This week, our In Focus聽section reviews key takeaways from the report, How State Medicaid Programs are Managing Prescription Drug Costs: Results from a State Medicaid Pharmacy Survey for State Fiscal Years 2019 and 2020, prepared by Kaiser Family Foundation (KFF) and 量子资源网 (量子资源网). The report was written by 量子资源网 Managing Principal Anne Winter and Principals Kathleen Gifford and Linda Wiant with Rachel Dolan, Marina Tian, and Rachel Garfield from KFF.
340 Results found.
量子资源网 examines Medicare-Medicaid integration: low FBDE enrollment in integrated programs
This week, our In Focus聽section reviews an issue brief written by 量子资源网 consultants examining Medicare-Medicaid integration. In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.
Examining key considerations for implementing group prenatal care
A team of 量子资源网 consultants have authored a peer-reviewed journal article聽drawing on data from the recently completed five-year evaluation of the聽Strong Start for Mothers and Newborns II Initiative聽to discuss key considerations for implementing a group prenatal care model, including barriers to implementation and sustainability as well as strategies for overcoming barriers and sustaining the model.
Dual eligible financial alignment demonstration 2020 enrollment update
This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (鈥淒uals Demonstrations鈥�) for beneficiaries dually eligible for Medicare and Medicaid (duals) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of duals into fully integrated plans providing both Medicaid and Medicare benefits (鈥淢edicare-Medicaid Plans,鈥� or 鈥淢MPs鈥�) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of February 2020, approximately 371, 200 duals were enrolled in an MMP. Enrollment fell 1.2 percent from February of the previous year.
量子资源网 experts examine Medicare-Medicaid integration
In 2019, 7.7 million people in the United States were eligible to receive access to full benefits under Medicare and individual state Medicaid programs. This group of people is known as the Full Benefit Dual Eligible (FBDE) population. While FBDE enrollment in integrated programs nearly quadrupled over the past five years, the number of people enrolled in an integrated program never rose above one in 10 FBDE people.
Medicare-Medicaid integration: integrated model enrollment rates show majority of Medicare-Medicaid dual eligible population not enrolled
Working in conjunction with Arnold Ventures, a team of 量子资源网 consultants has written an issue brief, Medicare-Medicaid Integration: Integrated Model Enrollment Rates Show Majority of Medicare-Medicaid Dual Eligible Population Not Enrolled. This brief presents key findings on their examination of the availability of integrated programs in states, the growth in enrollment rates, and differences in enrollment and programs across the country.
The 量子资源网 team cited several reasons why Medicare-Medicaid integrated program options are not equally available nationwide and why enrollment is limited in places where programs exist. The result is that millions of people are not enrolled in whole-person, integrated program options 鈥� a reality that is inefficient, and worse yet, inequitable.
The 量子资源网 team, led by Managing Principal Jon Blum and Principal Sarah Barth, includes Narda Ipakchi, Ellen Breslin, Mindy Cohen, Sharon Silow-Carroll and other 量子资源网 subject matter experts.
Medicare and Medicaid telehealth coverage in response to COVID-19
Telehealth service expansions by Medicare and most Medicaid programs aim to rapidly increase access to care and reduce transmission, but also provide a natural experiment for policymakers.
This week, our In Focus section examines the extensive scope of flexibilities Federal and State governments have made to Medicare and Medicaid telehealth coverage in response to the COVID-19 national emergency. In March and April 2020, federal and state policymakers responded to the COVID-19 emergency by temporarily and aggressively expanding the definition of and reimbursement for telehealth services鈥攎oves intended to improve access to care and reduce virus transmission. Under the Medicare and Medicaid programs, these temporary expansions have been rapid and historic in scope, and will have substantial implications for patients, providers, payers, and federal/state financing. For policymakers, this temporary expansion may serve as a natural experiment for assessing which forms of telehealth services successfully expand access to care and should become permanent healthcare policy.
量子资源网 model provides forecast of COVID-19 impact on Medicaid, Marketplace, and uninsured
A model developed by 量子资源网 (量子资源网) assesses COVID-19鈥檚 potential impact on health insurance coverage for each state and forecasts Medicaid enrollment could increase by 11 to 23 million across all states over the next several months.
量子资源网 review of state Appendix K waivers in response to COVID-19
This week, our In Focus section comes from 量子资源网 Principals Ellen Breslin (MA) and Sharon Lewis (OR). In direct response to COVID-19, the Centers for Medicare & Medicaid Services (CMS) has encouraged states to maximize Medicaid flexibilities to protect people during the pandemic emergency. This includes state flexibilities for people receiving home and community-based services. States may temporarily amend their Home and Community-Based Services (HCBS) 1915(c) waivers through an expedited process by submitting an. As of March 31, 2020, CMS had approved Appendix K submissions for thirteen states with effective periods ranging from four months to one year.[1] 聽The thirteen states are: Alaska, Connecticut, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Mexico, Pennsylvania, Rhode Island, Washington, West Virginia and Wyoming.
D-SNP 2021 hospital and SNF admission data sharing: opportunity for states and health plans to support care transitions
This week, our In Focus section provides an overview of new requirements and opportunities for states and Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs) to increase Medicare and Medicaid聽 coordination in plan year 2021. Specifically, states and health plans will need to partner for compliance with calendar year (CY) 2021 Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) data sharing requirements for D-SNPs that are not designated as a fully integrated D-SNP (FIDE SNP) or a highly integrated D-SNP (HIDE SNP)[1]. CY 2021 State Medicaid Agency Contracts (SMACs) with these D-SNPs must document the notification process for sharing hospital and skilled nursing facility (SNF) admissions for at least one group of high-risk enrollees.[2]
Medicare and Medicaid flexibilities during public health emergencies
This week, our聽In Focus聽comes from 量子资源网 Vice President聽Kathleen Nolan聽and Managing Principal聽Jon Blum.聽On March 13, 2020, President Trump declared a national emergency due to the rapid spread of COVID-19 virus. This declaration provides Health and Human Services (HHS) and the Centers of Medicare and Medicaid Services (CMS) new abilities to waive Medicare and Medicaid regulatory requirements to help health care providers, health plans and other stakeholders respond to immediate needs of their patients and communities.聽聽 In the past, HHS and CMS have solicited requests for relief needs from states, local providers and trade associations, among other stakeholders.聽 Health care providers, health plans and others should continue to monitor policy announcements from HHS and CMS and work with their states and trade associations to identify potential areas of need for requested regulatory relief.
Medicaid managed care enrollment update 鈥� Q4 2019
This week, our In Focus section reviews recent Medicaid enrollment trends in capitated, risk-based managed care in 29 states.[1] Many state Medicaid agencies post monthly enrollment figures by health plan for their Medicaid managed care population to their websites. This data allows for the timeliest analysis of enrollment trends across states and managed care organizations. All 29 states highlighted in this review have released monthly Medicaid managed care enrollment data into the fourth quarter (Q4) of 2019. This report reflects the most recent data posted. 量子资源网 has made the following observations related to the enrollment data shown on Table 1 (below):