Trends in Medi-Cal Reimbursement

Medicaid provides a safety net for the poorest Americans.  Although eligibility criteria vary from state to state, the health service Medicaid provides are often life saving.  One of the main problems Medicaid beneficiaries experience, however, is access to care.  Many physicians do not accept Medicaid because the reimbursement rates are much lower than those paid…

Medicaid P4P

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…

Value-Based Purchasing in Nursing Homes

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…

Medicaid and Long-Term Care Services

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…

Risk Adjustment: Predicting Future Expenditures

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…

Safety Net Patients in California

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…

Immigration and Medicaid

“…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…