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States can "drastically improve" the health of their sickest Medicaid beneficiaries by taking advantage of the new option in the Patient Protection and Affordable Care Act to offer "health homes" to enrollees with chronic conditions, according to Renée Markus Hodin, director of the Integrated Care Advocacy Project at Community Catalyst in Boston, MA.
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States have achieved substantial progress in streamlining Medicaid enrollment and renewal processes for children, but have achieved less progress in this area for adults, according to Samantha Artiga, MHSA, a principal policy analyst at Kaiser Family Foundation (KFF) in Menlo Park, CA.
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California's fiscal year 2008-2009 budget enacted several 10% Medi-Cal provider payment reductions, according to Toby Douglas, director of the California Department of Health Care Services and the state's Medi-Cal director.
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South Carolina Medicaid is taking a variety of innovative approaches to reduce waste in the program, reports Tony Keck, the state's Medicaid director. Optional services including adult vision, adult dental, and adult podiatry have already been eliminated, he says, with some exceptions based on Centers for Medicare & Medicaid Services (CMS) requirements.
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Dual eligibles account for 15% to 20% of Medicaid enrollment and almost 40% of Medicaid spending, notes Leslie Hendrickson, PhD, principal of Hendrickson Development, an East Windsor, NJ-based consulting group that helps to develop and strengthen long-term care programs, and former assistant commissioner in the New Jersey Department of Health and Social Services.
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The impact of Medicaid on state budgets is often overstated, according to a March 2011 report from the Georgetown University Health Policy Institute's Center for Children and Families in Washington, DC.
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There isn't a lot of data on the cost savings of state medical home initiatives because the state pilots and demonstrations are still new, according to Mary Takach, MPH, RN, the lead researcher on the Washington, DC-based National Academy for State Health Policy's Medical Homes II Consortium project.
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"Increased support for primary care providers who participate in Medicaid is one lever for securing more capacity in the program."
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Ensuring access to primary care in Medicaid is going to take a "multi-pronged strategy," according to Julia Paradise, MSPH, an associate director of the Kaiser Family Foundation's Kaiser Commission on Medicaid and the Uninsured and lead author of the organization's March 2011 brief, Improving Access to Adult Primary Care in Medicaid.
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When you consider the newly eligible population coming onto your state's Medicaid program in 2014, remember that "those 32 million people out there are already being seen somewhere. They are being seen by a range of safety net providers," says Georges C. Benjamin, MD, FACP, FNAPA, FACEP(E), executive director of the American Public Health Association in Washington, DC.
