Issue Briefs | Apr 25, 2017

State Strategies: Value-Based Payment for Medicaid Populations with Complex Care Needs

 Erin Taylor, Mary Beth Dyer and Michael Bailit, Bailit Health

Driven to improve care coordination and contain costs by moving away from a volume-based payment model, an increasing number of states are implementing risk-based managed care programs to deliver long-term services and supports (LTSS). As the primary payer for LTSS, state Medicaid programs have a significant interest in ensuring that entities with which they contract deliver high quality and cost-effective care to members. This issue brief identifies ways states can learn from value-based payment models being applied elsewhere to create more accountability for the quality and cost of LTSS.


Expert Perspectives

April 12, 2024

The Final 2025 Notice of Benefit and Payment Parameters: Implications for States

On April 2, 2024, the Centers for Medicare & Medicaid Services released the final Notice of Benefit and Payment Parameters for 2025, the annual rule which governs core provisions of the Affordable Care Act. This expert perspective focuses on provisions of the final rule of interest to state officials, including requirements for State-Based Marketplaces to adhere to standards that align more with the Federally Facilitated Marketplace, improvements to the processes for states to determine and update essential health benefits, and initiatives designed to streamline the eligibility and enrollment process for consumers.