MOE (Maintenance of Effort). The amount that a state must spend from its own funds to receive its full allocations under a federal grant program. Requirements are typically based on historic spending levels.
Maintenance-of-effort provision in the Affordable Care Act. A provision in the health care reform law that requires states to maintain their eligibility standards and enrollment practices for Medicaid and the Children’s Health Insurance Program (CHIP), with exceptions for states that have waivers in their current Medicaid programs. The provision prevents states from cutting costs by covering fewer people. The Medicaid requirement for adults lasts until 2014, when new nationwide standards go into effect and states have set up their health insurance exchanges. The Medicaid and CHIP requirements for children last until 2019.
Managed Care. Refers to the prepaid health care sector (e.g., HMOs) in which care is provided under a fixed budget so costs can be "managed."
Managing for Results. Managing an agency with concern for the quality, outcomes, and efficiency of the services it provides, usually including a formal performance measurement process that provides information on these factors.
Marginal Tax Rate. The tax rate that would have to be paid on an additional dollar of income. Marginal tax rates affect individuals' incentives to work, save, and shelter income from tax.
Marriage Penalty. Occurs when a couple filing joint returns experiences a greater tax liability than they would have if each of the two people were to file as single individuals; results from provisions throughout the federal income tax code designed to tax household income-whether the household consists of a married couple filing jointly or a single individual.
Medicaid. A federal entitlement program that reimburses states for a portion of the costs associated with providing acute and long-term care services to certain low-income individuals. States determine which services, and categories of people, beyond the minimum required by federal law, to cover. States also establish payment rates for providers and administer the program.
Medical home. A primary care practice that coordinates comprehensive, continuous health care under one roof—avoiding the often fragmented nature of medical services. Patients receive personalized care and have direct access to a primary care doctor who manages their overall health care. Medical homes aren’t literally homes where patients live; they’re “homes” for patient information. Staff often use electronic medical records or other technological innovations to better coordinate health care.
Medical loss ratio. For health insurance, the medical loss ratio is the portion of premiums spent on clinical services, quality, and certain other non-administrative costs. The Affordable Care Act requires insurance companies selling coverage in the large-group market to spend at least 85 percent of their premium dollars on clinical services and quality; insurers in the small-group and nongroup insurance markets must spend at least 80 percent on such costs. Carriers that don’t comply will be required to return the difference to enrollees.
Medical Savings Account (MSA). Personal funds established by individuals or their employers to pay current out-of-pocket medical costs and to accumulate funds for future expenses.
Medicare Part A. (Compare Medicare Part B.) The part of Medicare that covers hospital services, skilled nursing facility services, and some home health care. Anyone over age 65 who is eligible for Social Security and persons under age 65 who have received Social Security disability payments for two years are eligible.
Medicare Part B. (Compare Medicare Part A.) Supplementary Medical Insurance for Medicare beneficiaries; provides physician services and other ambulatory care (such as outpatient hospital services and tests). Beneficiaries must pay a premium to join, which is equivalent to one-fourth the costs of the benefit. All persons over the age of 65 and other Medicare beneficiaries can enroll.
Medicare premium support system. One option for reforming Medicare. Under a commonly recommended premium support system, the federal government would give beneficiaries a set amount of money to buy health insurance from traditional Medicare or private plans. The beneficiary would cover additional expenses if the plan costs more than the voucher or could keep the extra money if the voucher is worth more than the plan. Essentially, premium support converts Medicare from a defined benefit program to a defined contribution program.
Metropolitan Statistical Area (MSA). An economically integrated region including and surrounding a central city; areas in an MSA outside the central city are suburbs.
Microsimulation. A process of calculating the value of a variable or set of variables at the individual level conditional on a set of parameter assumptions, often using a large data set with thousands of individual observations. The TPC microsimulation model, for example, calculates income tax liability, marginal tax rates, etc., for a sample of about 200,000 individual income tax returns. Population aggregates may be calculated based on the weighted sum of individual observations. The models are particularly useful for measuring the effects of a policy on various types of households or tax units.
Mini-medical (mini-med) plans. Basic health insurance plans with limited benefits, low monthly premiums, and low annual spending limits. Mini-med plans are most commonly offered to low-wage or part-time workers. The Affordable Care Act prohibits annual and lifetime limits as of January 1, 2014, which will rule out these types of plans.
Moral Hazard. The incentives created by certain policies that cause affected individuals or entities to engage in costly, undesirable, or counterproductive behaviors. (For example, drivers with collision insurance may drive a bit more recklessly.)