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Racial and Ethnic Differences in Access to Care and Service Use for Children with Coverage through Medicaid and the Children's Health Insurance Program (Discussion Papers/Low Income Working Families)
Genevieve M. Kenney, Christine Coyer, Nathaniel Anderson

By 2010, Medicaid and CHIP covered 36 percent of all children and over half of all Hispanic and black children. Generally, the Hispanic, black, and white children served by Medicaid and CHIP appear to have high levels of access to care. However, black and Hispanic children with Medicaid/CHIP coverage may have more problems accessing care, relative to their white counterparts, in two areas: specialty and mental health care. While overall levels of care are similar, the magnitude of difference in specialty care requires further study to explore both the causes and the potential implications of these patterns.

Posted to Web: March 29, 2013Publication Date: March 29, 2013

The Composition of Children Enrolled in Medicaid and CHIP: A Summary (Policy Briefs)
Christine Coyer, Genevieve M. Kenney

In 2010, Medicaid and CHIP covered over a third of all children in the U.S., over a fifth of white children, and more than half of all Hispanic and black children. Full implementation of the Affordable Care Act (ACA) will lead to increased coverage for these children. This fact sheet summarizes analysis which reveals racial and ethnic variation in residential patterns and health status for children in these programs. Children covered by Medicaid and CHIP in these three groups live in different areas of the country, which can lead to variations in future changes to children’s access to care due to state differences in ACA implementation.

Posted to Web: March 29, 2013Publication Date: March 29, 2013

The Composition of Children Enrolled in Medicaid and CHIP: Variation over Time and by Race and Ethnicity (Discussion Papers/Low Income Working Families)
Christine Coyer, Genevieve M. Kenney

In 2010, Medicaid and CHIP covered over a third of all children in the U.S., over a fifth of white children, and more than half of all Hispanic and black children. Full implementation of the Affordable Care Act (ACA) will lead to increased coverage for these children. This paper summarizes analysis which reveals racial and ethnic variation in residential patterns and health status for children in these programs. Children covered by Medicaid and CHIP in these three groups live in different areas of the country, which can lead to variations in future changes to children's access to care due to state differences in ACA implementation.

Posted to Web: March 29, 2013Publication Date: March 29, 2013

Financing Medicare and Medicaid: Testimony Before the Subcommittee on Health Committee on Energy and Commerce U.S. House of Representatives (Testimony)
Judy Feder, Paul Van de Water

Continuing to slow health cost growth is essential; but Medicare and Medicaid are not in crisis. Recent per beneficiary cost growth has slowed so significantly that CBO has dramatically reduced its spending projections for the coming decade. In Medicare, refinement of existing payment mechanisms alongside payment reform can produce additional savings. But as the elderly population doubles over the coming decades, a balanced deficit-reduction package must include new revenues The alternative, changing entitlement structures through vouchers or block grants (or adopting an overly ambitious savings target that could produce the same results), would undermine essential protections and shift or even increase health care costs.

Posted to Web: March 27, 2013Publication Date: March 18, 2013

Can Medicare Be Preserved While Reducing the Deficit? (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, John Holahan, Stephen Zuckerman

The politically polarized debate over the role of Medicare in deficit and debt reduction often ignores the accumulating evidence that the program can achieve significant spending reductions without sacrificing Medicare's essential protections. We identify policies that correct long-standing gaps in financial protections that Medicare beneficiaries face, promote greater efficiency within payment systems, and recognize the need for additional revenues to pay for the impending surge in the number of beneficiaries in the program. Our illustrative package of reasonable Medicare policy options produces substantial budgetary savings, while preserving and, in some cases, enhancing the program for current and future beneficiaries. Together, these policies would provide savings or new revenues of about $600 billion after paying for permanent repeal of the SGR.

Posted to Web: March 07, 2013Publication Date: March 07, 2013

Emerging Opportunities for Addressing Maternal Depression under Medicaid (Research Brief)
Embry M. Howell, Olivia Golden, William Beardslee

This brief highlights opportunities and challenges for Medicaid programs in providing access to services for depressed mothers. Low income mothers have high rates of untreated depression, posing significant risks for them and their children. Medicaid covers many such mothers and children, and coverage will increase with implementation of the Affordable Care Act (ACA). Emerging opportunities include new approaches to screening and treatment and new federal funding for integrated health care models and patient-centered medical homes. Major challenges include fragmentation between primary care and mental health care systems and provider shortages. The brief provides suggestions for addressing these challenges.

Posted to Web: March 05, 2013Publication Date: January 24, 2013

Reducing Waste in Health Care (Research Report)
Nicole Cafarella Lallemand

A recent study by former Centers for Medicare and Medicaid Services administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that waste may constitute a third of US health spending. This policy brief examines waste in health care that may result from poor delivery of care, failed care coordination, overtreatment, administrative complexity, and uncompetitive pricing. The author concludes with presenting opportunities and challenges associated with efforts to eliminate waste in health care without harming consumers or reducing the quality of care provided.

Posted to Web: February 21, 2013Publication Date: February 21, 2013

SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System: Testimony before the Energy and Commerce Committee U.S. House of Representatives (Testimony)
Robert A. Berenson

On February 14, 2013, Urban Institute Fellow Robert Berenson testified before the House of Representatives Committee on Energy and Commerce on ways to improve the Medicare physician payment system. While everyone agrees that paying for value and not volume is important, Dr. Berenson argues value should be derived from how well particular services are performed as well as the mix of services beneficiaries receive. The current Medicare Fee Schedule reimburses too many technically oriented services and procedures, and not enough patient-clinician interactions to diagnose, and develop treatment approaches consistent with a patient's values and preferences. Nor does it encourage care coordination and other patient-centered activities that could improve patient outcomes.

Posted to Web: February 14, 2013Publication Date: February 14, 2013

After the Supreme Court Decision: The Implications of Expanding Medicaid for Uninsured Low-Income Midlife Adults (Research Report)
Lynda Flowers, Matthew Buettgens

The Affordable Care Act required states to expand their Medicaid programs to cover more low-income people, including mid-life adults. However, a recent U.S. Supreme Court decision, while upholding the rest of the health reform law, effectively turned the mandate into a state option. This brief examines the Court's decision and how uninsured midlife adults in states that take up this option could benefit.

Posted to Web: February 12, 2013Publication Date: February 12, 2013

How are CHIPRA demonstration States approaching practice level quality measurement and what are they learning? (Research Report)
Kelly J. Devers, Additional Authors

This Evaluation Highlight is the first in a series that presents descriptive and analytic findings from the 18-state evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)'s Quality Demonstration Grants. In this Highlight, we discuss the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. Our analysis is based on work completed by the States during the first two years of their five-year demonstration projects. These two years included a one-year planning period followed by a year of implementation.

Posted to Web: January 31, 2013Publication Date: January 31, 2013

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