Health Policy Research

"A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002." Audra T. Wenzlow, Robert Schmitz, and Kathy Shepperson, January 2008. This report examines how person-level data in the Medicaid Analytic eXtract (MAX) data system can be used to better understand long-term care service use and expenditures, and to evaluate the utility of MAX data for further study of long-term care. The authors compare expenditure and utilization-based measures of the balance of institutional and community-based long-term care services. They also examine long-term care expenditures and utilization for two key groups of enrollees—young disabled enrollees and enrollees ages 65 and older. The article decomposes community-based long-term care expenditures by type of service and summarizes other Medicaid services used and costs incurred in 2002. Executive Summary

"Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002." Audra T. Wenzlow, Robert Schmitz, and Jill Gurvey, January 2008. This report describes patterns of Medicaid nursing home utilization for each state and nationally. The authors address the following questions: (1) What are the characteristics of people who use Medicaid nursing home services? (2) How do these people become eligible for Medicaid? (3) How long do Medicaid-covered nursing home spells last and how often do individuals return to nursing homes? They also examine how state policies are associated with nursing home utilization. Executive Summary

"Federal Medical and Disability Program Costs Associated with Diabetes, 2005. Summary of Methods and Key Findings." Marsha Gold, Craig Thornton, Allison Hedley, Cheryl Fahlman, Suzanne Felt-Lisk, Bob Weathers, and Thomas Croghan, September 2007. Diabetes is a growing threat to the nation's health that has serious and costly complications. This paper looks behind the $79.7 billion estimates for 2005 of medical and disability costs to the federal government cited in Mathematica's main study. The estimates include $2.5 billion in disability payments associated with diabetes and $77.2 billion in increased medical costs. Nearly 80 percent of the medical costs to the federal government were incurred in the Medicare program. Without enhanced efforts to control blood glucose, reduce the risk of complications, and prevent the onset of diabetes, federal costs related to diabetes will grow in the future.

"Assessment of State Capacity to Identify and Track Disparities in the Leading Health Indicators." Allison Hedley Dodd, Melissa Neuman, and Marsha Gold, December 2007. Assessing health status is a core function of public health on the state level. This report summarizes the data available in each state for health assessment, a necessary step in achieving public health goals. Using the leading indicators from Healthy People 2010, the authors found that while data generally are available across all states, gaps do exist. Across states, data sometimes are not available for a few specific health objectives and for certain age groups.

"Health Plans' Use of Physician Resource Use and Quality Measures." Timothy Lake, Margaret Colby, and Stephanie Peterson, October 2007. In recent years, health plans have developed measures of health service resource use to assess the efficiency of care that physicians and other providers deliver—primarily relying on tools commonly known as “episode groupers.” This report investigates the use of episode grouper-based measures in the private sector in four health markets around the country: Austin, Boston, Cleveland, and Seattle. Health plans included in the study have multiple years of technical experience implementing physician resource use and quality measures; however, most are still in the early stages of determining the best ways to use these measures in their local markets. The report includes lessons for future quality measurement efforts in Medicare and other programs.

"Leading the Way? Maine's Initial Experience in Expanding Coverage Through Dirigo Health Reforms." Debra J. Lipson, James M. Verdier, Lynn Quincy, Robert Hurley, Elizabeth Seif, Shanna Shulman, and Matt Sloan, December 2007. Since enacting comprehensive health care reform in 2003, Maine's Dirigo Health program has helped expand coverage for low- and moderate-income individuals. By September 2006, about 16,100 individuals were enrolled in two coverage initiatives—DirigoChoice, a subsidized insurance product, and a Medicaid eligibility expansion for low-income parents of dependent children. While these programs are making health coverage more affordable to low-income individuals, small firms, and sole proprietors, with subsidies targeting those most in need, by late 2006 the initiatives had enrolled less than 10 percent of previously uninsured residents. To pay for this expanded coverage, Maine has utilized savings in the overall health care system due to lower uncompensated care and cost controls. However, the funds raised thus far are insufficient to pay for greater subsidized enrollment in Dirigo programs, leading to a search for other financing sources to sustain the program.

"Administration of Mental Health Services by Medicaid Agencies." James Verdier, Allison Barrett, and Sarah Davis, 2007. Medicaid spending for mental health care accounted for 26 percent of total mental health expenditures by all public and private payers combined in 2003, and 10 percent of all Medicaid dollars were spent on mental health services in that year. Medicaid now funds more than half of all mental health services administered by states and could account for two-thirds of such spending by 2017. This report, based on telephone interviews with state Medicaid directors in all 50 states and the District of Columbia between July 2005 and February 2006, provides state-by-state comparative information on how Medicaid and mental health agencies are structured, the degree and extent of their collaboration, how they share authority, and how Medicaid mental health services are funded.

More Reports

"Improving Processes and Increasing Efficiency: The Case for States Participating in a Process Improvement Collaborative." Sheila Hoag and Judith Wooldridge, September 2007. State Medicaid and SCHIP agencies provide vital health coverage to low-income populations and other groups, but they have limited administrative resources to support enrollment and renewal. This brief looks at experiences of some state Medicaid and SCHIP agencies in using a process change model to strengthen the way they approach enrollment and retention, concluding that committed leadership and resources are an effective model for changing Medicaid and SCHIP enrollment and retention processes rapidly and for sustaining improved processes. The brief also explores whether a process improvement collaborative is a worthwhile investment for states, finding that they have much to gain in terms of increased efficiency and savings using the model, which can be applied to any area of state administration.

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"Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families." In Brief #1. Christopher Trenholm, Embry Howell, Ian Hill, and Dana Hughes, November 2007. Since 2001, initiatives have emerged in 25 of California's 58 counties to expand health insurance coverage for children. These initiatives make use of a new insurance product, Healthy Kids, that covers children who are ineligible for Medi-Cal and Healthy Families, California's public programs for children in families with incomes up to 250 percent of the federal poverty level. This brief presents highlights from evaluations of Healthy Kids programs in Los Angeles, San Mateo, and Santa Clara counties. The brief notes that children's access to and use of medical care improved, unmet health care needs declined, and parents of children enrolled in Healthy Kids reported far more confidence that they could obtain care for their children.

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"New Medicaid Drug Use and Cost Data Highlight Issues for States After Medicare Part D." Trends in Health Care Financing, Issue Brief #7. James Verdier, Ann Bagchi, and Dominick Esposito, June 2007. This issue brief highlights a number of Medicaid prescription drug issues that remain for states after the movement of dual eligibles into the Medicare Part D drug benefit. The brief describes new data, prepared by Mathematica and available on the Centers for Medicare & Medicaid Services website, that provide detailed information on prescription drug cost and utilization for both nondual and dual eligible Medicaid beneficiaries for 2001 and 2002. The brief also notes that states can use this information as a starting point to highlight ways in which they may differ from other states or national averages, triggering more careful and thorough analysis.

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