Clear all

11 results found

reorder grid_view

Medicaid in Small Towns and Rural America: A Lifeline for Children, Families and Communities

June 6, 2017

Medicaid is a vital source of health coverage nationwide, but the program's role is even more pronounced in small towns and rural areas. Medicaid covers a larger share of nonelderly adults and children in rural and small-town areas than in metropolitan areas; this trend is strongest among children. Demographic factors have an impact on this relationship: rural areas tend to have lower household incomes, lower rates of workforce participation, and higher rates of disability— all factors associated with Medicaid eligibility. In addition, the role of Medicaid has increased in the past few years both in small towns and rural areas and in metropolitan areas, given the implementation of the Affordable Care Act (ACA) and more aggressive efforts to enroll children in Medicaid and the Children's Health Insurance Program (CHIP). Because Medicaid plays such a large role in small towns and rural areas, any changes to the program are more likely to affect the children and families living in small towns and rural communities.

The Role of Medicaid Managed Care In Delivery System Innovation

April 8, 2014

States are increasingly turning to Medicaid managed care as a key strategy to manage costs and encourage innovation in health care delivery. This report examines health care providers' perspectives on the role of managed care in improving health services for low-income adults in four communities: Milwaukee, Wisconsin; Oakland, California; Seattle, Washington; and Washington, D.C. It finds that providers do not generally perceive Medicaid managed care as a catalyst for delivery system reform. Fragmented delivery systems, limits on the types of services for which managed care organizations are at risk, and the volatility in managed care markets all present challenges to improving care delivery. Policy and operational changes could enhance the role of Medicaid managed care in promoting patient-centered, coordinated, and high-quality care.

Medicaid Managed Care in Florida: Federal Waiver Approval and Implementation

October 7, 2013

Florida's new Medicaid plan -- called the Managed Medical Assistance program -- will move nearly all of the state's Medicaid beneficiaries into managed-care plans. This new plan, approved in June 2013, is the final chapter in a Medicaid reform effort that is almost a decade old. Drawing on experiences from that decade of experimentation, the new plan incorporates significant consumer protections, some unique to Florida. Most of these protections establish the need for ongoing oversight and public input, creating opportunities for stakeholder monitoring and comment

Unexpected Charges: What States Are Doing About Balance Billing

April 8, 2009

Examines restrictions in California and four other states on balance billing, in which a patient must pay the difference between out-of-network providers' charges and insurers' reimbursements. Outlines limitations and considerations for policy makers.

The Medicare Part D Coverage Gap: Costs and Consequences in 2007

August 21, 2008

Analyzes data on Medicare Part D enrollees who reached the coverage gap and had to pay the full cost until they qualified for catastrophic coverage, who then stopped taking their medications or bought cheaper ones, and who received catastrophic coverage.

Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries

May 30, 2008

Examines options for simplifying Medicare's prescription drug benefit, including streamlining benefit procedures and descriptions; further standardizing benefit parameters, especially cost-sharing rules; and modifying rules on plan formularies.

Medicare Advantage: Options for Standardizing Benefits and Information to Improve Consumer Choice

April 14, 2008

Describes the complex choices Medicare Advantage enrollees face. Discusses whether providing better information and decision-support tools, limiting out-of-pocket expenses, or standardizing benefits and cost-sharing would lead to better-informed choices.

Medicare Prescription Drug Plans in 2008 and Key Changes Since 2006: Summary of Findings

April 1, 2008

Synthesizes findings from prior research on the scope and generosity of drug coverage under Medicare Part D, as well as on changes in drug coverage and costs since 2006. Looks at premiums, the coverage gap, tiered cost-sharing, and utilization management.

An In-Depth Examination of Formularies and Other Features of Medicare Drug Plans

April 1, 2006

Provides a detailed assessment of the formularies, drug costs, and utilization management tools offered by the fourteen nationwide organizations that account for most of the stand-alone prescription drug plans.

Voices of Beneficiaries: Early Experiences with the Medicare Drug Benefit

April 1, 2006

Presents findings from a survey that examines the enrollment decisions, experiences, and future concerns related to the prescription drug coverage of beneficiaries with the new Medicare prescription drug benefit. Part of a series of interviews.

Cost Containment Strategies for Prescription Drugs: Assessing the Evidence in the Literature

March 1, 2005

Outlines various options for addressing prescription drug spending growth, including a description of each cost containment strategy, its use by private or public payers, and a discussion of known evidence about its effectiveness or cost saving potential.