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Medicaid 101: A Primer for State Legislators

Posted on February 5, 2009 16:28

Topics: Medicaid | State Legislation

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From the Council of State Governments:

Medicaid is the largest health insurance program in the country, covering as many as 62 million low-income Americans over the course of a year, including one of every four children in the country. Medicaid has grown from about 10 percent of total state spending in 1987 to nearly 22 percent of total state spending in 2008, making it the top spending category for states. Medicaid, like all health care in America, is expensive— it comes with an annual price tag of more than $300 billion in combined federal and state dollars. The program is important to not only the millions of low-income Americans who receive benefits but also to the economy of each state where Medicaid funds support thousands of health-related jobs, medical education and work force development. It is incredibly complicated and different in each state, with no two Medicaid programs alike. Policies vary from state to state and the population Medicaid serves is incredibly diverse. The Medicaid program is loved by few, criticized by many and misunderstood by most. This primer will help you understand the basics and dispel some myths often associated with Medicaid. As a legislator, you come into contact with people who run the program in your state, service providers, those who are beneficiaries and those who are trying to become beneficiaries. This primer is designed to provide the information you need to help your constituents.

Full report: Medicaid 101: A Primer for State Legislators


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Issues in Mental Health Care Benefits: The Costs of Mental Health Parity (EBRI)

Posted on February 5, 2009 15:26

Topics: Mental Health | Parity

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From EBRI.org:

Summary

  • "This Issue Brief discusses issues in mental health care benefits. It describes the current state of employment-based mental health benefits and discusses studies and issues regarding full mental health parity. It also includes an analysis of the effect of full mental health parity on the uninsured population and the effects of the limited mental health parity provision contained in the VA-HUD appropriations bill. The final section discusses the implications of mental health parity for health plans and health insurers.
  • When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable.
  • The general strategies employers have used to manage their health care costs are cost sharing, utilization review, managed care, and the packaging of provider services. Employers' cost management strategies may be restricted, however. Five states have mental health parity laws, but three of the states—Rhode Island, Maine, and New Hampshire—apply these laws only to the seriously mentally ill. In addition, 31 states mandate that mental health benefits be provided. However, state mandates apply only to insured plans, not to self-insured employer plans, which are exempt from state regulation of health plans under the Employee Retirement Income Security Act of 1974 (ERISA).
  • A number of recent studies have examined the effect of mental health parity on health insurance premiums in a "typical"preferred provider organization and on the uninsured. In general, the studies concluded that mental health parity could increase health insurance premiums, decrease health insurance coverage for non-mental health related illnesses, and increase the number of uninsured individuals.
  • All studies of mental health parity, and mandated benefits in general, assume that there is a strong likelihood that increased health benefit costs would be passed along to workers in the form of higher cost sharing for health insurance, lower wage growth, or lower growth in other employee benefits."

 Find the Full briefing here: http://ebri.org/publications/ib/index.cfm?fa=ibDisp&content_id=92


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Requests for Increase in FMAP

Posted on February 5, 2009 14:37

Topics: Expenditures | Medicaid | State Legislation

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Governors at the National Governors’ Association meeting have called for an increase in Medicaid funds through an increase in the Federal Medical Assistance Percentage (FMAP) i.e, the “federal match.” The FMAP helps determine the funds distributed to the state for Medicaid services. Previous House and Senate bills related to an increase are currently stuck in committee, but the Governors believe that president-elect Obama will likely include some form of increase for Medicaid in future stimulus legislation.

More information on the requests by the governors is available on http://www.nga.org


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New Medicaid Rules for Premiums and Co-payments

Posted on February 5, 2009 14:34

Topics: Medicaid

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A new rule implementing the 2006 Deficit Reduction Act  allows states to impose premiums and higher co-payments for hospital care, prescriptions, and doctors’ services for those over the Federal Poverty Limit (those on TANF and SSI are exempt from the changes). The rule allows a sliding scale based on income requirements (up to a total of 5 percent of a family's income). It also allows for states to deny services to those who don’t pay the required premiums and co-payments. This may generate over a billion dollars in new revenue, though some worry that low-income individuals may forgo or delay services due to increased costs.

The rule is available at: http://edocket.access.gpo.gov/


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NASADAD Releases Inventory of Cost Offset Studies

Posted on February 5, 2009 14:32

Topics: State Data

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The National Association of State Alcohol/Drug Abuse Directors recently released “An Inventory of Cost Offset Studies for State Substance Abuse Agencies.” The inventory discusses the different components of cost offsets as well as methods for conducting and states where the studies have been done. Several of the studies present very good “business cases” for substance abuse treatment, showing billions of dollars in cost savings and other indirect benefits.

The inventory is available at: http://nasadad.org/resource.php?base_id=1564


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Study Says "Higher Costs Expected for ICD-10 Implementation"

Posted on February 5, 2009 14:28

Topics: Expenditures | Mental Health | Substance Use

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A new study questions cost projections for the transition from ICD-9 coding to ICD-10 within the CMS proposed timeframe of October 1, 2011. The ICD-10 Coalition, is seeking an extension of the timeframe due to the complexity of transition and cost estimates for implementation that are potentially higher than expected. The study by Nachimson Advisors for the Coalition estimates costs at $83,290 for a small practice to $2.7 million for a large practice. However, others, including the American Hospital Association support the rule. They contend that if implementation doesn’t occur by 2011, people will continue to buy products that cannot handle ICD-10, making the transition more difficult. The upgrade to ICD-10 is designed to  allow for more accurate coding of mental health and substance use disorders, which will likely have an effect on reimbursements for M/SU diagnoses. Concerns remain, however, about the lack of concordance between ICD and DSM for some diagnoses.

The study is available at: http://nachimsonadvisors.com/Documents/ICD-10%20Impacts%20on%20Providers.pdf

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