Changes in population-based payment models in health care delivery have spurred enhanced efforts toward closer integration between state purchasers of health care and state, county, and local public health officials. This issue brief, developed by Bailit Health Purchasing LLC and Dr. Karen Hacker, investigates approaches that state agencies might employ in order to better integrate public health and health care delivery as a means of improving health and the value of health care, and it is organized according to seven features of integration. The issue brief is accompanied by three case studies providing additional detail to some of the examples cited in the brief.
Medicaid and the Indian Health Service: New Guidance Explains How States May Secure Additional Federal Funds
Recent guidance released by the Centers for Medicare and Medicaid Services (CMS) in February 2016 increases the range of Medicaid services and providers for which states may claim full federal funding. States with significant American Indian and/or Alaska Native (AI/AN) populations stand to benefit from this increased federal Medicaid funding. This issue brief, developed by Manatt Health, summarizes the new policy expanding federal funding for state Medicaid services provided to AI/AN populations, and explains the ways in which these additional funds reduce the cost of Medicaid expansion for states.
Provider assessments, fees, and taxes are tools available to states to generate funds to cover the non-federal share of Medicaid payments. This issue brief, developed by the State Network team at Manatt Health, examines two revenue sources that states may utilize to fund the non-federal share of Medicaid expansion: provider assessments and provider donations. Both of these are authorized by federal law and have been used by states in connection with Medicaid expansion. The issue brief summarizes the rules regarding their use and describes the ways in which they have been utilized in several states.
In addition to the impact that state decisions to expand Medicaid have had on coverage rates across the country, there is an increasing body of evidence showing consistent economic benefits among these states. This report, prepared by Manatt Health, is an update to an April 2015 State Network report, and examines data regarding Medicaid expansion in eleven states, demonstrating that states continue to realize budget savings and revenue gains as a result of expanding Medicaid.
With states increasingly moving to develop population-based payment arrangements with provider organizations, the critical role of safety-net providers has become a challenging consideration for states. While safety-net providers typically lack the capital, experience, and/or scale to operate as an Accountable Care Organization (ACO), their role in state Medicaid programs underscores their integral role in the implementation of a population-based payment strategy with ACOs.
The recently released Proposed Payment Notice for 2017 formalizes a fourth model of marketplace – State-Based Marketplace/Federal Platform. Along with State Based Marketplaces, State Partnership Marketplaces and the Federally Facilitated Marketplace, states have a range of choices for what their Marketplace looks like. A key question for states will be how these different models help to achieve coverage goals.
Developing a State-based Quality Measurement Program Using an Episode-of-Care Framework: Recommendations for State Purchasers
In attempting to move toward value-based payments, there exist the inherent challenges posed by the availability of data. States wishing to accelerate the transformation of the existing delivery system into one that delivers high quality and affordable health care have to take action to develop a comprehensive data collection and reporting mechanism. Such an approach can be taken using episodes of medical care as the central unit of measure.
Federally Qualified Health Centers (FQHCs) traditionally provide health care services primarily to low-income individuals who are covered by Medicaid or who are uninsured. As state Medicaid programs increase their focus on value-based payment, it is important to consider how FQHCs may participate in payment reform strategies. This brief provides an overview of FQHC cost reporting, delves into state payment reform strategies that Include FQHCs, and offers considerations for states and FQHCs alike.
Recently, the Centers for Medicare and Medicaid Services (CMS) announced plans to increase the range of Medicaid services furnished by Indian Health Services (IHS) eligible for 100 percent federal match. This proposal, which will effectively reduce states’ costs for Medicaid expansion and buffer the impending decrease in the federal matching rate for newly eligible adults after 2016, may be of particular interest to states with a significant American Indian and Alaskan Native (AI/AN) population.
Medicaid Expansion and Criminal Justice Costs: Pre-Expansion Studies and Emerging Practices Point Toward Opportunities for States
The expansion of Medicaid under the ACA in many states has generated substantial interest in the potential role that Medicaid may play in tackling pressing criminal justice issues. Recent research by Manatt Health Solutions has examined the fiscal implications of Medicaid expansion. This issue brief, the fourth in this series, examines state experiences prior to expansion, focusing on state savings associated with providing health care services and social support to justice-involved individuals through state-funded programs, and also highlights some of the new approaches being adopted by states with Medicaid expansion to connect justice-involved individuals to coverage and care.