Unbiased Analysis of Today's Healthcare Issues
Health Reform will of course increase Medicaid spending as more people become eligible for this entitlement. Yet this is not the only reason Medicaid costs will rise due to Health Reform. From a working paper by Jagadeesh Gokhale. “Once ObamaCare becomes fully effective in 2014, the cost of newly eligible Medicaid enrollees will be almost fully covered…
As part of health reform, Medicare is looking to institute value-based purchasing or pay-for-performance programs in a number of settings. In fact, in my work for Acumen, I have worked on a number of these initiatives (e.g., P4P for physician efficiency profiling, implementing a VBP system in home health). Medicare, however, isn’t the only…
More than 3 million frail and disabled individuals rely on nursing home services in any given year. About half of these individuals consider the nursing home to be their primary place of residence. Nursing home quality, however, has often been called into question. Some experts believe pay-for-performance schemes will improve nursing home quality. Today, I…
The increased use of long-term care (LTC) services has been one of the forces increasing health care cost and utilization. Currently, 10.3 million Americans use LTC services. The Kaiser Family Foundation provides a summary of LTC Services and Supports in the U.S. Who uses LTC? One can divide LTC services into those who receive care…
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…