Unbiased Analysis of Today's Healthcare Issues
Many states rely on managed care organizations (MCOs) to provide medical services for their Medicaid beneficiaries. Contracting out medical services to private providers relies on the government’s capacity to accurately predict expected cost of care for each beneficiary. This is typically done through risk-adjusted capitation rates. Which risk adjustment strategy works best? The answer of…
The California Health Care Foundation (CHCF) reviews how California’s safety net residents receive medical care. Safety Net patients are considered those who have incomes below 300% of the federal poverty line. Below is a list of governmental and non-governmental programs which serve California Safety Net residents. State: Medi-cal (California’s Medicaid program) and Healthy Families (California’s CHIP…
“…in order to prevent undocumented families from obtaining benefits illicitly, a problem that could not even be verified, Congress mandated (under a provision of th eDRA) that all Medicaid recipients must submit proof of their citizenship and identity. Implemented in 2006, everyone subject ot the new law has to produce a birth certificate, passport, certificate…
Although Medicaid receives significant federal funding, States run each program. This often leads to problems when residents of one state wish to receive care in another state. This could occur if the Medicaid beneficiary is a snow-bird, or lives in one state and works in another. Hurricane Katrina, however, highlights best the problems of a…
Fraudulent providers can rob taxpayers of money due to Medicaid beneficiaries. Fraudulent offenses include: billing Medicaid for services provided to patients ineligible for Medicaid; billing for services not rendered; upcoding (i.e., charging for more expensive services or equipment that the patient received); providing inappropriate, risky or unncessrary treatments; requesting reimubrsement for care provided by unlicensed…
In the third post using information from The Politics of Medicaid series, we will discuss how States often try to reduce Medicaid spending. From a fiscal point of few, Medicaid spending is often attractive since it is accompanied by matching federal dollars. On the other hand, Medicaid trails only elementary and secondary education in terms…
In the 1990s, State Medicaid programs turned to Managed Care Organizations (MCOs) to reduce costs. States such as Florida, Indiana, Kentucky, Louisiana, Missouri, Ohio, South Carolina and Texas attempted to turn over their entire Medicaid programs to MCOs through waivers. For instance, in 2007 MO HealthNet mandated managed care for all participants by 2013. Some of the larger…
“If you’ve seen one Medicaid program, you’ve seen one Medicaid program.” This week, I will review some of the findings from a wonderful book titled The Politics of Medicaid. Author Laura Katz Olson writes a well-researched book that evaluates Medicaid from the points of view of its various stakeholders including beneficiaries, providers (esp., physicians and…
In early 2008, Oregon expanded it’s Medicaid eligibility. To take advantage of these new benefits, 85,000 individuals signed up. Oregon’s budget, however, only had enough money to fund Medicaid coverage for 30,000. In a researcher’s dream case, Oregon decided to select the 30,000 eligible to apply for coverage using random assignment. Because this policy in…
One of President Obama’s biggest initiatives as part of health reform was to reduce fraud, waste and abuse in Medicare and Medicaid. Today, I will discuss how the Medicaid program fights fraud at the federal level. Because Medicaid is state-run, the States have typically been the ones responsible for ensuring efficient Medicaid operations. However, the…