Medicaid’s 3 Big Changes: Consequences for Consumers

Presentation forConsumer Providers Association of New Jersey

Tom Pyle, AdvisorAugust 2013

What’s coming…

Topic: National & State Change

The biggest changes in 50 years…

How will consumers be affected?

What should CPANJ advocate?

...To Ask Lynn Kovich

What 3 Key Questions...

The Whole Thing, in 20 Words...

THE NATIONAL THING... Health insurance for

all Individual Mandate Corporate Requirement

Help for those who need it Medicaid Subsidies

THE STATE THING...

Comprehensive Waiver Consolidation: 8 1

B H to managed care Contracted FFS Medicaid rate setting

Merger of services MH + SUD

The Whole Thing, in 20 Words...THE NATIONAL THING... Health insurance for

THE STATE THING...

Help for those who need it Medicaid Exchanges Subsidies

THE STATE THING...

Medicaid’s 3 Big Changes

1. Reform “Innovations” (ACOs) “Benchmark” plans

2. Expansion 25% increase

3. Managed care BH ASO Grant FFS Case Capitated

...From the Perspective of...

1. Beneficiaries

2. Providers

3. Agencies

4. Government

Considered by... 5 Big Outcomes

1. Access2. Availabilit

y3. Quality4. Cost5. Innovatio

Dealing with... 10 Challenges

1. Coverage: As much?

2. Providers: Enough?3. Exchanges: Overlap?4. Transitions: Churn?5. “Woodwork Effect”?6. Measures: Of What?7. Outreach: Possible?8. IT: Too Complex?9. Deadlines: Too Tight?10.Agency $: Enough?

Dealing with... 10 Challenges

1. Coverage: As much?2. Providers: Enough?3. Exchanges: Overlap?4. Transitions: Churn?5. “Woodwork Effect”?6. Measures: Of What?7. Outreach: Possible?8. Implement: Complex?9. Deadlines: Too Tight?10.Agency $: Enough?

...and 1 Big Challenge

What is Medicaid?

An entitlement

Big funder of… Health care for poor, disabled Safety-net hospitals, LT care

Federal-state partnership FMAP: 50% to 83%

What is Medicaid?

An entitlement

What is Medicaid?

An entitlement

What is Medicaid?

What is “FMAP”?

Federal Medical Assistance Percentage:

% of Federal matching funds to state Medicaid.

What is “FMAP”? ...For NJ

Federal Medical Assistance Percentage

NJ: 50%

What is “FMAP”? ... Under ACA

For “new eligibles”:

Till 2017: 100%

By 2020: 90%

Medicaid: SMI Jersyans affected?(Substance Abuse and Mental Health Services Administration, 2013a)

10% (~42,000?)

Medicaid: Expenditures FY 2010 (Centers for Medicare and Medicaid, 2012)

$404.1 billion

By Contrast...

$404.1 billion $33.0 billion

Medicaid as % of…(Foster, 2012)

GDP: 2.8%

Health spending: 15%

Segments % paid by Medicaid (Foster, 2012)

BH Funding: Medicaid’s Share (Substance Abuse and Mental Health Services Administration, 2013)

Medicaid: Acute/LT Care 2009(Kaiser Commission on Medicaid and the Uninsured)

Waste, Fraud, Abuse(Kaiser Commission on Medicaid and the Uninsured, 2012)

Overtreatment Failure of care coordination Failure of care process (Tx) Administration complexity Failure of pricing Fraud and abuse

At least 20% of costs...(~ $80 billion?...)

Waste, Fraud, Abuse(Kaiser Commission on Medicaid and the Uninsured, 2012)

Overtreatment Failure of care coordination Failure of care process (Tx) Administration complexity Failure of pricing Fraud and abuse

At least 20% of costs...(~ $80 billion?...)

Enrollment & Shares, 2010(Centers for Medicare and Medicaid et al., 2012)

~ 60 mm

Overview: Role in state budgets

Counter-cyclical to economy

Largest source of federal revenue ( jobs)

Biggest target for state cost controls

Overview: How Control Costs?(Substance Abuse and Mental Health Services Administration, 2013)

Medicaid an entitlement

States can only...

States can only... Reduce provider payments

States can only... Reduce provider payments “Manage” utilization

States can only... Reduce provider payments “Manage” utilization Restrict eligibility

Medicaid: 5 Components(Kaiser Commission on Medicaid and the Uninsured)

Health insurance coverage 31 mm children; 16 mm adults; 16 mm E&D

Long-term care assistance 1.6 mm institutionals; 2.8 mm community-based

Assistance to Medicare beneficiaries 9.4 mm E&D (20% of Medicare enrollees)

Safety net & system funding 16% national health funding; 35% safety net

hospitals

Funding for state capacity FMAP

Health insurance coverage

Assistance to

Medicare beneficiar

Long-term care assistanc

Safety net & system funding

Funding for state capacity

hospitals

Assistance to

Medicare beneficiar

hospitals

Assistance to

Medicare beneficiar

hospitals

Assistance to

Medicare beneficiar

hospitals

Assistance to

Medicare beneficiar

Medicaid: 4 Constituencies

• Eligibility• Enrollment• Coverage• Cost

Consumers

• Rates• Autonomy• Referrals• Administration• Compliance

Providers

• “Rights”• “Access”• Administration• Quality• Cost

Governments

• Administration• Overheads• Compliance• Cash flow

Agencies

Consumers

Providers

Governments

Agencies

Consumers

Providers

Governments

Agencies

Consumers

Providers

Governments

Agencies

Review

3 Big Changes 5 Big Outcomes FMAP: NJ = 50% 2.8% of GDP 15% of all health spending W,F,A = 20% 18% beneficiaries 45% cost 5 Components 4 Constituencies

Eligibility (3 kinds)

Category

Financial

Resource

1. Category Eligibility: Required

Children Pregnant women Parents of certain children Seniors Individuals with disabilities

NOT childless non-elderly adults

2. Financial Eligibility

2013 Federal Poverty Limit (FPL)

2. Financial Eligibility

Family of 1: $11,490 x 133% =$15,282

Family of 4: $23,550 x 133% =$31,322

2013 Federal Poverty Limit (FPL)

FPL by Class (US)(Kaiser Commission on Medicaid and the Uninsured)

Eligibility: FPL by Class (NJ)(Kaiser Commission on Medicaid and the Uninsured)

Eligibility: FPL (After ACA)(Kaiser Commission on Medicaid and the Uninsured; Tate, 2012))

Eligibility: ACA’s effect(et al., 2013)

3. Resource Eligibility (SSI)

Eligibility: Overlap!(Blahous, 2013)

Medicaid: < 138% FPL. Exchanges: > 100% FPL.

Enrollment FY 2010(Centers for Medicare and Medicaid et al., 2012)

~ 62 mm

Today’s enrollee demographics(Kenen, 2012)

Poor families with children 2/3rd of enrollees 1/3rd of spending

Elderly and disabled 1/3rd of enrollees▪ (including 70% of those in nursing

homes) 2/3rd of spending

Enrollment demographics(Sommers & Epstein, 2010)

Eligibles: Nearly 1 in 3 not enrolled!

Enrolled eligibles: Highly variable by state

OK 44% MA 80%

Enrollment demographics(Sommers & Epstein, 2010)

Eligibles: Nearly 1 in 3 not enrolled!

Enrolled eligibles: Highly variable by state

OK 44% MA 80%

NJ 53%

Coverage

Medicaid: Focuses on...

Services, not programs

Discrete and individual, not comprehensive

Medicaid: Must Cover...(Substance Abuse and Mental Health Services Administration, 2013)

Inpatient hospital Outpatient hospital EPSDT Nursing facility Home health Physician Rural health clinic Federally qualified

health center (FQHC) Laboratory and X-ray Family planning Nurse midwife

Certified pediatric and family nurse practitioner

Freestanding birth center (when licensed or otherwise recognized by the state)

Transportation to medical care

Tobacco cessation and tobacco cessation counseling for pregnant women and youth under 21 as part of EPSDT

Coverage: Previous (Garfield, Lave, & Donohue, 2010)

Challenge: Less Coverage?(Garfield, Lave, & Donohue, 2010)

“Benchmark”EssentialBenefitscoverage

under ACA

Excludable

for newbiesunder ACA

Rehab Option: Its Scope(Substance Abuse and Mental Health Services Administration, 2013)

Service Setting Type of Provider Extent of Coverage

“Rehab Option”: A Distinction(Substance Abuse and Mental Health Services Administration, 2013)

“Habilitative” services: to develop skills never acquired (as among DD population) Only through home and community-based

waiver

“Rehabilitative” services: to restore lost functioning (as among PD population) Not limited to clinical treatment

Services Range

As per SAMHSA’s...

“Good and Modern Addictions and Mental Health Service System”

Services Range

Acute IntensiveOut-of-home Residential

Intensive SupportOutpatient Services

Healthcare Home/Physicial HealthMedication Services

Engagement ServicesPrevention

Community Support (Rehab)Other Support (Habilitative)

Recovery Support

Increasing Intensity of Medical and Behavioral Health Specialty

Increasing Intensity of Social and Community Services

Where are the peer provider positions?

Services Range

Healthcare Home/Physical HealthMedication Services

Recovery Support

Mobile crisisMedically monitored intensive inpxPeer-based crisisUrgent care23 hr. crisis stabilization24/7 crisis hotline

Services Range

Recovery Support

Crisis residential/stabilizationClinically managed 24 hr careClinically managed med. Intense careAdult mental health residentialChildren’s mental health residentialYouth subtance abuse residentialTherapeutic foster care

Services Range

Recovery Support

Substance abuse intensive outpxSubstance abuse ambulatory detoxPartial hospitalAssertive Community TreatmentIntensive home-base treatmentMulti-systemic therapyIntensive Case Management

Services Range

Recovery Support

Individual evidence-based therapiesGroup therapyFamily therapyMultifamily therapyConsultation to caregivers (e.g., IFSS)

Services Range

Recovery Support

Outpx medical servicesAcute primary careGeneral health screens, tests, etc.Comprehensive care managementCare coordination and health promotionIndividual and family supportReferral to community services

Services Range

Recovery Support

Medication managementPharmacotherapy (incl. MAT)Laboratory services

Services Range

Recovery Support

AssessmentSpecialized evaluationsService planning (incl. crisis planning)Consumer/Family Education (e.g. IMR)Outreach

Services Range

Recovery Support

Screening and referral to txBrief motivational interviewsParent trainingFacilitated referralsRelapse preventionWellness recovery supportWarm Line

Services Range

Recovery Support

Parent/caregiver supportSkills building (social, ADLs, cognitive)Case managementBehavior managementSupported EmploymentPermanent Supported HousingTherapeutic mentoring, life coachingDay habilitation

Services Range

Recovery Support

Personal careHomemakerRespiteSupported EducationTransportationAssisted livingRecreational services

Services Range

Recovery Support

Peer supportRecovery support coachingRecovery support center servicesSupports for self-directed careContinuing care for substance use disorders

Managed Care: 3 Types

1. Managed care organization (MCO)▪ Capitation: Per person per month▪ Risk: Who accepts it? State or vendor?

2. Primary care case management (PCCM)▪ Case management fee

3. Pre-paid Health Plans (PHP)▪ In-patient ▪ Ambulatory

Managed Care: Elements

Enrollment Benefits Usage Cost sharing (co-pays) Access Quality Accountability

…with “Carve Outs”

Dental

Medications

Transport

…with “Carve Outs”

Dental

Medications

Transport

Behavioral health

Grants (Block

Grants)

Encounter-based (Medicaid FFS)

Case rates

Capitation rates (MCO)

Medicaid Managed Care: Prevalence(Kaiser Commission on Medicaid and the Insured, 2012)

Medicaid67%

New Jersey 97%

Managed Care: Policy Issues Eligibility What class? By what means? Enrollment Voluntary or mandatory? Education What? How? Choice Self-select or auto-assign? Access/availability Sufficient network?

Continuity Many visits or “one-and-done”? Coordination PH & BH; PCPs and

specialists Rates What level? Costs Risk or non-risk? State or

Federal? Monitoring Access? Quality? Cost?

Satisfaction?

ACA’s Medicaid ExpansionNJ’s Comprehensive Waiver

Affordable Care Act

THE NATIONAL THING...

…bringing the biggest change in Medicaid since it began.

3 Years Later: 2/3rds Don’t Know!(Gold, 2013)

ACA: Goals(Tate, 2012)

Increase access

Control costs

Add benefits & protections

Address many smaller issues

ACA: 3 Legged Strategy

1. Insurance reform Individual mandate

2. Exchanges + subsidies Subsidies for those at 100% -400% of

3. Medicaid expansion For adults < 138% of FPL

Eligibility: FPL Limits by Class (US)(Kaiser Commission on Medicaid and the Uninsured)

Eligibility: FPL Limits by Class (NJ)(Kaiser Commission on Medicaid and the Uninsured)

Eligibility: FPL Limits (After ACA)(Kaiser Commission on Medicaid and the Uninsured; Tate, 2012))

Subsidies: Amounts by FPL

Income % of FPLPremium Cap as

a Share of Income

Income $ (family of 4)

Max Annual Out-of-Pocket Premium

Premium SavingsAdditional Cost-Sharing Subsidy

133% 3% of income $31,900 $992 $10,345 $5,040 150% 4% of income $33,075 $1,323 $9,918 $5,040 200% 6.3% of income $44,100 $2,778 $8,366 $4,000 250% 8.05% of income $55,125 $4,438 $6,597 $1,930 300% 9.5% of income $66,150 $6,284 $4,628 $1,480 350% 9.5% of income $77,175 $7,332 $3,512 $1,480 400% 9.5% of income $88,200 $8,379 $2,395 $1,480

Expansion: Projected Enrollments(Centers for Medicare and Medicaid, 2012)

Expansion Effect: NJ Coverage (Rutgers Center for State Health Policy, 2012)

Change in Coverage in NJ under ACA (ages 0-64)

For PCPs only Family practitioners Internists Pediatricians

Only for 2013, 2014

Also for managed care

US 0.72

WY 1.43AK 1.40DE 1.00PA 0.73CA 0.56NY 0.43

NJ 0.37

Rate Ratio (Zuckerman et al., 2009)

Innovation: Medicaid ACO

“Accountable Care Organization”

NJ’s Comprehensive WaiverGetting it all together

THE STATE THING...

NJ Medicaid

“Division of Medical Assistance and Health Services”

$11 billion (federal and state)

500 people

Director: Valerie Harr

NJ Medicaid: Enrollment

Medicaid: The State Plan

Required by Section 1902(a) (30)(A)

71 elements Rates Methodology Comment periods

Waivers by Type(Centers for Medicare & Medicaid, 2013)

Section 1115 Research and

demonstration

Section 1915(b) Managed Care

Section 1915(c) Home and

Community Based

Concurrent 1915(b) & (c)

…for more “flexibility”

1115: NJ “demonstrations” (new)

Health homes Concentrated care...

Accountable Care Organizations (ACO) Coordinated, cost-effective care...

1915(b): Mandatory Managed Care (Howell, Palmer & Adams, 2012)

KEEP…

Can be mandated, with choice of plans

Rates must be “actuarially sound”

CHANGE…

“Risk-based” payments and incentives

NJ’s Managed Care Companies

For physical health...

For behavioral health...

NJ’s Managed Care Companies

For physical health...

For behavioral health...

BH Managed Care ASO

One already exists! In DCF: “CSOC” 40,000 kids

Phase in to risk-based over 5 years

Administrative Services Organization

NJ Waivers: Previously (Centers for Medicare & Medicaid, 2013)

demonstration

(Mandatory)

Community Based

1. Childless adults2. Family coverage (SCHIP) ACOs

3. NJ Care 2000+4. NJ Family Care BH ASO

5. Global Options (LT care)6. Renewal Waiver7. Community Resources8. Community Care

Alternatives

NJ Waivers: Additional(Centers for Medicare & Medicaid, 2013)

demonstration

(Mandatory)

Community Based

1. Childless adults2. Family coverage (SCHIP) Accountable Care (ACO)

3. NJ Care 2000+4. NJ Family Care B H Managed Care

Alternatives

NJ Waivers: Additional(Centers for Medicare & Medicaid, 2013)

demonstration

(Mandatory)

Community Based

1. Childless adults2. Family coverage (SCHIP) Accountable Care (ACO)

3. NJ Care 2000+4. NJ Family Care B H Managed Care

Alternatives

NJ Waivers: Now (Centers for Medicare & Medicaid, 2013)

demonstration

(Mandatory)

Community Based

One Comprehensiv

e Waiver

Out Px

Primary Care

Specialist

Therapist

Case Worker

Hospital

PHP/IOP

LTCF LT Care Facility

Medicaid: Mechanics

Medicaid: The Old Way

Managed Care Organization (MCO)

Physical “Health Home”

Managed Care

Behavioral Health Home

“Behavioral

Health Home”

Managed Care After the Waiver?

“Behavioral

Health Home”

“Behavioral

Health Home”

Post Waiver: Unknown No. 1

“Fee for service”?

“Behavioral

Health Home”

“Behavioral

Health Home”

Integration?

Rates?

“Behavioral

Health Home”

10 Challenges for Consumers

1. Coverage: Less for Newbies? (Garfield, Lave, & Donohue, 2010)

“Benchmark”coverage

under ACA

Excludable

under ACA

Excludable

Advocacy Question:

Shouldn’t newly eligible Medicaid-covered consumers receive the same

benefits as current Medicaid-covered

consumers?

2. Providers: Enough?

2. Providers: Rate Ratios(Zuckerman et al., 2009)

𝑥=𝑴𝒆𝒅𝒊𝒄𝒂𝒊𝒅 𝑟𝑎𝑡𝑒𝑀𝑒𝑑𝑖𝑐𝑎𝑟𝑒𝑟𝑎𝑡𝑒

US 0.72

WY 1.43AK 1.40DE 1.00PA 0.73CA 0.56NY 0.43

NJ 0.37

US 0.72

WY 1.43AK 1.40DE 1.00PA 0.73CA 0.56NY 0.43

NJ 0.37

US 0.72

WY 1.43AK 1.40DE 1.00PA 0.73CA 0.56NY 0.43

NJ 0.3750t

2. Providers: Supply = f(Rate Ratio) (Decker, 2012)

% doctors accepting

2. Providers: Supply = f(Rate Ratio) (Decker, 2012)

% doctors accepting

100%! …for PCPs and those they supervise… …even in managed care… …even for dual eligibles.

Result: 10-24% increase in accepting PCPs?

Not for specialists (e.g., psychiatrists)

Only for 2013 and 2014 Extend? Measurement will be key…

2. Providers: “Rate Bump” For…?(Kaiser Commission on Medicaid and the Uninsured, 2012a)

= 100%

Advocacy Question:

Shouldn’t NJ set Medicaid rates sufficient to...

...attract more providers, especially specialists

(at least to 70% accepting new patients)?

...assure a living wage to community behavioral health sector workers,

especially peer providers?

3. Exchanges: FPL Overlap?(Blahous, 2013)

Overlap! Medicaid: < 138% FPL. Exchanges: > 100% FPL.

Partial expansion? All > 100% to exchanges, where no state funding needed…

HHS: 100% FMAP if states do partial? NO!

NO! HHS: 100% FMAP if states do partial

4. Transitions: Coverage Churn?(Ingram, McMahon & Guerra, 2012)

Medicaid Exchanges: 35% of all adults below 200% FPL More for those with

Exchanges Medicaid: 28 million

4. Transitions: Coverage Churn?(Ingram, McMahon & Guerra, 2012)

Medicaid Exchanges: 35% of all adults below 200% FPL More for those with

Exchanges Medicaid: 28 million

Advocacy Questions:

How will consumers who get “churned”

be assured smooth and seamless coverage?

Who will help them? In what way?

What impact will “churning”have on consumer employment?

5. “Woodwork” Effect?(Castro, 2013; Alaigh, 2002)

234,000total

eligibles

(@ $8000 per)

FMAP = 100%

New eligibles vs. old eligibles not enrolled

5. “Woodwork” Effect?(Castro, 2013; Alaigh, 2002)

234,000total

eligibles

(@ $8000 per)

FMAP = 100%

New eligibles vs. old eligibles not enrolled

Advocacy Question:

Will unexpected costs (e.g. only 50% FMAP for old eligibles)

cause the State to cut its share of Medicaid funding?

6. Measures: Of What?

HEDIS: measure behavioral health? Healthcare Effectiveness Data and

Information Set

System metrics, not consumer metrics

Information Set

System metrics, not consumer metrics

Advocacy Questions:

What specific consumer outcomesdoes the State propose to measure ?

Who will decide? When?

7. Outreach: Can It Succeed?(Sommers & Epstein, 2010)

Publicity hurdles 150 different languages in NJ Cultural differences

Application hurdles Multipage application Documentation of income and residency

Tracking hurdles ACA does not apply to incomes < IRS tax filing

threshold ($9,350 for singles, $18,700 for joint) = 50% of eligible uninsureds

Advocacy Questions:

How specifically willuninsured consumers be reached?

How will private health and financial information be protected?

What role will consumer providers play?

What training will be required?

8. Implementation: Too Complex?

South Carolina’s IT Enterprise Strategy Map

8. Implementation: Too Complex?

South Carolina’s IT Enterprise Strategy MapAdvocacy Questions:

What assurance is NJ seeking that the Federal systems will be ready on time?

What privacy protections will be in place?

How will identity theft be prevented?

What state oversight (e.g., by DOBI)will be exercised?

Deadlines: Too Tight?

ASO: July 1! “Managed care”, but… Fee for service

“Go Live”: January 1! Medicaid Expansion Exchanges

“Go Live”: January 1! Medicaid Expansion ExchangesPOSTPONED!

Advocacy Questions:

Why is NJ setting Medicaid ratesbefore the ASO is established?

Why is NJ not permitting the ASOthis management flexibility so better

to help the agencies transition?

9. Compliance: Too Heavy?

Reporting

Documentation

Audits

Clawbacks

Penalties

9. Compliance: Too Heavy?

Reporting

Documentation

Audits

Clawbacks

Penalties

Advocacy Questions:

What is NJ specifically doing to help agencies

address conflicting auditing requirements?

What transition period will agencies have

to manage their compliance transitions

without onerous penalties?

10. Agency Cash Flow: Enough?

Reduced fees

Increased costs

New investments EMR Compliance Training

10. Agency Cash Flow: Enough?

Reduced fees

Increased costs

New investments EMR Compliance Training

Advocacy Question:

Why financial support (e.g., working capital)

will NJ provide to help non-profit agencies

manage the heavy investment requirements

of both the ACA and B H Managed Care?

1 Big Challenge for America

Entitlement Spending...

The Ultimate Advocacy Question

Outcomes

AccessAvailabilityQualityCostInnovation

Access

To the System

To Providers

To PsyR services

(To Insurance…)

Availability

Of basic care

Of specialty care

Of emergency care

Of evidence-based practices

Quality

Provider What level? What training? What experience? What supervision?

Process Simpler? Smoother?

Co-pays

Deductibles

Premiums

(Work incentives?)

Innovation

Practices

Medications

Technology

Management

Will Outcomes Improve?

Winners and Losers... 1 2 3 4 5 6

Mechanisms Medicaid Private Insurance

Insurance Exchanges

Cost Containment

Quality Improvement

Eligibility Change FMAP Increase rates Coverages Caps Cancellations Elements Features More groups

Higher FPLs

FMAP to 100%, then 90% (instead of 50%) for new eligibles

Medicaid rates = 100% Medicare rates (instead of 72%)

10 basics

No lifetime caps No rescission Premium subsidies

Cost subsidies

Benefits Fewer uninsured

More costs paid by Federal gov’t

More incentive for PCP participation

More coverage More coverage for big problems

Durable coverage

“Affordable” premiums, lower costs.

Costs More waiting

Faster visits

More APNs

...but not for “old eligibles”

...but not for specialists, only for 2 years.

Applied to others

Very expense for Fed gov’t. Very complex. Very systems intensive. Pri-vacy issues.

Improve? Access Availability Quality Cost Innovation Winners? Clients (old and new “elig-ibles”, and existing bene-ficiaries)

Existing:

Providers Agencies Government State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal:

State:

Federal: Insurers

Conclusion?

References

Alzer, A., Currie, J., & Moretti, E. (2007). Does Medicaid managed care hurth health? Evidence from Medicaid mothers. The Review of Economics and Statistics, 89(3).

Averill, Patricia M., Ruiz, Pedro, Small, David R., Guynn, Robert W., & Tcheremissine, Oleg. (2003). Outcome assessment of the Medicaid managed care program in Harris County (Houston). Psychiatric Quarterly, 74(2), 103-114.

Bigelow, Douglas A., McFarland, Bentson H., McCamant, Lynn E., Deck, Dennis D., & Gabriel, Roy M. (2004). Effect of Managed Care on Access to Mental Health Services Among Medicaid Enrollees Receiving Substance Treatment. Psychiatric Services, 55(7), 775-779.

Cook, Judith A., Heflinger, Craig Anne, Hoven, Christina W., Kelleher, Kelly J., Mulkern, Virginia, Paulson, Robert I., . . . Kim, Jong-Bae. (2004). A Multi-site Study of Medicaid-funded Managed Care Versus Fee-for-Service Plans' Effects on Mental Health Service Utilization of Children With Severe Emotional Disturbance. The Journal of Behavioral Health Services & Research, 31(4), 384-402.

Coughlin, Teresa A., & Long, Sharon K. (2000). Effects of medicaid managed care on adults. Medical Care, 38(4), 433-446.

Cunningham, Peter J., & Nichols, Len M. (2005). The Effects of Medicaid Reimbursement on the Access to Care of Medicaid Enrollees: A Community Perspective. Medical Care Research and Review, 62(6), 676-696. doi: 10.1177/1077558705281061

Felix, Holly C., Mays, Glen P., Stewart, M. Kathryn, Cottoms, Naomi, & Olson, Mary. (2011). Medicaid Savings Resulted When Community Health Workers Matched Those With Needs To Home And Community Care. Health Affairs, 30(7), 1366-1374. doi: 10.1377/hlthaff.2011.0150

Gold, Marsha, & Mittler, Jessica. (2000). "Second-generation" Medicaid managed care: Can it deliver? Health Care Financing Review, 22(2), 29-47.

Kaye, H. Stephen, LaPlante, Mitchell P., & Harrington, Charlene. (2009). Do noninstitutional long-term care services reduce Medicaid spending? Health Affairs, 28(1), 262-272. doi: 10.1377/hlthaff.28.1.262

Keenan, Patricia S., Elliott, Marc N., Cleary, Paul D., Zaslavsky, Alan M., & Landon, Bruce E. (2009). Quality assessments by sick and healthy beneficiaries in traditional Medicare and Medicare managed care. Medical Care, 47(8), 882-888.

Liu, Heng-Hsian Nancy. (2012). Policy and practice: An analysis of the implementation of supported employment in Nebraska. Dissertation Abstracts International: Section B: The Sciences and Engineering, 72(7-B), 4324.

McCombs, Jeffrey S., Luo, Michelle, Johnstone, Bryan M., & Shi, Lizheng. (2000). The Use of Conventional Antipsychotic Medications for Patients with Schizophrenia in a Medicaid Population: Therapeutic and Cost Outcomes over 2 Years. Value in Health, 3(3), 222-231.

McFarland, Bentson H., Deck, Dennis D., McCamant, Lynn E., Gabriel, Roy M., & Bigelow, Douglas A. (2005). Outcomes for Medicaid Clients With Substance Abuse Problems Before and After Managed Care. The Journal of Behavioral Health Services & Research, 32(4), 351-367.

Norris, Margaret P., Molinari, Victor, & Rosowsky, Erlene. (1998). Providing mental health care to older adults: Unraveling the maze of Medicare and managed care. Psychotherapy: Theory, Research, Practice, Training, 35(4), 490-497.

Parks, Joseph J. (2007). Implementing practice guidelines: Lessons from public mental health settings. Journal of Clinical Psychiatry, 68(Suppl4), 45-48.

Ray, Wayne A., Daugherty, James R., & Meador, Keith G. (2003). Effect of a mental health "carve-out" program on the continuity of antipsychotic therapy. The New England Journal of Medicine, 348(19), 1885-1894.

Wallace, Neal T., Bloom, Joan R., Hu, Teh-Wei, & Libby, Anne M. (2005). Medication treatment patterns for adults with schizophrenia in Medicaid managed care in Colorado. Psychiatric Services, 56(11), 1402-1408.

Wan, Thomas T. (1989). The effect of managed care on health services use by dually eligible elders. Medical Care, 27(11), 983-1001.

Warner, Richard, & Huxley, Peter. (1998). Outcome for people with schizophrenia before and after Medicaid capitation at a community agency in Colorado. Psychiatric Services, 49(6), 802-807.

West, Joyce C., Wilk, Joshua E., Rae, Donald S., Muszynski, Irvin S., Stipec, Maritza Rubio, Alter, Carol L., . . . Regier, Darrel A. (2009). Medicaid prescription drug policies and medication access and continuity: Findings from ten states. Psychiatric Services, 60(5), 601-610

Privacy

Navigators Training reduced from 30 t0 20 hours 20% of funding for navigators from

diversion from disease prevention. (Attorney Gen’l Bondi, FL)

Medicaid’s 3 Big Changes: Consequences for Consumers

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Transcript of Medicaid’s 3 Big Changes: Consequences for Consumers

Ecological Interactions 8.L.3.2 – Summarize the relationships among producers, consumers, and decomposers including the positive and negative consequences.

ANNEX 2 TO FINAL REPORT - European Commission€¦ · Annex 2 to Final Report - Case Studies of Option Scenario Examination and assessment of consequences for industry, consumers,

Licence to Capture: The Cost Consequences to Consumers of Occupational …€¦ · There are many cases where the interest of the public favours occupational regulation for reasons

The Ohio Department of Medicaid’s Methodology for Covered ......1 The Ohio Department of Medicaid’s Methodology for Covered Families & Children (CFC), Aged, Blind, or Disabled

Restrictions on Payday Lending and Access to Credit€¦ · 20 K. Edmiston, FRBKC May 24, 2011 Restrictions on payday lending may have some unintended consequences for consumers,

Medicaid’s Role in the Delivery and Payment of SUD

An In-Depth Follow-Up of Utah Medicaid’s Implementation Of ...

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Outcomes and Implications of Florida Medicaid’s e-Prescribing Pilot Project

Medicaid’s Final Rule for Home and Community Based Setting ... · Medicaid’s Final Rule for Home and Community Based Setting Requirements Decision final de Medicaid de requerimientos

Are Consumers Concerned about Palm Oil? · Abstract: A lab experiment evaluates the consequences of the palm oil controversy on ... consumer information campaign versus a per-unit

Fake News, Real Consequences - Magazine News Real Consequences 10... · Fake News, Real Consequences: Impact on Consumers, Publishers and Advertisers – PDRF 2017 Madrid. 2 …written

ugust Medicaid’s Role for Dual Eligible Beneficiaries · Medicaid’s Role for Dual Eligible Beneficiaries ugust by Katherine Young, Rachel Garfield, MaryBeth Musumeci, Lisa Clemans-Cope,

Medicaid’s Evolving Role in Health Coverage Alice Burton, Director AcademyHealth National Governor’s Association Health Policy Advisors Meeting September.

Medicaid’s Role for Dual Eligible Beneficiaries, April ... · Medicaid’s Role for Dual Eligible Beneficiaries by Katherine Young, Rachel Garfield, MaryBeth Musumeci, Lisa Clemans-Cope,

Car wars: Trade integration and trade disruption in the ... · Car wars: Trade integration and trade disruption in the worldwide car industry Consequences for output and consumers

California · Web viewThese provisions were intended to cast a “chilling effect” on non-parties to the agreements, with tremendous consequences for California consumers-- if

ANTECEDENTS AND CONSEQUENCES OF FEMALE CONSUMERS’ ATTITUDE ...etd.uum.edu.my/5427/2/s93568_abstract.pdf · Penilaian amalan etika pemasaran dalam perniagaan dari perspektif pengguna

Medicaid’s Evolving Role in Health Coverage Alice Burton, Director AcademyHealth

Virginia Medicaid’s Preferred Drug List (PDL) Common Core ... · Virginia Medicaid’s Preferred Drug List (PDL) Common Core Formulary 2/18/2019 1 | P a g e Virginia Medicaid’s