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Measuring Up: A Novel Approach to Assessing State Oversight of Medicaid Managed Care

The lack of recognized standards for what constitutes sufficient monitoring has hindered efforts to assess the effectiveness of state oversight of managed care plans. This brief describes an approach used to evaluate state oversight of a new Medicaid managed care program for individuals with disabilities in Washington. The approach evaluates both the type and vigor of monitoring activities by the state and the degree to which the state's activities achieved their desired program outcomes.

Short URL: http://www.advancingstates.org/node/65960

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Safety Net Health Plans: Working with Providers in Underserved Areas to Integrate Behavioral Health and Primary Care

Better integration of physical and behavioral health is a critical component of improving outcomes and reducing costs for Medicaid beneficiaries, especially those with high levels of need. This report profiles four examples where the safety net community – health plans, community health centers, community mental health centers, and the centers’ primary care and behavioral health clinicians – have collaborated to develop programs to integrate care for this population.

Short URL: http://www.advancingstates.org/node/65948

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Transitions from Medicare-Only to Medicare-Medicaid Enrollment

This study focuses on understanding the rates and patterns of enrollment in Medicaid among individuals already enrolled in Medicare, the factors that predict this transition to dual coverage, and those that predict nursing home entry. This volume of this report is a descriptive examination of the number and characteristics of Medicare beneficiaries who transition to dual coverage in the coming year.

Short URL: http://www.advancingstates.org/node/65916

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Racial and Ethnic Disparities in Alzheimer's Disease: A Literature Review

This study aimed to describe and characterize the published literature on disparities between racial and ethnic groups among individuals with Alzheimer's disease and related dementias. The literature shows consistent and adverse disparities among blacks and Hispanics compared to non-Hispanic whites in the prevalence and incidence of Alzheimer's disease, mortality, participation in clinical trials, use of medications, use of LTSS, health care expenditures, quality of care, and caregiving.

Short URL: http://www.advancingstates.org/node/65914

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Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis

The Non-Elderly Disabled Category 2 (NED2) Housing Choice Voucher Program aimed to increase access to affordable housing for non-elderly people (age 62 and under) with disabilities currently residing in institutions, such as a nursing home. This evaluation examined the program's implementation in a subset of communities that received NED2 vouchers and estimated the impact of the program on the change in the rate of community transitions among the eligible population.

Short URL: http://www.advancingstates.org/node/65912

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Medicaid-Financed Institutional Services: Characteristics of Nursing Home and ICF/IID Residents and Their Patterns of Care

Despite states' rebalance of long-term care (LTC) systems with greater emphasis on home and community-based services (HCBS), many low-income elderly, persons with physical disabilities, and persons with intellectual/developmental disabilities continue to reside in institutions. Through an analysis of Medicaid enrollment and LTC claims data, this report provides information on the characteristics of institutionalized enrollees, their stays, and the interaction of institutional services and HCBS.

Short URL: http://www.advancingstates.org/node/65911

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An Investigation of Interstate Variation in Medicaid Long-Term Care Use and Expenditures Across 40 States in 2006

Shifting the balance in publicly-funded long-term care provision away from institutional care toward greater reliance on home and community-based services has been a federal goal for the past three decades -- a goal often referred to as "re-balancing" state LTC systems. This report explores inter-state variations in LTC expenditure and service use patterns, in terms of institutional and non-institutional services, and also by Medicaid LTC users' age and type of disability.

Short URL: http://www.advancingstates.org/node/65900

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How Many Medicaid Beneficiaries Receive Long-Term Services and Supports?

This report is a comprehensive account of the number of individuals in each state who received Medicaid-funded LTSS in calendar year 2010 based on the Medicaid Analytic eXtract (MAX). The MAX data source is a set of Medicaid administrative data files designed to facilitate Medicaid research. The report identifies the number of people by population group who received institutional and non-institutional services. With some exceptions, State and national data are included.

Short URL: http://www.advancingstates.org/node/65896

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Disabled Dual-Eligible Beneficiaries: Integration of Medicare and Medicaid Benefits May Not Lead to Expected Medicare Savings

In this report, the GAO examined claims, expenditure, and quality data from Dual Eligible Special Needs Plans (D-SNPs) during 2009. The GAO notes that D-SNPs with higher levels of Medicare and Medicaid integration performed better on quality outcomes but did not reduce utilization of costly Medicare services. The GAO concludes that CMS projected savings from the Financial Alignment Demonstration and other initiatives to integrate care for dual eligible beneficiaries may be overstated.

Short URL: http://www.advancingstates.org/node/65894

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State Standards for Access to Care in Medicaid Managed Care

The OIG report examines state standards and requirements for network adequacy and access to care. The report was based on surveys and interviews of state officials, CMS employees, and External Quality Review Organizations. In the report, OIG notes that state standards on access to care vary widely, and that state oversight of health plans also varies. Based on its findings, OIG offers recommendations to CMS in the report.

Short URL: http://www.advancingstates.org/node/65893


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