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Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee
Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee
National Health Policy Forum
This paper, the first of two on the general topic of public disability and health benefits, centers on the fundamentals of the Disability Insurance and Supplemental Security Income programs and their relationships with Medicare and Medicaid. In addition to looking at the programs’ definitions, distinctions, and overlaps, it reviews the effects on them of the Ticket to Work and Work Incentives Improvement Act of 1999 and, to a lesser extent, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee
Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee
National Health Policy Forum
The second of two papers on the general topic of public disability and health benefits, this background paper lays out some key issues confronting the Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid programs. It also discusses major initiatives to address those issues, in light of growing administrative, fiscal, and other problems.
Sailing Schip Through Troubled Waters, Jennifer Ryan
Sailing Schip Through Troubled Waters, Jennifer Ryan
National Health Policy Forum
As the State Children’s Health Insurance Program (SCHIP) enters its sixth year of operation, states have continued their commitment to children’s coverage and to reaching out to the uninsured. This issue brief explores the current status of SCHIP in light of fiscal pressures that have been created by the state budget crisis. It highlights some of the key successes in the program thus far and notes several examples of state initiatives to serve particularly vulnerable populations and collect outcomes data and information about access to care.
Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super
Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super
National Health Policy Forum
This site visit to the Geisinger Health System in central Pennsylvania explored the use of technology in providing health care to an aging, rural population with a high index of chronic-care needs. The agenda included an in-depth examination of Geisinger’s electronic medical record and its use in various domains of care, including outpatient clinics, disease management, and non-Geisinger medical practices and community hospitals. The program also highlighted specific care management initiatives in the areas of radiology, stroke, and obesity. Geisinger’s advantages as an integrated system dominant in its market, with the resources to invest in technology were weighed in considering …
Dually Eligible For Medicare And Medicaid: Two For One Or Double Jeopardy?, Jennifer Ryan, Nora Super
Dually Eligible For Medicare And Medicaid: Two For One Or Double Jeopardy?, Jennifer Ryan, Nora Super
National Health Policy Forum
This issue brief describes the characteristics of the population of individuals known as “dual eligibles,” who are eligible for health insurance coverage through both Medicare and Medicaid. It also looks at the differences between “full Medicaid” and “supplemental Medicaid” dual eligibles and the ongoing challenges associated with enrollment and eligibility, integration and coordination, and managed care. The paper presents several examples of integrated care programs designed to better serve the dual-eligible population, including the Program of All-Inclusive Care for the Elderly, Evercare, social health maintenance organizations, and state/federal initiatives such as the Wisconsin Partnership Program, Texas STAR+PLUS, and others. Finally, …
Medical Response For Terrorist And Public Health Threats: One Region's Experience (Pittsburgh), Eileen Salinsky, Lisa Sprague
Medical Response For Terrorist And Public Health Threats: One Region's Experience (Pittsburgh), Eileen Salinsky, Lisa Sprague
National Health Policy Forum
This site visit, planned and convened in conjunction with the Agency for Healthcare Research and Quality’s User Liaison Program, examined the efforts underway in the greater Pittsburgh area to develop emergency medical response capabilities for mass causality events. The site visit explored efforts to improve infectious disease surveillance capabilities and looked at the Region 13 collaborative’s development of a regionalized approach to emergency management planning and response. Hospital preparedness activities were also studied, including a discussion of lessons learned from a recent drill to test response to a radiological event and an exploration of conceptual frameworks to guide hospital planning …
Shaping Public Programs Through Medicare, Medicaid, And Schip Waivers: The Fundamentals, Cynthia Shirk
Shaping Public Programs Through Medicare, Medicaid, And Schip Waivers: The Fundamentals, Cynthia Shirk
National Health Policy Forum
This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care services in federally financed health coverage programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program. The paper also looks at the mechanics of waivers as well as their history and political context in shaping public programs. In addition, it explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy.
The Medicare Prescription Drug Proposals And Health Insurance Risk, Dawn Gencarelli
The Medicare Prescription Drug Proposals And Health Insurance Risk, Dawn Gencarelli
National Health Policy Forum
In order to facilitate a better understanding of the complex issues raised by Senate and House proposals to establish a prescription drug benefit for Medicare beneficiaries, this paper briefly addresses some fundamentals of the health insurance market, defines key risk-sharing mechanisms, including risk corridors and reinsurance, and identifies the relevant risk provisions in the bills. Other issues related to cost management strategies and program design, which may have an impact on cost and adverse selection, are also discussed.
Wic Reauthorization: Opportunities For Improving The Nutritional Status Of Women, Infants, And Children, Harriette Fox, Margaret Mcmanus, Harry Schmidt
Wic Reauthorization: Opportunities For Improving The Nutritional Status Of Women, Infants, And Children, Harriette Fox, Margaret Mcmanus, Harry Schmidt
National Health Policy Forum
This paper examines the main reform issues affecting the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is coming up for reauthorization this year. The paper provides background information on the WIC program, including its dramatic growth in participation and funding. It also reviews WIC’s link to health care and its impact on health outcomes. A series of considerations for WIC’s future are raised, including food package and program eligibility changes, nutrition education strategies to reduce obesity, financial risks and health consequences of relying on infant formula rebates, and new opportunities for research and demonstration.
Obesity In America: A Growing Threat, Eileen Salinsky, Wakina Scott
Obesity In America: A Growing Threat, Eileen Salinsky, Wakina Scott
National Health Policy Forum
This background paper seeks to clarify the nature and causes of the obesity epidemic in the United States and provides an overview of the associated economic and health costs. The paper summarizes existing federal programs and policies that address obesity and examines new and emerging policy strategies to battle the bulging American silhouette. Topics explored include population-based prevention, federal food- and nutrition-assistance programs, Medicare and Medicaid payment policies, school health initiatives, and publicly funded biomedical research.
The Geography Of Medicare: Explaining Differences In Payment And Costs, Nora Super
The Geography Of Medicare: Explaining Differences In Payment And Costs, Nora Super
National Health Policy Forum
This issue brief examines the sources of variation in Medicare payment and costs across different geographic areas and different sites of care. It discusses the payment policies that address variation in the cost of providing care, such as input price adjustments and special payments to hospitals. It also considers differences due to beneficiaries’ health status and in physician practice patterns. Finally, it explores policy options to address Medicare geographic variation.
Doing It Rite: Exploring A Decade Of Health Coverage Innovation (Rhode Island), Jennifer Ryan, Ginger P. Parra
Doing It Rite: Exploring A Decade Of Health Coverage Innovation (Rhode Island), Jennifer Ryan, Ginger P. Parra
National Health Policy Forum
This site visit to the state of Rhode Island provided an opportunity to experience and understand the decade of health coverage innovation that has resulted in near universal coverage for children. Site visitors had the opportunity to interact with health care providers, state officials, and consumer advocates, as well as other leaders in health care community. The group also visited the Thundermist Health Center in Woonsocket; a school based health clinic at Woonsocket High School; the HELP Lead Safe Center in South Providence; and a local provider, St. Joseph’s Hospital for Specialty Care, that houses several preventive care clinics and …
Disease Management To Population-Based Health: Steps In The Right Direction?, Lisa Sprague
Disease Management To Population-Based Health: Steps In The Right Direction?, Lisa Sprague
National Health Policy Forum
This issue brief reviews the evolution of the disease management model and the ways it relates to care coordination and case management approaches. It also looks at examples of population-based disease management programs operating in both the private and public sectors and reviews the evidence of their success. Finally, the paper considers the policy implications of adapting this model to a Medicare fee-for-service population.
Medicaid Prescription Drug Coverage: State Efforts To Control Costs, Dawn Gencarelli
Medicaid Prescription Drug Coverage: State Efforts To Control Costs, Dawn Gencarelli
National Health Policy Forum
This paper provides a brief summary of the Medicaid prescription drug benefit. It explains the mechanisms being used by states to control their prescription drug spending within the Medicaid program. The paper also highlights some of the concerns that have been expressed with these mechanisms and the litigation that has been initiated in several states as a result of these efforts. It takes a closer look at three states with cost containment strategies that have been the focus of increased scrutiny.
The U.S. Health Workforce: Definitions, Dollars, And Dilemmas, Karen Matherlee
The U.S. Health Workforce: Definitions, Dollars, And Dilemmas, Karen Matherlee
National Health Policy Forum
This background paper provides a comprehensive view of the structure of the health workforce. It explores public and private insurance coverage and payment policies, as well as discretionary grant programs, that govern it. The paper also looks at health workforce concerns: supplies of certain types of physicians, health workforce mix, challenges from complementary and alternative medicine, shortages of nurses and pharmacists (and some other practitioners), maldistribution issues, and lack of diversity in response to demographic changes. It presents proposals that are on the table to reform the health workforce, at a time when it is demanding greater attention from health …
Reauthorizing Head Start: The Future Federal Role In Preschool Programs For The Poor, Jane Koppelman
Reauthorizing Head Start: The Future Federal Role In Preschool Programs For The Poor, Jane Koppelman
National Health Policy Forum
This paper describes the implications of President Bush’s proposal to devolve authority for running the Head Start program to the states and to alter the organization and funding of all government early childhood programs—with the goal of improving the school readiness skills of low-income children. The administration plan to allow states to mix Head Start funds with state-funded preschool money and, if desired, child care monies to create a more uniform early childhood care system with an educational focus raises numerous questions. This paper addresses questions raised by this plan, including the potential quality of these new systems, the extent …
Is Community Care A Civil Right? The Unfolding Saga Of The Olmstead Decision, Randy Desonia
Is Community Care A Civil Right? The Unfolding Saga Of The Olmstead Decision, Randy Desonia
National Health Policy Forum
This paper lays the groundwork for understanding the implications of the historic U.S. Supreme Court decision in the case of Olmstead v. L.C., which has far-reaching consequences for the long-term care of people with disabilities. The paper reviews the critical components influencing the case: the Medicaid program’s role in funding community-based long-term care; the Americans with Disabilities Act, which serves as the statutory basis for the decision; and the Court’s legal reasoning. The paper also describes the federal and state responses to the ruling and concludes with a brief discussion of some legal issues that will be debated in the …
Who Will Pay For The Adverse Events Resulting From Smallpox Vaccination? Liability And Compensation Issues, Robin J. Strongin, Eileen Salinsky
Who Will Pay For The Adverse Events Resulting From Smallpox Vaccination? Liability And Compensation Issues, Robin J. Strongin, Eileen Salinsky
National Health Policy Forum
This paper summarizes liability and compensation concerns surrounding the smallpox vaccination program announced by President Bush on December 13, 2002. The paper examines the nature of adverse health events that are likely to occur in connection with the smallpox vaccine, assesses the liability protections that have been established for organizations and individuals participating in the vaccination program, and discusses the compensation mechanisms being considered to address the damages incurred by volunteers who may suffer from adverse vaccine reactions. Specifically, the implications of the Federal Tort Claims Act, workers’ compensation programs, and the creation of a new no-fault compensation fund are …
Converging On Nursing Home Quality, Lisa Sprague
Converging On Nursing Home Quality, Lisa Sprague
National Health Policy Forum
This paper looks at nursing home quality initiatives, built around public reporting of quality data, that have been inaugurated by the Centers for Medicare and Medicaid Services and the California HealthCare Foundation. How the projects were developed is explored, along with preliminary indicators of their impact on consumers and providers and likely next steps in their evolution.