- ACA Implementation & State Health Reform
- Coverage and Access
- Federal/State Issues
- Medicaid and CHIP
- Population and Public Health
- Providers and Services
- Acute Care
- Assisted Living
- Behavioral Health
- Case Management
- Child Development Services
- Chronic Care Management
- Community Health Centers
- Developmental Screening
- Early Childhood Services
- Emergency Care
- EPSDT
- Family Planning
- Federally Qualified Health Centers
- Home & Community Based Services
- Hospitals
- Long Term Services & Supports
- Medical Homes & Health Homes
- Mental Health
- Nursing Homes
- Oral Health
- Preventive Care
- Primary Care
- Safety Net Providers
- Quality, Cost, and Health System Performance
- ACOs
- Adverse Event Reporting
- Care Transitions
- Comparative Effectiveness
- Cost Sharing
- Delivery System Reform
- Fraud and Abuse
- Health Care Workforce
- Health Information Technology
- Managed Care
- Medical Homes & Health Homes
- Medical Malpractice
- Patient Safety
- Payment Reform
- Performance Measurement
- Provider Payment Policy
- Quality Oversight
- Specific Populations
- Adolescents
- Childless Adults
- Children
- Children with Special Health Care Needs
- Dual Eligibles
- Elders
- Families
- Low Income People
- Parents
- People with Chronic Conditions
- People with Developmental Disabilities
- Transitional Youth
- Vulnerable Populations
- Young Adults
- Youth
- Youth in Foster Care System
- Youth in Juvenile Justice System
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Interagency Collaboration for Quality Care in Medicaid Managed Care for Low Income Mothers and Children
This paper reports on the experiences of two states, Colorado and Virginia, in their efforts to develop an interagency collaborative approach to the oversight of managed care entities generally, and Medicaid managed care entities in particular. The demonstration project was a year-long effort conducted by the National Academy for State Health Policy (NASHP), funded by the David and Lucile Packard Foundation, to see if by implementing an interagency approach among Medicaid, Health, and Insurance, a state could strenghten its approach to oversight of prepaid managed care organizations, particularly those serving Medicaid eligible low income women and children.
December 1997» -
Transitioning to Managed Care: Medicaid Managed Care in Mental Health
This report reflects the discussion of nine states participating in "Transitioning to Managed Care: Medicaid Managed Care in Mental Health." The symposium was funded by the Henry J. Kaiser Family Foundation and the federal Health Care Financing Administration (HCFA).
June 1997» -
The Lay of the Land: What Program Managers Need to Know to Serve People With HIV/AIDS In Medicaid Managed Care
This report will help state officials, advocates and consumers implement risk-based Medicaid managed care programs that meet the health care needs of people with HIV/ AIDS in cost-effective ways.
May 1997» -
State Eligibility Rules and Assessment Instruments: Implications for People with Alzheimer's Disease
The rising number of people with Alzheimer's disease presents significant challenges for family members, caregivers, advocates, public policy makers and service providers. Faced with budgetary pressures and concerns about access to care and continuity of care, states are developing managed care programs for elderly Medicaid beneficiaries, reviewing eligibility policies and fine tuning assessment tools used to measure need for long term care. This study focuses on the development of assessment tools and eligibility criteria and explores the implications of these developments for people with Alzheimer's disease and related disorders. The study examined three areas: Medicaid spending patterns, case studies based on activities in two states and the assessment instruments used in selected states.
March 1997» -
Directory of Risk-Based Medicaid Managed Care Programs Enrolling Elderly Persons or Persons with Disabilities
This directory provides a snapshot of states enrolling elderly persons and/or persons with disabilities into risk-based Medicaid managed care programs as of January 1, 1997. For each state, it focuses on such issues as:
- Waivers
- Eligibility
- Specialty/generic program
- Voluntary/mandatory enrollment
- Service package
- Contractors
- Risk limitation mechanisms
- Case management
- Linkage with the long-term care system
January 1997» -
Quality Improvement Primer for Medicaid Managed Care
This Quality Improvement (QI) Primer is a compilation of insights and tools gathered over a two-year period as three states implemented a new approach for monitoring the quality of services under Medicaid managed care arrangements. Through funds made available from The Henry J. Kaiser Family Foundation, Minnesota, Ohio and Washington worked with the National Academy for State Health Policy to test the effectiveness and feasibility of quality improvment guidelines published by the Health Care Financing Administration (HCFA).
June 1995» -
The Decline of State-Based Hospital Rate Setting: Findings and Implications
This paper summarizes the results of a conference in Albany, New York in November 1994 that brought together representatives from the four current and former "all payer" rate setting states of Maryland, Massachusetts, New Jersey and New York.
State-based prospective hospital rate setting has declined from its former position as "the center of the policy paradigm for controlling health care costs" that it held in the 1970s. In 1980, about 30 states had some form of payer or budget regulation of hospitals; today, only six maintain any form of mandatory rate setting or budget controls: Florida, Maine, Maryland, New York, Rhode Island, West Virginia; Arizona and Vermont maintain voluntary systems.
May 1995» -
Managing Care for Older Beneficiaries of Medicaid and Medicare: Prospects and Pitfalls
States have demonstrated that it is possible to improve care for the elderly and contain costs at the same time. Notable examples of this success are the creative home- and community-based waiver and state-funded programs operating in Wisconsin, Oregon and Washington, which have shown that people who are nursing home certifiable can be given the less restrictive services they prefer at a cost lower than nursing home care. Yet these programs and others operated by states in every part of the country can only go so far before they bump into the Medicare wall. When an elderly person needs acute care services (as they frequently do), they enter a different part of the service delivery system where Medicare is the major payer. Typically, this part of the service system is disconnected from the long-term care portion, making transitions abrupt and traumatic for consumers. Rather than working together for the maximum benefit of consumers, each part of the system is motivated to guard its resources jealously, shifting patients and their costs to the other part of the system rather than managing those costs.
September 1994 -
Challenges for Decisionmakers: How Managed Competition Could Affect Children with Special Health Care Needs
This briefing report is written to alert public and private sector decision makers to the potential advantages and disadvantages of a health care reform strategy based on managed competition from the perspective of an important and vulnerable population -- children with special health care needs. Nearly a third of all children in the U.S. currently have a chronic physical, developmental, learning, emotional, and behavioral problem. A small but growing proporation of children -- 6 percent nationwide -- are limited in their ability to play or to attend school. Many of these children are poor; in fact, poor children are more likely to experience severe health problems than their nonpoor counterparts.
April 1994 -
Managed Care for the Elderly: A Profile of Current Initiatives
The purpose of this document is to summarize the current state-of-the-art in managed care for the elderly and to provide states with background information needed to launch their own initiatives to provide quality, cost effective care to the rapidly aging population. As you will see, attempts to truly coordinate primary, preventive, acute, and long term care have been limited, but the demonstrations that do exist show promise. As the health care reform debate unfolds, it is likely that states will seek to do more to manage care for the elderly, and we hope this document provides useful, baseline information.
November 1993»
