Law Commons^™

The Future Of Medicaid Supplemental Payments: Can They Promote Patient-Centered Care?, Laura Hermer, Merle Lenihan

Faculty Scholarship

Supplemental Medicaid payments such as DSH and UPL are the exception to the financing of specific services to specific patients. Medicaid DSH funds currently finance over 30 percent of hospital care to the uninsured. As a result of the Affordable Care Act (ACA), DSH funds will be substantially reduced. At the same time, their importance will be heightened, especially in states that refuse to take up the ACA’s Medicaid expansion. DSH payments to hospitals have been plagued by a lack of accountability and transparency and an inability to assess whether patients benefit from such payments. Flexibility in the DSH program …

On The Uneasy Relationship Between Medicaid And Charity Care, Laura D. Hermer, Merle Lenihan

Faculty Scholarship

Medicaid and charity care have a lengthy relationship fraught with complications. These complications will remain and in some respects become even more acute following the implementation of the Patient Protection and Affordable Care Act.

This article focuses on the uneasy relationship between Medicaid and charity care, one that becomes particularly acute in the context of Medicaid reimbursement. It traces the lineage of Medicaid in charity, and uses Medicaid reimbursement and supplemental payments as lenses through which to examine the relationship between Medicaid and charity care. The tension that we uncover will need to be resolved if Medicaid is to come …

Rationalizing Home And Community-Based Services Under Medicaid, Laura Hermer

Faculty Scholarship

This article examines efforts states are making to expand access to community-based services for elderly and disabled Medicaid beneficiaries and suggests several options that might improve such access nationally. Like much of Medicaid, Medicaid long term services and supports (LTSS) have developed through a complex process of accretion. Policymakers appear only rarely to have considered an overarching view of such services and the needs of those who require them. Rationalizing Medicaid LTSS will accordingly require not only additions but also substantial pruning, and may even warrant a reconsideration of who should have ultimate authority to develop and direct such services. …

"Keep Government Out Of My Medicare": The Search For Popular Support Of Taxes And Social Spending, Gillian Lester

Faculty Scholarship

Despite the broad reach of the American welfare state, Americans continue to have conflicted and contradictory attitudes about the role of the state in mediating economic equality through both taxation and social spending. This chapter identifies several key themes that help explain these contradictions. Specifically, information about taxes and spending is complex and hard to understand, cognitive biases and limitations hamper people’s ability to process information in a way that is always consistent, and affective and symbolic factors influence social attitudes about taxes and government benefits. This chapter explores the implications of these insights for public policy, including the possibility …

The Child-Welfare System And The Limits Of Determinacy, Clare Huntington

Faculty Scholarship

Robert Mnookin’s article, Child-Custody Adjudication: Judicial Functions in the Face of Indeterminacy, is a classic. His insights into the substance and process of family law have influenced scholars for nearly four decades. This essay, written for a symposium marking the upcoming anniversary of the article, demonstrates that Congress adopted many of Mnookin’s proposals to introduce greater determinacy into the child welfare system. And yet the problems he described nearly forty years ago sound all too familiar today. After engaging in a detailed analysis of the reforms, I argue that with the evidence on determinacy now in hand, it is time …

The Child-Welfare System And The Limits Of Determinacy, Clare Huntington

Faculty Scholarship

To read Robert Mnookin’s seminal 1975 article, Child-Custody Adjudication: Judicial Functions in the Face of Indeterminacy, is to see a blueprint for legislative action. To a remarkable degree, the reforms Mnookin proposed to the child-welfare system are what Congress and the states adopted in the following two decades. And yet reading Mnookin’s article is also a Groundhog Day experience. The problems he described with the child-welfare system nearly forty years ago sound all too familiar today.

Mnookin famously argued that the best-interests standard was indeterminate in the context of the child-welfare system. According to Mnookin, this open-ended standard created …