Research Report)
Sabrina Corlette, Kevin Lucia, Sandy Ahn

During the transition to new health insurance marketplaces, insurers revamped their approach to network design, and many now offer narrower provider networks. Researchers assessed network changes and efforts at regulatory oversight in six states. Researchers found that insurers made significant changes to the networks of their individual market plans. Insurers and state officials reported confusion about which plan networks included which providers, but most received few complaints about consumers' ability to obtain in-network services. While half these states have taken action to improve provider directories, it appears unlikely that states will dramatically change network standards, at least in the short-term.

Posted to Web: September 24, 2014Publication Date: September 24, 2014

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