Medicaid and CHIP Managed Care Payment Methods and Spending in 20 States: Final Report to the Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services (Research Report)
This study of Medicaid and CHIP managed care programs in 20 states indicates that capitation rate-setting became more data-driven and transparent during the time period 2001-2010. Benefit packages were fairly consistent over time and among states, with carve outs in every state for a least one acute service. Total spending on managed care services for Medicaid enrollees varied considerably across states and subgroups; nondisabled children had the lowest average monthly spending and adults with disabilities had the highest.
Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
|Posted to Web: October 17, 2013||Publication Date: December 01, 2012|
Using data from the 2008 Survey of Income and Program Participation, we find that information about past income and employment that is available to state Medicaid programs can potentially verify (a) initial financial eligibility for between 55 and 79 percent of eligible applicants and (b) renewed eligibility for between 60 and 71 percent of eligible enrollees. Verifying eligibility based on data matches, rather than documentation from consumers, could lower administrative costs; cut paperwork burdens for consumers, thereby increasing participation levels among those who qualify for help; and prevent eligibility errors.
Administrative Renewal, Accuracy of Redetermination Outcomes, and Administrative Costs (Research Report)
|Posted to Web: October 14, 2013||Publication Date: October 14, 2013|
When a Medicaid beneficiary approaches the end of a 12-month enrollment period, coverage should be "administratively renewed," according to ACA a regulation, if "reliable information" shows the beneficiary remains eligible. The beneficiary is sent a notice explaining the basis for renewal and the legal duty to make needed corrections. If none are forthcoming, coverage continues. We find that using administrative renewal should lower the number of mistaken outcomes if it is used with beneficiaries known to have an 80 percent or greater likelihood of eligibility. However, administrative renewal will change most mistakes from incorrect terminations to incorrect renewals.
Reaching and Enrolling the Uninsured: Early Efforts to Implement the Affordable Care Act (Research Report)
|Posted to Web: October 14, 2013||Publication Date: October 14, 2013|
The Affordable Care Act's success depends on whether eligible, uninsured persons can enroll in health coverage. Meeting enrollment goals partially hinges on the effectiveness of marketing campaigns to raise public awareness, and application assistance programs that help consumers enroll. This brief describes early state efforts, and finds that government officials have taken many positive steps including launching multi-pronged campaigns that combine broad marketing with grass-roots outreach, and funding community-based organizations and providers to provide hands-on assistance. Differences in the intensity of these efforts across states are stark, however, and may contribute to noticeably different enrollment experiences during early ACA implementation.
Medicaid/CHIP Participation Rates Among Children: An Update (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: October 09, 2013||Publication Date: October 09, 2013|
This brief assesses Medicaid/Children's Health Insurance Program (CHIP) participation rates and the number of uninsured children who are eligible for Medicaid or CHIP using the most recent data available from the American Community Survey. Since 2008, Medicaid/CHIP participation rates have risen by 5.5 percentage points among children, increasing to 87.2 percent in 2011; in that year, 20 states (including the District of Columbia) had participation rates at or above 90 percent and four states had rates below 80 percent. These findings suggest that the increased state and federal policy efforts aimed at reducing the number of eligible but uninsured children have been yielding results and that there is scope for more progress, by increasing participation in the lower-performing states. However, despite the potential for further progress, there is uncertainty about how children’s coverage will change in the coming years.
No Wrong Door: Improving Health Equity and the Health Coverage Consumer Experience in Connecticut (Policy Briefs)
|Posted to Web: September 19, 2013||Publication Date: September 19, 2013|
"No Wrong Door" (NWD) is a system that allows consumers to apply for health insurance through different agencies, and then seamlessly routes them to the program for which they qualify. We find that over the course of a year under the Affordable Care Act, NWD would prevent 36,000 Connecticut residents from losing health insurance coverage for at least part of the year. Connecticut's leaders have committed to full implementation of NWD by the end of 2015. If this commitment is fulfilled, significant gains will result for both state government and residents. However, monitoring implementation in the transition period is critical.
How are CHIPRA Quality Demonstration States working to improve adolescent health care? (Research Brief)
|Posted to Web: September 06, 2013||Publication Date: September 01, 2013|
Several CHIPRA Quality Demonstration states are working with participating clinicians to enhance their ability to improve the quality of health care delivered to adolescents. Specifically, North Carolina and Utah are facilitating adolescent-focused quality improvement collaboratives for primary care practices, and Colorado and New Mexico are providing support and coaching to school-based health centers serving adolescents. This Evaluation Highlight describes barriers these states encountered in their efforts to improve care for this population, identifies strategies to address these barriers, and suggests actions state Medicaid agencies could take to enhance adolescent health care.
How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? (Research Report)
|Posted to Web: September 06, 2013||Publication Date: August 03, 2013|
Many Medicaid and CHIP programs and private health plans are pursuing medical home initiatives aimed at improving the quality of health care, but varying conceptual definitions and measurement goals have led to the development of a number of different medical home measurement tools. This Evaluation Highlight, funded by the U.S. Department of Health and Human Services, examines the measurement of "medical homeness" in selected CHIPRA Quality Demonstration projects, describes the development of the Medical Home Index-Revised Short Form (an adaptation of the Medical Home Index survey), and presents preliminary statistics on medical homeness for demonstration practices in six States.
Achieving the Potential of Health Care Performance Measures (Policy Briefs/Timely Analysis of Health Policy Issues)
|Posted to Web: June 14, 2013||Publication Date: June 14, 2013|
There is a consensus that evaluating and reporting on the performance of health care providers can be instrumental in improving value in U.S. health care. But the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide incentives to improve performance. This Robert Wood Johnson Foundation-funded paper describes the current state of performance measurement and reporting, details what’s wrong, and outlines seven policy recommendations that offer a path to achieving the promise of performance measurement while avoiding its adverse consequences.
An Early Look at the Impact of Express Lane Eligibility on Medicaid and Children's Health Insurance Program Enrollment:: An Analysis of the Statistical Enrollment Data System (Research Report)
|Posted to Web: May 23, 2013||Publication Date: May 23, 2013|
With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.
|Posted to Web: May 22, 2013||Publication Date: June 04, 2012|