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108 Results found.

Brief & Report

Medicare Advantage Ground Ambulance Cost Sharing Levels Strain Enrollees and Ground Ambulance Entities

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This white paper presents findings from 量子资源鈥� (HMA) 2025 analysis of state-level variation in MA plan copayments for ground ambulance transports. We identify the range of cost sharing used by MA plans by state, the average MA plan copayment by state, and compare these average copayment levels to both national Medicare FFS cost sharing levels for ground ambulance services. The report also examines average state-level MA plan copayment levels for emergency department services.

As our analysis demonstrates, the flexibility permitted to MA plans to establish beneficiary cost sharing levels for ground ambulance services has resulted in wide variation in MA plan copayments and significantly higher cost sharing for ground ambulance services for MA beneficiaries than those enrolled in traditional Medicare. The flexibility of the MA benefit design for ground ambulance services has potentially negative consequences for the millions of MA plan enrollees and the roughly 11,000 ambulance entities which conduct these services and collect beneficiary cost sharing.

Brief & Report

Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss

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The upcoming 2026 open enrollment period for the Affordable Care Act (ACA) marketplaces is likely to be one of the most complex since the program鈥檚 implementation. Recent federal policy changes, ongoing litigation, and uncertainty around the extension of enhanced premium tax credits (ePTCs) are converging to create significant challenges for federal and state regulators, policymakers, and issuers. Rising premiums, expiring subsidies, and shifting federal regulations also have created an environment of significant uncertainty for consumers, navigators and brokers.

In this report, Complexity for the 2026 Marketplace Open Enrollment: Risks of Consumer Confusion & Coverage Loss, authored by 量子资源 (HMA) and Wakely, an HMA Company, with support from the Robert Wood Johnson Foundation, explains these changes and their collective effect on costs and consumer experiences.

HMA and Wakely 量子资源s preview the analysis and the options policymakers, states, regulators, issuers, consumer advocates, and enrollment assisters, and other stakeholders can plan for to mitigate this confusion and coverage losses.

Brief & Report

New Report Offers Profile of ACA Marketplace Enrollees Using Claims Data

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HMA and Wakely, an HMA Company, have released a new Issue Brief that provides a comprehensive profile of ACA Marketplace enrollees primarily based on claims data from nearly 6 million of the 24 million Marketplace enrollees.

The issue brief answers these key questions:

  1. How many people receive coverage through the Marketplace and where does CBO project enrollments to be in 2026 and beyond?聽 What are Marketplace enrollee demographics 鈥� i.e. age, gender, geographic location?
  2. What type of health conditions do Marketplace enrollees have and what types of services do they use?
  3. What types of prescription drugs do Marketplace enrollees use?
  4. What does the share of costs shouldered by the enrollee look like for Marketplace enrollees if the Advanced Premium Tax Credits expire?

Please fill out this form to receive a copy of the issue brief.

Contact any of the report authors with further questions, or to discuss potential applications of this work for your organization.

Brief & Report

Coding, Coverage, and Reimbursement: Considerations for Women’s Health Access

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Persistent gaps in women’s health research, funding, clinical outcomes and access are increasingly well-studied, however less emphasis is placed on the role of coding, coverage, and reimbursement and whether male or female gaps exist in each of these key market access domains. The paper, Coding, Coverage and Reimbursement: Considerations for Women鈥檚 Health Access, examines challenges in these areas and offers recommendations to increase awareness, establish evaluative processes, and collaborative action to achieve incremental policy changes that can have a significant impact over time.

Brief & Report

Finding a Path to Support Aging in Place in California聽

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New HMA report discusses the unmet needs of older adults in low-income housing, highlighting the challenges of siloed programs and the difficulty in blending services

Research consistently shows that more than 70 percent of Americans want to age in place, remaining in their own homes. Yet the country鈥檚 shifting demographics, rising costs for long-term services and supports, and changing financing landscape make achieving this goal more challenging than ever, especially for low-income older adults. In fact, more than one-quarter million older Californians live in senior affordable housing developments that range in size from a few dozen apartments to over a thousand units in large high rises. Most striking was the finding that while many of these residents are not only low-income and disproportionately burdened with chronic disease and also dually eligible for Medicaid and Medicare鈥攁 group shown in countless studies to represent a considerable proportion of Medicare and Medicaid costs, but that few residents appear to participate in aligned Medicare and Medicaid special needs plans (D-SNPs) or to access Medi-Cal waiver services.

The report gathers direct input from older adults, including Asian populations, in eight languages, addresses critical funding gaps, and identifies policy priorities that if implemented offer innovative recommendations for California to reduce duplication and better serve older adults using current resources.

Brief & Report

Medicaid Financing for Social Health: A Resource Compendium for Illinois Community-Based Organizations & Networks

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量子资源 (HMA) prepared this compendium in September 2025 on behalf of the Chicago Department of Public Health. It was developed at a pivotal moment, as Illinois was poised to take action on multiple program initiatives of critical importance to community providers: reprocure its Medicaid Managed Care system, initiate provider training for 1115 Medicaid Waiver services that address social determinants of health (SDOH), prepare a new Community Health Worker (CHW) benefit, continue implementation of Doula services as a Medicaidcovered benefit, and establish a Third Party Administrator (TPA) support system to promote statewide access to new services, potentially via regional hubs.

A team of subject matter 量子资源s with deep experience in Illinois鈥檚 social health and healthcare sectors, as well as national social health integration efforts, created this resource to help organizations evaluate how these program initiatives will affect the services they provide, understand their opportunities to successfully participate in the Medicaid delivery system, and support their ability to effectively serve the needs of their communities. The team brings extensive knowledge of how community-based organizations (CBOs) deliver Medicaid-financed CHW and SDOH services, as well as the alternative payment methodologies managed care organizations (MCOs) use as they engage CBOs to promote population health.

In this context, this compendium is intended to address the following targeted needs identified by stakeholders across the Illinois community-based social health service ecosystem:

  • Guidance to support CBOs鈥� understanding of their value in advancing population health improvement goals, aligning with regional healthcare providers and payers, and identifying opportunities to sustainably fund social health services through Medicaid
  • Insights for CBOs, CBO networks, and emerging CBO hubs and Community Care Hubs (CCHs), with a focus on governance, shared IT infrastructure, financing and integration into the healthcare delivery system
  • Strategic considerations for contracting with Managed Care Organizations to provide social health care services Information to clarify the roles, scopes, and opportunities for collaboration/dual certifications within the community-based workforce that delivers Medicaid services, specifically CHWs, Doulas, and Peer Support Specialists
  • Information from other states on their Doula benefits implementation and Doula hubs to support Medicaid service delivery

Complete the form to receive a copy of the report

Brief & Report

Understanding Substance Use Disorders & the Use of Medications for聽Treatment

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Education Materials for Patients, Families, Educators and Non-Prescribing Providers

This is a comprehensive set of substance use disorder聽(SUD)聽education materials for patients, families, educators, and non-prescribing providers.聽In recognition of September being National Recovery Month, this document is fully downloadable for community use without restriction. 聽聽

The toolkit was made available through a joint effort of the California Department of Health Care Services Opioid Response Project and 量子资源. Coaching and technical assistance for this project was funded through DHCS by State Opioid Response Funds from SAMHSA. The bilingual patient education materials are written in accessible language for most audiences, in both Spanish and English. 

The materials can be used to broadly disseminate information across a community or with individual patients, family members and non-prescribing providers. These SUD educational materials were created using the latest research and information available. They are meant to be concrete and easily accessible with simple language that promotes increased understanding of each topic.  Some of the topics touched upon include evidenced-based treatment options such as Medications for Addiction Treatment (MAT) and Medications for Opioid Use Disorder (MOUD).  

Brief & Report

Medicaid Coverage of Breastfeeding Support and Supplies

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This report presents an independent landscape analysis by 量子资源 (HMA) examining Medicaid coverage of breastfeeding services and supplies in six states: Arkansas, Colorado, Kansas, North Carolina, Oregon, and Vermont. The analysis explores the availability and implementation of lactation consultation services and breast pump benefits within these state Medicaid programs, based on policy reviews and interviews with key stakeholders. Participants included state Medicaid officials, WIC representatives, lactation providers, managed care organizations, community-based organizations, and breastfeeding 量子资源s.

Findings reveal persistent barriers to access, inconsistencies in policy execution, and implementation gaps. The report highlights effective practices currently in use and offers targeted policy recommendations to enhance service delivery, promote equitable access, and improve maternal and infant health outcomes. This analysis serves as a strategic resource for stakeholders seeking to strengthen Medicaid鈥檚 role in supporting breastfeeding families.

Brief & Report

Project FoodBox: The Case for Food Is Medicine

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This literature review explores the concept of Food Is Medicine (FIM)鈥攁 healthcare approach that integrates nutrition-based interventions to prevent, manage, and treat chronic diseases. The report emphasizes the role of produce prescriptions, medically tailored meals (MTMs) and groceries in improving health outcomes, especially among low-income populations.

Brief & Report

Los Angeles County Child Welfare-Involved Population Medi-Cal Analysis

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Comparative Analysis of the Engagement in Care for Children in Medi-Cal Fee-for-Service vs. Managed Care and Learnings from Enhanced Care Management Early Implementation

In November 2023, the Los Angeles (LA) County Board of Supervisors passed a motion to address the implementation of new benefits for the child welfare-involved population launched through California鈥檚 Medicaid waiver, California Advancing and Innovating Medi-Cal, known as CalAIM. The CalAIM waiver expanded services to managed care beneficiaries, including enhanced care management (ECM) for coordinated case management, referrals, and community resource navigation and community supports, such as housing assistance, medically tailored meals, housing modifications, respite care for caregivers, and asthma management. These benefits are designed to better address health and social needs for the most vulnerable and at risk Medi-Cal beneficiaries, including children and youth involved in the child welfare system. The Board directed the Office of Child Protection (OCP), in collaboration with key county departments, to engage 量子资源, Inc. (HMA), as the technical assistance provider.

Recognizing that approximately two-thirds of child welfare-involved children and youth in LA County are enrolled in fee-for-service (FFS) Medi-Cal and ineligible for new CalAIM supports, HMA conducted a comparative analysis of the experience of children involved in the child welfare system in FFS versus managed care Medi-Cal through an analysis of federal T-MSIS data looking at a snapshot of data from December 2022. The analysis examined the experience of the child welfare-involved population in primary and preventive healthcare services (including well-child visits, dental visits, behavioral health) in Medi-Cal FFS versus managed care plan enrollment (MCPs) to inform decisions about existing practices for care management among the child welfare-involved population. The comparative analysis of the child welfare population in Los Angeles County, San Diego County, and Riverside County revealed children in managed care consistently showed higher rates of engagement in primary and preventative healthcare services.

Brief & Report

Medicaid Expansion: Data-Driven Insights into Healthcare Needs and State 1115 Implementation Trends

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This 10-slide presentation, Medicaid Expansion: Data-Driven Insights into Healthcare Needs, offers a focused analysis of the Medicaid Expansion population鈥攏on-disabled adults ages 19鈥�64 with incomes up to 138% of the Federal Poverty Level鈥攁cross more than 40 states. Using recent T-MSIS data, the deck highlights the high prevalence of chronic and behavioral health conditions within this group, while also detailing demographic trends among the approximately 16 million enrollees.

Developed by Matt Powers, Shreyas Ramani, Loren Anthes, and Lora Saunders, the presentation contextualizes health needs with Medicaid spending patterns, comparing the Expansion group to other eligibility categories, such as dual eligibles and children. It also breaks down pharmacy spending by therapeutic class, spotlighting common conditions like opioid use disorder. In light of recent federal legislative proposals such as H.R. 1, the deck explores how states are beginning to navigate policy changes through 1115 waiver activity鈥攑articularly around medically frail and good cause exemptions鈥攐ffering early insight into likely implementation strategies.

Brief & Report

Disaggregating Managed Care Payments Provides Opportunities for New Insights into Medicaid Spending for Critical Populations

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HMA focused this paper on how states disperse Medicaid funds to certain subpopulations within the program鈥檚 categorical eligibility infrastructure. A previous companion paper centered on increasing our understanding of Medicaid managed care spending by provider, offering more detail on the relative order of magnitude of the amounts spent on inpatient and outpatient hospital care, professional services, long-term care, pharmacy, and other health services.

As the latest national Medicaid managed care enrollment data show 75% of Medicaid beneficiaries were enrolled in comprehensive managed care organizations (MCOs), these two foundational papers illustrate the importance of developing a sound methodology to reliably estimate costs associated with MCOS. These papers, which are the first to present findings related to the development of the MCO methodologies, help lay the foundation for further work that will enable us to answer relevant questions, including:

  • How much do we spend on Medicaid patients with chronic conditions like asthma, diabetes, and hypertension?
  • How much do we spend on Medicaid patients receiving long-term services and supports (LTSS) and what is the unmet need?
  • How is Medicaid funding spent on childbirth and a child鈥檚 first year of life?
  • What are the opportunities to be more efficient and effective with Medicaid resources?
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