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This is the Health Chairs e-Bulletin for August 2005.Resources On LineThe Health of State BudgetsThe fiscal picture continues to improve thanks to rising revenues, according to the most recent fiscal survey from NGA and NASBO. But Medicaid costs are still putting pressure on state budgets. The report includes detailed table on rates of Medicaid spending growth and recent and anticipated state actions, and a table that contrasts groups that contributed the most to enrollment changes with those that contributed most to the rise in expenditures. http://www.nasbo.org/Publications/fiscalsurvey/fsspring2005.pdf MedicaidHappy Birthday: Medicare and Medicaid turn forty this year. See Kaiser’s birthday party including commentaries from past administrators, printed in Health Affairs. http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1479 The June NCSL State Health Chairs meeting provided a great intermediate course on Medicaid, complete with a shelf-worth of readings. You can access web casts, transcripts, and links to the readings from the Chairs meeting page at http://www.ncsl.org/programs/health/forum/chairs/healthchairsmtgb.htm The National Governors Association (NGA) has officially adopted its preliminary plan for Medicaid reform. It includes recommendations related to prescription drugs, assets, flexibility on benefits, cost sharing, changes in waiver process and legal barriers, and a better deal for the territories. In addition to Medicaid reform, the report discusses improving quality and controlling costs throughout the system, enhancing private insurance, and slowing the growth of long term care. Details at http://www.nga.org/portal/site/nga/menuitem.6c9a8a9ebc6ae07eee28aca9501010a0/?vgnextoid=828361d4e1584010VgnVCM1000001a01010aRCRD With Congress seeking to reduce Medicaid spending by $10 billion, there have been discussions about how to lower prices or reduce demand without changing services and eligibility. Among the approaches discussed are reducing fraud and abuse, increasing estate recovery, and pay-for-performance. Fraud and Abuse. A July 18 New York Times article about fraud and abuse in the state’s Medicaid program—per capita, the country’s costliest—has set off a reaction both in and out of state. Access the article http://www.nytimes.com/2005/07/18/nyregion/18medicaid.html The next day Governor Pataki responded with a fraud-buster program and the appointment of a Medicaid Inspector General (MIG). http://www.state.ny.us/governor/press/year05/july19_2_05.htm North Carolina also announced the creation of a fraud control unit that week. http://www.dhhs.state.nc.us/pressrel/7-21-05.htm CMS has a website with links to state Medicaid fraud statutes. http://www.cms.hhs.gov/states/fraud/mfs/State_Select.asp Pay for Performance. The Medicare program is trying it. Now there’s growing interest in seeing how it works for Medicaid. The Alliance for Health Reform recently held a briefing on Medicaid pay for performance. For webcast—and an excellent collection of background materials—go to http://www.allhealth.org/event_071505.asp Estate Recovery. A June AARP report takes a look at state programs and practices for Medicaid estate recovery. Congress is taking a close look at this as an option for improving Medicaid’s financial outlook, although some analysts argue there isn’t much to be found there. Recoveries amounted to less than .01 percent (LA) to 2.2 percent (OR) of state Medicaid long term care expenditures, with only 8 states (AZ, CA, HI, ID, IA, MA, NH, OR) recovering more than 1 percent. http://assets.aarp.org/rgcenter/il/2005_06_recovery.pdf MedicareThe Commonwealth Fund is also honoring the anniversary of Medicare’s creation, with a page dedicated to Fund resources on this program including articles on Medicare and privatization, the disabled, quality and prescription drugs. http://www.cmwf.org/General/General_show.htm?doc_id=283209 A three-part Washington Post series about problems with quality and cost in Medicare began July 23. http://www.washingtonpost.com/wp-dyn/content/linkset/2005/07/23/LI2005072300409.html It includes fascinating graphics including this interactive map with rates of certain Medicare procedures http://www.washingtonpost.com/wp-dyn/content/custom/2005/07/22/CU2005072201387.html Medicare Advantage Plans are the latest version of public-private Medicare partnerships, with HMOs and other private plans participating. Kaiser has published information about them organized by state and by plan, including payment rates and enrollment. http://www.kff.org/medicare/HealthPlanTracker. Kaiser has also released a new Medicare Chart Book, with 89 pages of charts, graphs, explanations and state-specific data about every aspect of the program. You can download the entire book, order a copy or access it chapter by chapter at http://www.kff.org/medicare/7284.cfm The dually eligible population—receiving both Medicaid and Medicare—are the most vulnerable and expensive recipients in both programs. They are 14 percent of the Medicaid population, but 40 percent of program spending goes to their care. Kaiser has just published the most recent data on numbers and costs of this important group, together with some state-by-state analyses of the impact of shifting various services between states and the federal government. Required reading! http://www.kff.org/medicaid/7346.cfm You can also compare state data on duals using Kaiser’s State Health Facts on Line http://statehealthfacts.org/r/duals.cfm |
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