Dual Eligibles

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Development of Quality Indicators for Home and Community-Based Services Population: Project Methodology

This report details development of the Agency for Healthcare Research and Quality (AHRQ)’s Quality Indicators (QI) for the HCBS population. It includes key sections: 1) the introduction section providing background on the HCBS QI development project. 2) the methods section on an overview of the QI development process, 3) results of details of empirical analyses performed to support QI, 4) the concluding thoughts section providing a discussion of interpretation of the indicators.

Short URL: http://www.advancingstates.org/node/53316

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Using Propensity Score Matching Techniques to Assess Medicare/Medicaid Service Use

This poster describes the use of a propensity score matching methodology to identify comparison groups among Medicare-Medicaid beneficiaries who received Medicaid-paid LTSS via HCBS waivers versus those who did not receive LTSS. This matching technique was used to establish comparable treatment/control pairs for subsequent analysis of cross-payer effects of providing Medicaid-paid LTSS on Medicare acute care resource use, and could be used more generally to strengthen policy analyses.

Short URL: http://www.advancingstates.org/node/53313

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Pathways to Medicare-Medicaid Eligibility: A Literature Review

The purpose of this literature review is to better understand the various pathways to Medicare-Medicaid eligibility, how and why and individual becomes eligible for both programs. Also, this report presents examples of federal government- and state-sponsored programs and supports aimed at delaying or preventing a descent into functional decline and/or poverty. The ways to simplify the enrollment process for those who quality and need Medicare and Medicaid benefits are discussed as well.

Short URL: http://www.advancingstates.org/node/53312

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Long-Term Services and Supports: Challenges and Opportunities for States in Difficult Budget Times

This paper discusses the progress states have made in moving away from institutional care for Long-Term Supports and Services and toward home and community-based programs. It analyzes the opportunities available through the Affordable Care Act and other programs whereby states can continue that progress even in a challenging budget environment.

Short URL: http://www.advancingstates.org/node/53311

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New Medicare-Medicaid Enrollees in Maryland: Demographic and Programmatic Characteristics

This study focuses on new Medicare-Medicaid enrollees in Maryland and the circumstances that shaped their initial eligibility for both programs. This report details the demographic and programmatic characteristics of new enrollees. Specifically, it serves as the vehicle for establishing an initial operational definition of new enrollees and developing the terminology needed to describe the circumstances surrounding initial Medicare-Medicaid eligibility.

Short URL: http://www.advancingstates.org/node/53310

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New Medicare-Medcaid Enrollees in Maryland: Prior Medicare and Medicaid Resource Use

This report describes and analyzes chronic disease patterns and health care expenditures of persons in Maryland who in 2008 began to receive coverage from both Medicare and Medicaid. The analysis focuses on disease and expenditure patterns in the year before these individuals, most of whom had been enrolled in Medicare alone or Medicaid alone, became enrollees in both programs. The results can provide a better understanding of simultaneous enrollment in Medicare and Medicaid.

Short URL: http://www.advancingstates.org/node/53309

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Medicaid Today: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013

This survey reports on trends in Medicaid spending, enrollment and policy initiatives for FY 2012 and FY 2013. The report describes policy changes in reimbursement, eligibility, benefits, delivery systems and long-term care, as well as detailed appendices with state-by-state information, and a more in-depth look through four state-specific case studies of the Medicaid budget and policy decisions in Massachusetts, Ohio, Oregon and Texas.

Short URL: http://www.advancingstates.org/node/53303

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WASHINGTON STATE PARTNERs TO COORDINATE CARE FOR MEDICARE-MEDICAID ENROLLEES: MOU

Washington is the first state to enter into a MOU to participate in the new managed-fee-for-service Demonstration to integrate the service delivery across primary, acute, prescription drugs, behavioral health and LTSS. This document details the principles under which CMS and the State plan to implement and operate the Demonstration. It also outlines the activities CMS and the State plan to conduct in preparation for implementation of the Demonstration and initiate the Demonstration.

Short URL: http://www.advancingstates.org/node/53302

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Massachusetts' Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries

Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid. This policy brief summarizes the MOU terms in the several key areas, including enrollment, care delivery model, benefits, financing, beneficiary protections and monitoring and evaluation.

Short URL: http://www.advancingstates.org/node/53295

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State Demonstrations to Integrate Care and Align Financing for Dual Eligible Beneficiaries

This paper examines the contents of the 26 states’ proposals, which intent to test on two models related to financing dual eligible beneficiaries, in the areas of target population, implementation date, enrollment, financing, benefits, beneficiary protections, stakeholder engagement, and demonstration evaluation as set out in the states’ initial submission to CMS. Negotiations between CMS and the states are ongoing and are likely to result in some changes from the states’ initial proposals.

Short URL: http://www.advancingstates.org/node/53294

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