Accountable Care Organizations
Drug Rebate Equalization
EHR Incentive Program/Meaningful Use
Health Information Technology
Health Insurance Exchanges
Health Insurer Fee
States and Medicaid Health Plans
Accountable Care Organizations
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Medicaid Accountable Care: Accountable Care Organizations, Medicaid, and Medicaid Health Plans
October 2011: This White Paper was developed by MHPA's partner Sellers Dorsey with guidance from MHPA's ACO workgroup. It discusses similarity of purpose of ACOs and Medicaid health plans, and notes that health plans need to be essential partners in development of ACOs. Click here to read the paper.
Actuarial Soundness back to top
GAO Report on Actuarial Soundness Released
August 2010: The Government Accountability Office released a report on CMS's oversight of states' compliance with actuarial soundness requirements in Medicaid managed care rate-setting. Click here to read the report on GAO's website.
Rate Setting and Actuarial Soundness in Medicaid Managed Care
January 2006: This study surveyed state Medicaid program to determine how states are implementing actuarial soundness requirements, in order to identify both best practices and continuing areas of concern. Click here to read the study.
Cost Savingsback to top
Medicaid Capitation Expansion's Potential Cost Savings
April 2006: This study by the Lewin Group quantifies quantify the savings that can be realized through the adoption of the full-risk, integrated care model that involves state Medicaid agencies entering into capitation contracting with Medicaid managed care organizations (MCOs). Click here to read the study
Comparative Evaluation of Pennsylvania's HealthChoices Program and Fee-for-Service Program
May 2005: This study showed significant cost savings to Pennsylvania's Medicaid from utilizing managed care compared to fee-for-service. Click here to read the study.
Children's Healthback to top
GAO Report on Children's Access to Medicaid Dental Services (September 2009)
GAO Testimony on Children's Access to Medicaid Dental Services (10/7/09)
CMS Testimony on Children's Access to Medicaid Dental Services (10/7/09)
Disparitiesback to top
The Economic Burden of Health Inequalities in the United States -- The Joint Center for Political and Economic Studies
Resources Examine Racial and Ethnic Disparities Among Women at State Level - Kaiser Family Foundation
Drug Rebate Equalizationback to top
Projected Impacts of Adopting a Pharmacy Carve-In Approach Within Medicaid Capitation Programs
January 20, 2011: The Lewin Group found that 14 states can realize $11.7 billion savings in Medicaid over 10 years by adopting the Pharmacy Carve-In Model in a report commissioned by MHPA. The recently passed health reform law included equalization provisions that gave Medicaid health plans the same rebates as the fee-for-service program, effectively removing the primary incentive for states to use the pharmacy carve-out model.
Technical Report on the Medicaid Prescription Drug Rebate Equalization Act
June 3, 2009: The Lewin Group analyzed technical aspects of the Medicaid Prescription Drug Rebate Equalization Act in a new report commissioned by MHPA. Click here to view or download this report.
Dual Eligiblesback to top
Dual Eligibles and Cost Savings - November 2008: MHPA joins with the Association for Community Affiliated Plans (ACAP) in commissioning The Lewin Group to conduct a study on dual-eligible cost savings across state and federal program. The newly-released study, " Increasing Use of the Capitated Model for Dual Eligibles: Cost Savings Estimates and Public Policy Opportunities," can be viewed by clicking here.
Electronic Health Record Incentive Program/Meaningful Useback to top
The Electronic Health Record Incentive Program called for under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides federal funding for eligible health care professionals and hospitals to receive Medicare and Medicaid incentive payments when they adopt certified EHR technology and use it to achieve specified objectives.
David Blumenthal on EHR Final Rules in the NEJM
Health Information Technologyback to top
CHCS Policy Brief on EHR Incentives
Center for Health Care Strategies released a policy brief, Electronic Health Record Incentive Programs for Medicaid Providers: How Are States Preparing? that is based on interviews with Medicaid leaders in six States (Kansas, Michigan, Missouri, Oklahoma, Pennsylvania, and Virginia). Roles for Medicaid health plans varied, however Medicaid directors anticipated increased health plan involvement and were thinking strategically about leveraging health plan resources.
Health Insurance Exchangesback to top
Medicaid’s Role in the Health Benefits Exchange: A Road Map for States
The National Academy for State Health Policy (NASHP) report addresses issues for states to consider in the relationship between Medicaid and the Exchange in four key areas:
1) Eligibility, Enrollment and Outreach
2) Health Plan Contracting, Standards, and Requirements
3) Benefit Package Design
4) Exchange Infrastructure: Governance, Operations, and Finance
Health Insurance Exchanges - How Economic and Financial Modeling Can Support State Implementation
Insurance exchanges will need careful planning by states to ensure they are efficient and able to compete in the insurance market. Many states plan to conduct quantitative analyses to predict and measure the impact of the ACA and the outcomes of different exchange options. A report from the State Coveragee Initiatives (SCI) and State Health Access Data Assistance Center (SHADAC) programs provides an overview of how states may most effectively conduct these analyses through a modeling approach. Click here to read the report on the Robert Wood Johnson Foundation website.
Health Insurer Feeback to top
The January 2014 report, "ACA Health Insurer Fee: Estimated Impact on State Medicaid Programs and Medicaid Health Plans," prepared for MHPA by Milliman, Inc., shows a provision of the health reform law intended to tax health insurance companies to help fund coverage expansions, will cost the Medicaid program $37.7 billion over ten years according to a moderate growth scenario. This will cost the states about $13.6 billion and the federal Medicaid program about $24.1 billion due to the state-federal Medicaid matching formula.
Estimated Premium Impacts of Annual Fees Assessed on Health Insurance Plans
Prepared by Oilver Wyman, October 2011
Impact of ACA Annual Health Insurance Tax on State Medicaid Programs
Prepared by the Marwood Group, October 2011
MHPA Fact Sheet on Actuarial Soundess and the Health Insurer Fee
View MHPA's health insurer fee policy efforts
Long-term Careback to top
Deloitte Issue Brief: Medicaid Long-Term Care - The Ticking Time Bomb - An issue brief highlighting the fiscal concerns with Medicaid Long-Term Care, prepared by the Deloitte Center for Health Solutions
National Advisory Board to Improve Healthcare for Seniors and People with Disabilities (NAB) - Declaration for Independence: A Call to Transform Health and Long-Term Services for Seniors and People with Disabilities.
“The Expanded State of Medicaid in the United States,” a report from PwC, shows Medicaid enrollment grew by 9 million lives in 2014, with the number of Americans covered by private Medicaid health plans increasing even more by 9.3 million. Notably, the report found that the number on Medicaid fee-for-service actually decreased for the first time, dropping by 300,000 enrollees. The report shows this growth in Medicaid and Medicaid managed care was largely driven by Medicaid expansion, with expanding states increasing by 24 percent.
Medicaid Fundingback to top
Extra Federal Support for Medicaid
In August 2010, Congress voted to temporarily increase federal Medicaid funding for recession-plagued states that will avert potentially drastic state spending cuts. This health policy brief by Health Affairs breaks down the issues, background, and what's next for this extension for federal Medicaid funding. Click here to read the entire brief.
Covering Low-Income Childless Adults in Medicaid: Experiences from Selected States
In this study, the Center for Health Care Strategies and its partners from Mathematica Policy Research examine experiences from 10 states with existing programs for low-income childless adults to shed light on the potential expansion population. Click here to read the study.
Medical Homesback to top
MHPA White Paper and Policy Statment on Medical Homes
On September 21, 2010, MHPA released a policy statement and white paper highlighting the common ground between Medicaid plans and the patient-centered medical home (PCMH) model. According to MHPA, the capabilities of Medicaid plans are closely aligned with the principles of PCMHs and therefore plans should be included in states' PCMH implementation strategies. Click here to read the Executive Summary or dowload the full White Paper and Policy Statement directly.
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Report Shows Need for National Medicaid Out-of-Network Claims Policy
July 13, 2009: This report by the Lewin Group, commissioned by MHPA and ACAP, has demonstrated a need for a national Medicaid Out-of Network claims policy to reduce inappropriate billing and unpredictable payment issues. Click here to read the report.
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The User's Guide to the ROI Forecasting Calculator: Estimating ROI for Medicaid Quality Improvement Program
The Center for Healthcare Strategies and The Commonwealth Fund
States and Medicaid Health Plansback to top
State Pushback on Medicaid Expansion in Health Care Reform
Wall Street Journal. June 2009
Using Data Strategically in Medicaid Managed Care - Center for Health Care Strategies