Medicaid: Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.Centers for Medicare and Medicaid Services (U.S.): A component of the Department of Health and Human Services to oversee and direct the Medicare and Medicaid programs and related Federal medical care quality control staffs. Name was changed effective June 14, 2001.State Health Plans: State plans prepared by the State Health Planning and Development Agencies which are made up from plans submitted by the Health Systems Agencies and subject to review and revision by the Statewide Health Coordinating Council.United StatesEligibility Determination: Criteria to determine eligibility of patients for medical care programs and services.Managed Care Programs: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.Insurance, Health, Reimbursement: Payment by a third-party payer in a sum equal to the amount expended by a health care provider or facility for health services rendered to an insured or program beneficiary. (From Facts on File Dictionary of Health Care Management, 1988)State Government: The level of governmental organization and function below that of the national or country-wide government.Medically Uninsured: Individuals or groups with no or inadequate health insurance coverage. Those falling into this category usually comprise three primary groups: the medically indigent (MEDICAL INDIGENCY); those whose clinical condition makes them medically uninsurable; and the working uninsured.Medicare: Federal program, created by Public Law 89-97, Title XVIII-Health Insurance for the Aged, a 1965 amendment to the Social Security Act, that provides health insurance benefits to persons over the age of 65 and others eligible for Social Security benefits. It consists of two separate but coordinated programs: hospital insurance (MEDICARE PART A) and supplementary medical insurance (MEDICARE PART B). (Hospital Administration Terminology, AHA, 2d ed and A Discursive Dictionary of Health Care, US House of Representatives, 1976)Insurance Coverage: Generally refers to the amount of protection available and the kind of loss which would be paid for under an insurance contract with an insurer. (Slee & Slee, Health Care Terms, 2d ed)Reimbursement Mechanisms: Processes or methods of reimbursement for services rendered or equipment.Health Services Accessibility: The degree to which individuals are inhibited or facilitated in their ability to gain entry to and to receive care and services from the health care system. Factors influencing this ability include geographic, architectural, transportational, and financial considerations, among others.Capitation Fee: A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.Insurance, Health: Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.Insurance Claim Review: Review of claims by insurance companies to determine liability and amount of payment for various services. The review may also include determination of eligibility of the claimant or beneficiary or of the provider of the benefit; determination that the benefit is covered or not payable under another policy; or determination that the service was necessary and of reasonable cost and quality.Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (HEALTH CARE COSTS) and may or may not be shared among the patient, insurers, and/or employers.Cost Control: The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)Rate Setting and Review: A method of examining and setting levels of payments.Child Health Services: Organized services to provide health care for children.Fees, Medical: Amounts charged to the patient as payer for medical services.Reimbursement, Disproportionate Share: Payments that include adjustments to reflect the costs of uncompensated care and higher costs for inpatient care for certain populations receiving mandated services. MEDICARE and MEDICAID include provisions for this type of reimbursement.Insurance Claim Reporting: The design, completion, and filing of forms with the insurer.Personal Health Services: Health care provided to individuals.Patient Protection and Affordable Care Act: An Act prohibiting a health plan from establishing lifetime limits or annual limits on the dollar value of benefits for any participant or beneficiary after January 1, 2014. It permits a restricted annual limit for plan years beginning prior to January 1, 2014. It provides that a health plan shall not be prevented from placing annual or lifetime per-beneficiary limits on covered benefits. The Act sets up a competitive health insurance market.Health Services Research: The integration of epidemiologic, sociological, economic, and other analytic sciences in the study of health services. Health services research is usually concerned with relationships between need, demand, supply, use, and outcome of health services. The aim of the research is evaluation, particularly in terms of structure, process, output, and outcome. (From Last, Dictionary of Epidemiology, 2d ed)Uncompensated Care: Medical services for which no payment is received. Uncompensated care includes charity care and bad debts.Cost Savings: Reductions in all or any portion of the costs of providing goods or services. Savings may be incurred by the provider or the consumer.Poverty: A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.Formularies as Topic: Works about lists of drugs or collections of recipes, formulas, and prescriptions for the compounding of medicinal preparations. Formularies differ from PHARMACOPOEIAS in that they are less complete, lacking full descriptions of the drugs, their formulations, analytic composition, chemical properties, etc. In hospitals, formularies list all drugs commonly stocked in the hospital pharmacy.Health Maintenance Organizations: Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)Federal Government: The level of governmental organization and function at the national or country-wide level.Health Care Reform: Innovation and improvement of the health care system by reappraisal, amendment of services, and removal of faults and abuses in providing and distributing health services to patients. It includes a re-alignment of health services and health insurance to maximum demographic elements (the unemployed, indigent, uninsured, elderly, inner cities, rural areas) with reference to coverage, hospitalization, pricing and cost containment, insurers' and employers' costs, pre-existing medical conditions, prescribed drugs, equipment, and services.OregonTennesseeFloridaMarylandNursing Homes: Facilities which provide nursing supervision and limited medical care to persons who do not require hospitalization.Health Care Surveys: Statistical measures of utilization and other aspects of the provision of health care services including hospitalization and ambulatory care.Budgets: Detailed financial plans for carrying out specific activities for a certain period of time. They include proposed income and expenditures.Health Policy: Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.ArkansasHealth Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from HEALTH EXPENDITURES, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost.Insurance, Pharmaceutical Services: Insurance providing for payment of services rendered by the pharmacist. Services include the preparation and distribution of medical products.Economics, Hospital: Economic aspects related to the management and operation of a hospital.New JerseyDrug Costs: The amount that a health care institution or organization pays for its drugs. It is one component of the final price that is charged to the consumer (FEES, PHARMACEUTICAL or PRESCRIPTION FEES).North CarolinaNew YorkDental Care for Children: The giving of attention to the special dental needs of children, including the prevention of tooth diseases and instruction in dental hygiene and dental health. The dental care may include the services provided by dental specialists.Insurance Benefits: Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.MichiganCaliforniaInflation, Economic: An increase in the volume of money and credit relative to available goods resulting in a substantial and continuing rise in the general price level.Medicare Assignment: Concept referring to the standardized fees for services rendered by health care providers, e.g., laboratories and physicians, and reimbursement for those services under Medicare Part B. It includes acceptance by the physician.Reimbursement, Incentive: A scheme which provides reimbursement for the health services rendered, generally by an institution, and which provides added financial rewards if certain conditions are met. Such a scheme is intended to promote and reward increased efficiency and cost containment, with better care, or at least without adverse effect on the quality of the care rendered.MaineRisk Sharing, Financial: Any system which allows payors to share some of the financial risk associated with a particular patient population with providers. Providers agree to adhere to fixed fee schedules in exchange for an increase in their payor base and a chance to benefit from cost containment measures. Common risk-sharing methods are prospective payment schedules (PROSPECTIVE PAYMENT SYSTEM), capitation (CAPITATION FEES), diagnosis-related fees (DIAGNOSIS-RELATED GROUPS), and pre-negotiated fees.Fraud: Exploitation through misrepresentation of the facts or concealment of the purposes of the exploiter.Social Welfare: Organized institutions which provide services to ameliorate conditions of need or social pathology in the community.Medical Assistance: Financing of medical care provided to public assistance recipients.Drug Utilization Review: Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.Contract Services: Outside services provided to an institution under a formal financial agreement.Fee Schedules: A listing of established professional service charges, for specified dental and medical procedures.Cost Sharing: Provisions of an insurance policy that require the insured to pay some portion of covered expenses. Several forms of sharing are in use, e.g., deductibles, coinsurance, and copayments. Cost sharing does not refer to or include amounts paid in premiums for the coverage. (From Dictionary of Health Services Management, 2d ed)Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.OhioInsurance, Physician Services: Insurance providing benefits for the costs of care by a physician which can be comprehensive or limited to surgical expenses or for care provided only in the hospital. It is frequently called "regular medical expense" or "surgical expense".Legislation, Hospital: Laws and regulations concerning hospitals, which are proposed for enactment or enacted by a legislative body.Public Assistance: Financial assistance to impoverished persons for the essentials of living through federal, state or local government programs.Quality of Health Care: The levels of excellence which characterize the health service or health care provided based on accepted standards of quality.Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.KentuckyFinancing, Government: Federal, state, or local government organized methods of financial assistance.Utilization Review: An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.Cost Allocation: The assignment, to each of several particular cost-centers, of an equitable proportion of the costs of activities that serve all of them. Cost-center usually refers to institutional departments or services.Drug Utilization: The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.Health Services Needs and Demand: Health services required by a population or community as well as the health services that the population or community is able and willing to pay for.South CarolinaDiagnosis-Related Groups: A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.Case Management: A traditional term for all the activities which a physician or other health care professional normally performs to insure the coordination of the medical services required by a patient. It also, when used in connection with managed care, covers all the activities of evaluating the patient, planning treatment, referral, and follow-up so that care is continuous and comprehensive and payment for the care is obtained. (From Slee & Slee, Health Care Terms, 2nd ed)Prenatal Care: Care provided the pregnant woman in order to prevent complications, and decrease the incidence of maternal and prenatal mortality.Disabled Persons: Persons with physical or mental disabilities that affect or limit their activities of daily living and that may require special accommodations.Costs and Cost Analysis: Absolute, comparative, or differential costs pertaining to services, institutions, resources, etc., or the analysis and study of these costs.Drug Prescriptions: Directions written for the obtaining and use of DRUGS.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Health Care Sector: Economic sector concerned with the provision, distribution, and consumption of health care services and related products.Ownership: The legal relation between an entity (individual, group, corporation, or-profit, secular, government) and an object. The object may be corporeal, such as equipment, or completely a creature of law, such as a patent; it may be movable, such as an animal, or immovable, such as a building.Models, Econometric: The application of mathematical formulas and statistical techniques to the testing and quantifying of economic theories and the solution of economic problems.MassachusettsHealthcare Disparities: Differences in access to or availability of medical facilities and services.Legislation, Medical: Laws and regulations, pertaining to the field of medicine, proposed for enactment or enacted by a legislative body.MissouriUnited States Dept. of Health and Human Services: A cabinet department in the Executive Branch of the United States Government concerned with administering those agencies and offices having programs pertaining to health and human services.Skilled Nursing Facilities: Extended care facilities which provide skilled nursing care or rehabilitation services for inpatients on a daily basis.Home Care Services: Community health and NURSING SERVICES providing coordinated multiple services to the patient at the patient's homes. These home-care services are provided by a visiting nurse, home health agencies, HOSPITALS, or organized community groups using professional staff for care delivery. It differs from HOME NURSING which is provided by non-professionals.Fees, Pharmaceutical: Amounts charged to the patient or third-party payer for medication. It includes the pharmacist's professional fee and cost of ingredients, containers, etc.

Can restrictions on reimbursement for anti-ulcer drugs decrease Medicaid pharmacy costs without increasing hospitalizations? (1/1973)

OBJECTIVE: To examine the impact of a policy restricting reimbursement for Medicaid anti-ulcer drugs on anti-ulcer drug use and peptic-related hospitalizations. DATA SOURCES/STUDY SETTING: In addition to U.S. Census Bureau data, all of the following from Florida: Medicaid anti-ulcer drug claims data, 1989-1993; Medicaid eligibility data, 1989-1993; and acute care nonfederal hospital discharge abstract data (Medicaid and non-Medicaid), 1989-1993. STUDY DESIGN: In this observational study, a Poisson multiple regression model was used to compare changes, after policy implementation, in Medicaid reimbursement for prescription anti-ulcer drugs as well as hospitalization rates between pre- and post-implementation periods in Medicaid versus non-Medicaid patients hospitalized with peptic ulcer disease. PRINCIPAL FINDINGS: Following policy implementation, the rate of Medicaid reimbursement for anti-ulcer drugs decreased 33 percent (p < .001). No associated increase occurred in the rate of Medicaid peptic-related hospitalizations. CONCLUSIONS: Florida's policy restricting Medicaid reimbursement for anti-ulcer drugs was associated with a substantial reduction in outpatient anti-ulcer drug utilization without any significant increase in the rate of hospitalization for peptic-related conditions.  (+info)

Incidence and duration of hospitalizations among persons with AIDS: an event history approach. (2/1973)

OBJECTIVE: To analyze hospitalization patterns of persons with AIDS (PWAs) in a multi-state/multi-episode continuous time duration framework. DATA SOURCES: PWAs on Medicaid identified through a match between the state's AIDS Registry and Medicaid eligibility files; hospital admission and discharge dates identified through Medicaid claims. STUDY DESIGN: Using a Weibull event history framework, we model the hazard of transition between hospitalized and community spells, incorporating the competing risk of death in each of these states. Simulations are used to translate these parameters into readily interpretable estimates of length of stay, the probability that a hospitalization will end in death, and the probability that a nonhospitalized person will be hospitalized within 90 days. PRINCIPAL FINDINGS: In multivariate analyses, participation in a Medicaid waiver program offering case management and home care was associated with hospital stays 1.3 days shorter than for nonparticipants. African American race and Hispanic ethnicity were associated with hospital stays 1.2 days and 1.0 day longer than for non-Hispanic whites; African Americans also experienced more frequent hospital admissions. Residents of the high-HIV-prevalence area of the state had more frequent admissions and stays two days longer than those residing elsewhere in the state. Older PWAs experienced less frequent hospital admissions but longer stays, with hospitalizations of 55-year-olds lasting 8.25 days longer than those of 25-year-olds. CONCLUSIONS: Much socioeconomic and geographic variability exists both in the incidence and in the duration of hospitalization among persons with AIDS in New Jersey. Event history analysis provides a useful statistical framework for analysis of these variations, deals appropriately with data in which duration of observation varies from individual to individual, and permits the competing risk of death to be incorporated into the model. Transition models of this type have broad applicability in modeling the risk and duration of hospitalization in chronic illnesses.  (+info)

Making Medicaid managed care research relevant. (3/1973)

OBJECTIVE: To help researchers better understand Medicaid managed care and the kinds of research studies that will be both feasible and of value to policymakers and program staff. The article builds on our experience researching Medicaid managed care to provide insight for researchers who want to be policy relevant. PRINCIPAL FINDINGS: We draw four lessons from our work on Medicaid managed care in seven states. First, these are complex programs that differ substantially across states. Second, each program faces common challenges and issues. The need to address common design elements involving program eligibility, managed care and provider contracting, beneficiary enrollment, education, marketing, and administration and oversight provides a vehicle that researchers can use to help understand states and to provide them with relevant insight. Third, well-designed case studies can provide invaluable descriptive insights. Such case studies suggest that providing effective descriptions of state programs and experience, monitoring information on program performance and tradeoffs, and insight on implementation and design are all valuable products of such studies that have considerable potential to be converted into policy-actionable advice. And fourth, some questions demand impact studies but the structure of Medicaid managed care poses major barriers to such studies. CONCLUSIONS: Many challenges confront researchers seeking to develop policy-relevant research on managed care. Researchers need to confront these challenges in turn by developing second-best approaches that will provide timely insight into important questions in a relatively defensible and rigorous way in the face of many constraints. If researchers do not, others will, and researchers may find their contributions limited in important areas for policy debate.  (+info)

The changing elderly population and future health care needs. (4/1973)

The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term care services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.  (+info)

Who bears the burden of Medicaid drug copayment policies? (5/1973)

This DataWatch examines the impact of Medicaid prescription drug copayment policies in thirty-eight states using survey data from the 1992 Medicare Current Beneficiary Survey. Findings indicate that elderly and disabled Medicaid recipients who reside in states with copay provisions have significantly lower rates of drug use than their counterparts in states without copayments. After controlling for other factors, we find that the primary effect of copayments is to reduce the likelihood that Medicaid recipients fill any prescription during the year. This burden falls disproportionately on recipients in poor health.  (+info)

What quality measurements miss. (6/1973)

Measurable indices of health care quality are all the rage these days. But physicians know that not everything in health care can be quantified. If reportable numbers become our principal focus, what is in danger of falling through the cracks?  (+info)

Prepaid capitation versus fee-for-service reimbursement in a Medicaid population. (7/1973)

Utilization of health resources by 37,444 Medicaid recipients enrolled in a capitated health maintenance organization was compared with that of 227,242 Medicaid recipients enrolled in a traditional fee-for-service system over a 1-year period (1983-1984) in the state of Kentucky. Primary care providers in the capitated program had financial incentives to reduce downstream costs like specialist referral, emergency room use, and hospitalizations. The average number of physician visits was similar for both groups (4.47/year in the capitated program; 5.09/year in the fee-for-service system). However, the average number of prescriptions (1.9 versus 4.9 per year), average number of hospital admissions per recipient (0.11 versus 0.22 per year), and average number of hospital days per 1,000 recipients (461 versus 909 per year) were 5% to 60% lower in the capitated group than in the fee-for-service group. The Citicare capitated program resulted in a dramatic reduction in healthcare resource utilization compared with the concurrent fee-for-service system for statewide Medicaid recipients.  (+info)

Hospitals and managed care: catching up with the networks. (8/1973)

Although the growth of managed care is having a significant impact on hospitals, organizational response to managed care remains fragmented. We conducted a survey of 83 hospitals nationwide that indicated that most hospitals now have at least one person devoted to managed care initiatives. These individuals, however, often spend most of their time on current issues, such as contracting with managed care organizations and physician relations. Concerns for the future, such as network development and marketing, although important, receive less immediate attention form these individuals. Hospital managed care executives must take a more proactive role in long range managed care planning by collaborating with managed care organizations and pharmaceutical companies.  (+info)

  • Historical analyses have found opioid prescribing rates for the Medicaid population to be more than double the rates for non-Medicaid enrollees, raising concerns that Medicaid expansion may inadvertently act as a driver of opioid abuse and addiction. (
  • That is one reason expanding Medicaid will not necessarily boost access to care: many new Medicaid enrollees cannot find doctors who will treat them for the paltry fees Medicaid pays them. (
  • The Office of Inspector General (OIG) investigators called 1,800 providers listed in Medicaid managed care plans to assess availability and the time it took to get an appointment for enrollees. (
  • The study suggests that when states require enrollees to demonstrate eligibility on a more frequent basis, they may see an increase in hospitalizations for common health conditions: lacking insurance to cover the costs of primary care, many former Medicaid enrollees end up in hospitals and are then re-enrolled in Medicaid. (
  • The elderly and disabled Medicaid populations make up approximately one quarter of enrollees but over 60 percent of all Medicaid payments are made on their behalf. (
  • For example, nursing facility services are consumed by less than 3 percent of Medicaid enrollees but due to the high cost of these services, make up 16 percent of total spending. (
  • Specifically, a database was built comprised of all Medicaid enrollees and claims in the states that share in common both adverse minority health outcomes and the historical roots of racial health disparities in the South. (
  • To hold down costs, states are cutting Medicaid payments to doctors and hospitals, limiting benefits for Medicaid recipients, reducing the scope of covered services, requiring beneficiaries to pay larger co-payments and expanding the use of managed care. (
  • And so starting today people in Utah - individuals who are on the Medicaid program, providers - they can receive immediate reimbursement for these types of services. (
  • Of those, 48% were covered by Medicaid, a government program that provides health care to people with low income or disabilities. (
  • In the final study, researchers found that Chicago women were less likely to receive medically advanced techniques for diagnosing breast cancer if they had Medicaid or Medicare, the government insurance program for older Americans. (
  • Patients often have trouble finding a doctor or hospital that participates in Medicaid, because the program traditionally has not paid as well as Medicare or private insurance for medical services, said Patel and Dr. Harold Burstein. (
  • Washington - The Obama administration injected billions of dollars into Medicaid, the nation's low-income health program, as the recession deepened two years ago. (
  • The Congressional Budget Office estimates that federal Medicaid spending will decline in 2012 for only the second time in the 46-year history of the program. (
  • In order to improve care and outcomes for people with complex medical problems, several states have started the Medicaid Health Home (HH) program, including New York State (NYS) in 2012. (
  • In July 2014, CMS launched the Medicaid Innovation Accelerator Program (IAP), a collaborative between the Center for Medicaid and CHIP Services (CMCS) and the Center for Medicare & Medicaid Innovation (CMMI). (
  • This webinar provides an overview of the IAP SUD program area, including recent efforts and upcoming opportunities, and highlights ways to engage in Medicaid SUD delivery system reform. (
  • During most of the time of this study, 1998 to 2002, California which has the largest Medicaid program in the U.S. required beneficiaries to report on their eligibility every 3 months. (
  • States will need to ensure that people have access to the Medicaid program when they need it most, said Commonwealth Fund President Karen Davis. (
  • Medicaid is a public health insurance program for low income children and adults that is financed by the state and federal governments. (
  • The final rule also discusses the definition of a "covered outpatient drug" and other issues with implications for both Medicaid and the 340B Drug Pricing Program. (
  • LePage released a statement this morning claiming he will not implement Medicaid expansion unless the state legislature appropriates an amount of funding for the program that LePage pulled straight out of his ass. (
  • Maine's non-partisan Office of Fiscal and Program Review calculated that the state will need to spend nearly $55 million more per year to expand Medicaid, but will draw an additional $525 million from the federal government. (
  • The survey shows big differences across states driven largely by the states' decisions on the Medicaid expansion and also provides an examination of state Medicaid policy and program changes across the country. (
  • This entry was posted in Health and tagged Health insurance coverage , Medicaid , States by admin . (
  • New York, NY Interruptions in Medicaid coverage are associated with a higher rate of hospitalization for conditions that can often be treated in an ambulatory care setting, including asthma, diabetes, and hypertension, according to a new study in today s issue of the Annals of Internal Medicine. (
  • The analysis, which examines interrupted Medicaid coverage and hospitalization rates, finds that increased risk for hospitalization is highest in the first three months after an interruption in Medicaid coverage. (
  • The study authors recommend that states implement policies to reduce the frequency of interruptions in Medicaid coverage, to help prevent health events that require hospitalization and thereby reduce high-cost hospital spending. (
  • Individuals are more likely to seek Medicaid coverage during an economic downturn at the same time states are more likely to face budget shortfalls and are likely to seek ways to cut health care costs. (
  • The final factor in Medicaid cost growth is the rate at which the federal government reimburses states for Medicaid expenditures. (
  • The comparative impact of this natural variation can be measured in meaningful outcomes such as emergency department visits, hospital admissions, inpatient bed-days, deaths, and total Medicaid expenditures, as well as community-level disparity rate-ratios. (
  • The people of Maine went to the polls yesterday and voted to expand Medicaid under Obamacare by an overwhelming margin of nearly 60 to 40, but Governor Paul LePage is not ready to accept the results of this decisive vote. (
  • Half of all providers listed in Medicaid managed care plan are not available to new Medicaid patients. (
  • As a result, doctors are reluctant to participate in Medicaid managed care plans. (
  • Consequently, our existing Medicaid patients have an increasingly difficult time accessing care. (
  • In fact, there are very few physicians who like taking care of Medicaid patients, since it's an indigent care plan and offers the lowest form of payment. (
  • WEDNESDAY, June 4, 2014 -- Medicaid patients appear to receive worse cancer care than people who can afford private insurance, a trio of new studies says. (
  • Many factors likely contribute to this, including the fact that Medicaid patients often aren't experienced in navigating the health care system, said Dr. Jyoti Patel, an oncologist at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago. (
  • The reasons behind the poorer cancer care for Medicaid patients are complex, ASCO spokespeople said. (
  • Doctors hope that increased access to Medicaid under the Affordable Care Act will improve the care patients receive. (
  • Our findings suggest that expanding Medicaid may be a useful strategy for reducing opioid-related hospitalizations ," Hefei Wen, PhD, faculty member of the Harvard Medical School Department of Population Medicine at the Harvard Pilgrim Health Care Institute, and colleagues wrote. (
  • The data were stratified by states that implemented Medicaid expansion that occurred before 2014 and during or after 2014 because the post-2014 expansions were more comprehensive under the Affordable Care Act . (
  • Cuts in Medicaid payments to doctors, for example, make it less likely that they will accept Medicaid patients and more likely that people will turn to hospital emergency rooms for care. (
  • Hospitals and other health care providers often try to make up for the loss of Medicaid revenue by increasing charges to other patients, including those with private insurance, experts say. (
  • Medicaid is very much on the chopping block," said Senator John D. Rockefeller IV, Democrat of West Virginia and chairman of the Senate Finance Subcommittee on Health Care. (
  • The goal of IAP is to improve the health and health care of Medicaid beneficiaries and to reduce costs by supporting states' ongoing payment and delivery system reforms. (
  • Before his work on IAP, Sadwith served at the CMS San Francisco Regional Office where he led efforts to implement the Medicaid provisions of the Affordable Care Act and provide technical assistance to the California Medicaid agency. (
  • Fourth, states determine, with approval from the federal government, the amount they will reimburse health care providers for services rendered to Medicaid patients. (
  • Medicaid data allow users to follow a complex patient (e.g., comorbid diabetes and schizophrenia or COPD and CHF) from treatment to outcomes through every billable service in the health care system (i.e., from doctor's visit to lab tests to prescriptions to emergency room visits or hospital admissions). (
  • Mainers for Health Care, the organization behind the campaign to expand Medicaid, said despite LePage's bluster, he can't stop the expansion train without violating state law. (
  • Ehimare Akhabue, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues compared the mean payer mix proportions and in-hospital mortality for expansion and non-expansion states for 2009 to 2013 (preceding the Affordable Care Act [ACA] Medicaid expansion) and 2014 (the year after expansion). (
  • Fortunately, Medicaid residents have this care paid for by their MCO or TNCARE provider. (
  • For eye care appointments, Medicaid (except Blue Care) will pay for the NET (Non-Emergency Transport), but not for an ambulance to take residents. (
  • Medicaid has mandated that residents receive dental care, but has not approved payment for transports. (
  • WEDNESDAY, April 17, 2019 (HealthDay News) -- For women who deliver a baby by cesarean section, the risk of developing a surgical site infection is higher if she is covered by Medicaid versus private insurance, a new study finds. (
  • In 2014, about 40% of U.S. cesarean births were covered by Medicaid, the researchers noted. (
  • Sadwith first joined CMS in 2011, when he served in the Center for Medicare & Medicaid Innovation with a focus on designing, launching and implementing the Partnership for Patients, a national HHS-led patient safety campaign working with over 4,000 hospitals across the country. (
  • There are several factors driving Medicaid cost growth. (
  • Medicaid expansion may have led to reductions in opioid-related hospitalizations between 2005 and 2017, according to a study published in JAMA Internal Medicine . (
  • Wen and colleagues compared differences in opioid-related hospitalizations and ED visits in nonfederal, nonrehabilitation hospitals in U.S. states that implemented Medicaid expansions between 2005 and 2017 and changes in these events in states that did not implement Medicaid expansion. (
  • t accepting new Medicaid patients. (
  • For doctors who are accepting new Medicaid patients, the average wait to get an appointment is two weeks, with a quarter of patients having waits of one month or longer. (
  • Medicaid patients also are more likely to die from cancer than people with private insurance, researchers found. (
  • About 59 percent of people with private insurance received a diagnosis before cancer had a chance to spread throughout their body, compared with 50 percent of Medicaid patients. (
  • Medicaid patients were less likely to receive radiation treatment with just 35 percent undergoing the therapy, compared with 43 percent of privately insured patients. (
  • And finally, privately insured patients were more likely to survive, with 84 percent surviving their lymphoma compared with 71 percent of Medicaid patients. (
  • They found that patients were two and a half times likelier to be diagnosed with late-stage melanoma if they were covered by Medicaid, said lead author Katherine Chiang, a fourth-year medical student at Case Western. (
  • Only 47 percent of Medicaid or Medicare patients received a breast MRI, compared with 81 percent of those with private insurance, researchers found. (
  • Image-guided core needle biopsy, which uses imaging scans to guide the needle to the site of the suspected cancer, had similar utilization differences -- 25 percent of Medicaid or Medicare patients received this test, compared with 81 percent of patients with private insurance. (
  • Medicaid patients also tend to have more health problems overall, which means they may put off cancer screening to focus on chronic illnesses like heart disease or diabetes, Chiang noted. (
  • Our study underscores the importance of Medicaid expansion in altering how patients with opioid use disorder interact with the medical system," Wen and colleagues wrote. (
  • The investigators plan to use two data sources that show what happens to individual patients over time: 1) NYS Medicaid insurance data 2) the New York City-Clinical Data Research Network (NYC-CDRN). (
  • Medicaid patients are characterized by clinical and social complexity -- the very characteristics which often exclude them from clinical trials and yet drive health disparities. (
  • TUESDAY, Sept. 4, 2018 (HealthDay News) -- States that expanded Medicaid had a greater reduction in the proportion of uninsured hospitalizations for major cardiovascular events, according to a study published online Aug. 24 in JAMA Network Open . (
  • In addition to enabling states to expand Medicaid eligibility to low-income adults, the ACA established guidance such that state benchmark plans must include a specified set of essential health benefits, including mental health and substance use disorder services. (
  • In contrast, health plan services are utilized by nearly 80 percent of Medicaid clients and consume 50 percent of the budget. (
  • The HBCU-based team had extensive previous experience training health services researchers (especially minority investigators) to use Medicaid claims data for research. (
  • To train, develop, cultivate, and support emerging minority investigators (especially at Historically Black colleges and universities (HBCUs) and other minority-serving institutions) as independently-funded health services researchers who are increasingly proficient in multivariate analysis of Medicaid and Medicare claims data. (
  • Therefore, my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated, and I will not support increasing taxes on Maine families, raiding the rainy day fund or reducing services to our elderly or disabled. (
  • Specific Aims: Using Medicaid Claims Data To build a Medicaid claims dataset (including socieconomic, contextual, and geospatial analytic variables, NDC cross-walk data and therapeutic class codes, as well as certain Medicare data for dual-eligibles) to support projects focused on the intersection between disparities research and comparative effectiveness research in clinically and socially complex patient populations. (
  • Neither the White House nor Congress has tried to extend the extra federal financing for Medicaid, even though the number of beneficiaries is higher now than when Congress approved the aid as part of an economic recovery package in February 2009. (
  • More investigation is needed to determine why women with Medicaid health insurance had a much greater burden of surgical site infections after cesarean delivery than privately insured women," Yi said in a news release from the Society for Healthcare Epidemiology of America. (
  • LePage has threatened to do many things, like sue his own secretary of state if Medicaid expansion wasn't described as "welfare" on the ballot initiative, but he rarely follows through on any of them. (
  • LePage claims Medicaid expansion will cost the state $100 million per year, which is a relatively small number in the grand scheme of things, but he's also wrong about that. (
  • Surgical site infections occurred in 0.75% of the deliveries covered by Medicaid and 0.63% of those covered by private insurance. (
  • In other words, women covered by Medicaid had a 1.4-fold higher risk, the researchers reported. (
Iowa hospital sues Medicaid insurers for underpayment
Iowa hospital sues Medicaid insurers for underpayment (
Architect of Indiana's Medicaid plan faces confirmation hearing
Architect of Indiana's Medicaid plan faces confirmation hearing (
Let data guide Medicaid reforms | Opinion
Let data guide Medicaid reforms | Opinion (
Scoliosis (for Teens) - Aetna Better Health of Virginia (Medicaid)
Scoliosis (for Teens) - Aetna Better Health of Virginia (Medicaid) (
Asthma (for Parents) - Aetna Better Health of Virginia (Medicaid)
Asthma (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Birthmarks (for Parents) - Aetna Better Health of Virginia (Medicaid)
Birthmarks (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Depression (for Parents) - Aetna Better Health of Virginia (Medicaid)
Depression (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Varicocele (for Teens) - Aetna Better Health of Virginia (Medicaid)
Varicocele (for Teens) - Aetna Better Health of Virginia (Medicaid) (
Spirometry (for Parents) - Aetna Better Health of Virginia (Medicaid)
Spirometry (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Bursitis (for Teens) - Aetna Better Health of Virginia (Medicaid)
Bursitis (for Teens) - Aetna Better Health of Virginia (Medicaid) (
Abscess (for Teens) - Aetna Better Health of Virginia (Medicaid)
Abscess (for Teens) - Aetna Better Health of Virginia (Medicaid) (
Thyroid Disease (for Parents) - Aetna Better Health of Virginia (Medicaid)
Thyroid Disease (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Lymphatic Malformations (for Parents) - Aetna Better Health of Virginia (Medicaid)
Lymphatic Malformations (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Ankle Sprains (for Teens) - Aetna Better Health of Virginia (Medicaid)
Ankle Sprains (for Teens) - Aetna Better Health of Virginia (Medicaid) (
Inguinal Hernias (for Parents) - Aetna Better Health of Virginia (Medicaid)
Inguinal Hernias (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Poison Ivy (for Teens) - Aetna Better Health of Virginia (Medicaid)
Poison Ivy (for Teens) - Aetna Better Health of Virginia (Medicaid) (
Republicans war poverty welfare Medicaid food stamps seniors
Republicans war poverty welfare Medicaid food stamps seniors (
Blood Test: Hemoglobin (for Parents) - Aetna Better Health of Virginia (Medicaid)
Blood Test: Hemoglobin (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Sickle Cell Disease (for Parents) - Aetna Better Health of Virginia (Medicaid)
Sickle Cell Disease (for Parents) - Aetna Better Health of Virginia (Medicaid) (
CAT Scan: Abdomen (for Parents) - Aetna Better Health of Virginia (Medicaid)
CAT Scan: Abdomen (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Ventricular Septal Defect (for Parents) - Aetna Better Health of Virginia (Medicaid)
Ventricular Septal Defect (for Parents) - Aetna Better Health of Virginia (Medicaid) (
GOP Medicaid bill: Counties see mandate relief
GOP Medicaid bill: Counties see mandate relief (
Medicaid costs up $950M as hospitals privatize
Medicaid costs up $950M as hospitals privatize (
Broken Collarbone (Clavicle Fracture) (for Teens) - Aetna Better Health of Virginia (Medicaid)
Broken Collarbone (Clavicle Fracture) (for Teens) - Aetna Better Health of Virginia (Medicaid) (
X-Ray Exam: Hip (for Parents) - Aetna Better Health of Virginia (Medicaid)
X-Ray Exam: Hip (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Peritoneal Dialysis (for Teens) - Print Version - Aetna Better Health of Virginia (Medicaid)
Peritoneal Dialysis (for Teens) - Print Version - Aetna Better Health of Virginia (Medicaid) (
Magnetic Resonance Imaging (MRI): Brain (for Parents) - Aetna Better Health of Virginia (Medicaid)
Magnetic Resonance Imaging (MRI): Brain (for Parents) - Aetna Better Health of Virginia (Medicaid) (
Auditory Neuropathy Spectrum Disorder (ANSD) (for Parents) - Aetna Better Health of Virginia (Medicaid)
Auditory Neuropathy Spectrum Disorder (ANSD) (for Parents) - Aetna Better Health of Virginia (Medicaid) (
3 Ways to Build Strong Bones (for Parents) - Aetna Better Health of Virginia (Medicaid)
3 Ways to Build Strong Bones (for Parents) - Aetna Better Health of Virginia (Medicaid) (