Improving the Delivery of Key Work Supports: Policy & Practice Opportunities at a Critical Moment

Examines the consequences of a lack of coordination and seamless service delivery across support programs. Outlines policy, procedural, and data utilization options and best practices to expedite receipt of benefits across programs, as well as challenges

Medicaid's Future: What Might ACA Repeal Mean?

Issue: Republicans in Congress are expected to repeal portions of the Affordable Care Act (ACA) using a fast-track process known as budget reconciliation.Goals: This issue brief examines how repeal legislation could affect Medicaid, the nation's health care safety net, which insured 70 million people in 2016.Findings and Conclusions: Partial-repeal legislation that passed Congress but was vetoed by President Obama in 2016 offers some insight but new legislation could go further. It could repeal the ACA's Medicaid eligibility expansions for adults and children but also roll back other provisions, such as simplified enrollment and improvements in long-term services and supports for beneficiaries with disabilities. Additionally, the Trump Administration could expand use of demonstration authority to introduce deeper structural changes into Medicaid, such as eligibility restrictions tied to work, required premium contributions and lock-out for nonpayment, annual enrollment periods, and coverage limits and exclusions. Together, these changes would have far-reaching implications for Medicaid's continued role as the nation's safety-net insurer

Legal Solutions in Health Reform: Insurance Discrimination on the Basis of Health Status: An Overview of Discrimination Practices, Federal Law, and Federal Reform Options

Provides an overview of the insurance industry's discriminatory practices based on health status in designing and administering health insurance and employee health benefit plans. Discusses current federal law and interim and long-term reform options

Community Health Centers in an Era of Health System Reform and Economic Downturn: Prospects and Challenges

Reviews 2008 legislation reauthorizing community health centers and the factors affecting their role as providers for the uninsured, publicly insured, and underinsured. Outlines health centers' patient mix, quality of care, revenues, and challenges

Health Care Fraud

Provides an overview of trends in fraud and abuse involving private insurance, Medicaid, and Medicare; types of schemes; risk factors; and consequences. Examines federal and state laws aimed at healthcare fraud, reported cases, and enforcement efforts

Examining the Evidentiary Basis of Congress's Commerce Clause Power to Address Individuals' Health Insurance Status

Outlines the issues involved in whether the 2010 Affordable Care Act's individual mandate is constitutional under the commerce clause, presents research literature on the effect of uninsurance on the broader economy, and reviews the lower courts' rulings

Monitoring and Assessing the Use of External Quality Review Organizations to Improve Services for Young Children: A Toolkit for State Medicaid Agencies

Assesses the extent to which states use external quality review organizations in studying the quality of preventive and developmental services for young children enrolled in Medicaid, and provides guidance on determining their scope of work

Medicaid Payment and Delivery Reform: Insights from Managed Care Plan Leaders in Medicaid Expansion States

Issue: Managed care organizations (MCOs) are integral to Medicaid payment and delivery reform efforts. In states that expanded Medicaid eligibility under the Affordable Care Act, MCOs have experienced a surge in enrollment of adults with complex needs.Goal: To understand MCO experiences in Medicaid expansion states and learn about innovations related to access to care, care delivery, payment, and integration of health and social services to address nonmedical needs.Methods: Interviews with leaders of 17 MCOs in 10 states that have seen large Medicaid enrollment growth and have undertaken payment and delivery reforms.Findings and Conclusions: MCO leaders regard their ability to enroll and serve the Medicaid expansion populations as a signal achievement. They have focused on identifying and helping high-risk populations and addressing the social determinants of health. MCOs are testing value-based payment strategies that link payment with performance and are increasingly focused on engaging patients in their care. Leaders report common challenges: setting appropriate payment rates; managing members whose needs differ from traditional Medicaid beneficiaries; ensuring access to specialty care; and effectively implementing payment reform and practice transformation. All point to the need for a stable policy environment and a strong working relationship with state Medicaid agencies