A State Policymakers' Guide to Federal Health Reform: Part I: Anticipating How Federal Health Reform Will Affect State Roles

Examines how federal healthcare reform will affect states' tools and roles in connecting people to services, promoting coordination and integration, improving care for those with complex needs, being results-oriented, and increasing efficiencies

Retail Clinics: Six State Approaches to Regulation and Licensing

Examines approaches to regulation and licensing of retail clinics in California, Florida, Illinois, Massachusetts, New Jersey, and Texas. Outlines issues of patient safety and quality of care, payment structure, conflict of interest, and other challenges

AHCA making progress but stronger detection, sanctions, and managed care oversight needed (Report No. 08-08)

Since our 2006 review, AHCA has taken steps we recommended to improve performance reporting and to strengthen its ability to safeguard the state against provider waste, abuse, and fraud in the Medicaid program. However, AHCA has not implemented our recommendations to develop a sustainable advanced detection system using artificial intelligence and to strengthen its sanctioning process by establishing fines that represent a minimum percentage of identified overpayments. While AHCA has strengthened its oversight of Medicaid managed care organizations, more steps are needed to deter and detect corporate level abusive and fraudulent practices.Research ReportFinal report publishe

Medicaid Reform: Beneficiaries earn enhanced benefits credits but spend only a small proportion (Report 08-45)

The Medicaid Reform enhanced benefits account program rewards beneficiaries for participating in activities that can improve their health. Beneficiaries can earn credits up to $125 per year which are maintained in individual enhanced benefits accounts. Beneficiaries can earn these credits in a variety of ways including keeping doctor appointments, taking preventive measures such as mammograms and immunizations, and participating in disease management or other activities to improve their health such as smoking cessation and weight-loss programs. Beneficiaries can redeem their credits at participating Medicaid pharmacies to purchase health-related products. From September 2006 through April 2008, beneficiaries had earned credits totaling nearly$13.8 million and had redeemed about $1.6 million (11.4%) of this amount for health-related products. Stakeholders are concerned that some Reform beneficiaries are unaware of the program or may find it difficult to redeem earned credits. In addition, the program design may not adequately support long-term change in healthy behaviors. While the Agency for Health Care Administration has taken steps to improve beneficiaries’ awareness, additional operational and program design challenges remain.Research ReportFinal report publishe