Do Medicaid and CHIP Measure Errors Correctly?

Measuring and reducing errors in Medicaid and CHIP is important, but the current program and the proposed regulatory provisions are flawed and misleading. Reducing errors should involve not only reducing payments that are issued in error, but reducing the rate at which eligible applicants are erroneously denied Medicaid coverage. CMS should give develop a better, more valid approach to error determination when there are cases of missing or insufficient provider or eligibility data and issue a new proposed rule that offers a new approach or approaches

Restoring Medicaid and SCHIP Coverage to Legal Immigrant Children and Pregnant Women: Implications for Community Health and Health Care for Tomorrow\u27s Citizens

In the coming weeks, Congress will consider the reauthorization of the State Children\u27s Health Insurance Program (SCHIP), whose legislative authorization will expire on March 31, 2009. SCHIP\u27s overarching goal, in tandem with Medicaid, is to assure coverage of low-income children, regardless of race or national origin. As the proportion of uninsured immigrant children grows, a crucial question is whether the SCHIP reauthorization will address the need to restore eligibility for legal immigrant children and pregnant women. Although SCHIP and Medicaid have been successful in improving health insurance coverage for most low-income American children since the mid-1990s, the health coverage gaps for immigrant children have deepened and about half of all low-income immigrant children are now uninsured. SCHIP reauthorization represents a critical opportunity to restore access to Medicaid and SCHIP coverage for some of the most vulnerable children and pregnant women, those who are legally-admitted immigrants. (Undocumented immigrants would remain ineligible for Medicaid and SCHIP, as they always have been, except for coverage of emergency care under Medicaid.) Welfare reform legislation passed in 1996 requires that most legal immigrants wait for five years before qualifying for coverage under Medicaid, regardless of how poor or sick they are. While numerous Senators and Congressmen from both sides of the aisle have supported proposals to allow states to restore coverage for legal immigrant children and pregnant women, they have yet to come to a full vote before both chambers of Congress. The lack of coverage makes it harder for these children and pregnant women to get necessary health care, especially if they lack access to a health center or other safety net provider. Thus, they may fail to receive immunizations or prenatal care, which are needed to grow up healthy. The restoration of Medicaid and SCHIP would enhance health centers\u27 ability to furnish care for more needy patients in the community, by freeing up funds now used for uncompensated care. Barring coverage for legal immigrant children and pregnant women jeopardizes community health while discriminating against future citizens, workers and family members. Restoring Medicaid and SCHIP coverage to these vulnerable populations will improve their health and strengthen their ability to contribute to the nation and economy

Strengthening Immigrants\u27 Health Access: Current Opportunities

This brief summarizes key opportunities helping the nation’s newcomers in gaining health insurance coverage and health access that are possible under the current law. Provisions of the Affordable Care Act (ACA) will help millions of legal immigrants gain access to affordable health insurance coverage. At the same time, however, immigrants will also face new responsibilities. Like citizens, lawfully present immigrants will be responsible for having health insurance coverage or paying a tax penalty, although some are exempt. Rules about immigrants’ access to health insurance benefits are often complicated because they depend on specific immigration categories, as well as eligibility for other insurance programs

Saving Money: The Massachusetts Tobacco Cessation Medicaid Benefit: A Policy Paper

In the United States, about 70% of smokers want to quit and 50% make a quit attempt each year. Unfortunately, only a small percent are successful, due in part to the lack of easy access to tobacco dependence treatments that have been proven effective. In light of the societal costs of tobacco-related illness, government must do everything it can to encourage and enable smokers to quit. The tobacco use landscape in this country has changed in recent years -- people with lower income and education levels have a much higher probability of smoking. For instance, the smoking rate for those with a college degree is under 10%, but for those insured by Medicaid it is over 35%. Unfortunately, Medicaid coverage for tobacco cessation treatment depends on the state in which you live. While federal health reform guarantees nationwide coverage for pregnant women, it does not for all other Medicaid beneficiaries. Some states have made this a public health priority, but others have not

Using Primary Care to Bend the Cost Curve: The Potential Impact of Health Center Expansion in Senate Reforms

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including$105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases for federal health center grants and provide for the use of the prospective payment system for health center payments under health insurance exchange plans. However, it is important to note that, although both the Senate and House bills authorize increased health center appropriations up to certain levels, the House bill also creates a mandatory trust fund which can be tapped for health center appropriations, increasing the likelihood that actual appropriations would reach the levels authorized in the bills

Estimating the Effects of Health Reform on Health Centers\u27 Capacity to Expand to New Medically Underserved Communities and Populations

Nearly 100 million persons reside in urban and rural communities that can be considered medically underserved as a result of inadequate supply of primary care physicians and elevated health risks. A report by the National Association of Community Health Centers and the Robert Graham Center estimated that 60 million people are medically disenfranchised and lack access to adequate primary health care because of where they live, even though many have health insurance. This brief assesses the potential effects of national health reform on health centers and on the number of patients they can serve. Because improving primary care access is regarded by experts is key to the success of health reform, a critical question is how the proposals before Congress would address health centers\u27 ability to expand the availability of primary care in communities across the country. This Brief examines the effects of the draft House Tri-Committee (Energy and Commerce, Education and Labor and Ways and Means Committees) health reform bill, as issued July 14, 2009