LDI issue brief最新文献

{"title":"Medicaid Work Requirements: Will They Help the Unemployed Gain Jobs or Improve Health?","authors":"L. Ku, Erin Brantley, Erika Steinmetz, Brian K. Bruen, Pillai Drishti","doi":"10.26099/WKT3-XJ41","DOIUrl":"https://doi.org/10.26099/WKT3-XJ41","url":null,"abstract":"Issue\u0000The Centers for Medicare and Medicaid Services approved Medicaid work requirement demonstration projects in four states, and other states also have applied. However, the future of these projects has been clouded by legal and policy challenges.\u0000\u0000\u0000Goal\u0000To assess whether state Medicaid work requirement projects are designed for success in promoting employment among unemployed Medicaid beneficiaries.\u0000\u0000\u0000Methods\u0000To examine the design of new work requirement projects, we reviewed the evidence, analyzed the overlap of Medicaid and Supplemental Nutrition Assistance Program (SNAP) work requirements, and convened a roundtable of seven experts who have research or implementation experience with work programs for Medicaid and public assistance recipients.\u0000\u0000\u0000Findings and Conclusion\u0000Mandatory work programs would be less effective and efficient than well-administered voluntary programs. Far more people will be subject to Medicaid work requirements than are currently subject to them in SNAP. This surge could overwhelm the limited resources of existing employment training and support programs. Medicaid demonstration projects contribute almost no additional funding to train the unemployed or provide necessary social supports. Medicaid work requirement programs are not well designed to help people get jobs or improve health and are more likely to lead to a loss of health insurance coverage.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"252 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75809013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Current State of Evidence on Bundled Payments.","authors":"Aaron Glickman,&nbsp;Claire Dinh,&nbsp;Amol S Navathe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A review of the evidence shows that bundled payments for surgical procedures can generate savings without adversely affecting patient outcomes. Less is known about the effect of bundled payments for chronic medical conditions, but early evidence suggests that cost and quality improvements may be small or non-existent. There is little evidence that bundles reduce access and equity, but continued monitoring is required.</p>","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"22 3","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36568277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing a Medicare Help at Home Benefit: Lessons from Maryland’s Community First Choice Program.","authors":"K. Davis, Amber Willink, I. Stockwell, Kaitlyn Whiton, Julia G. Burgdorf, C. Woodcock","doi":"10.13016/M2X921N95","DOIUrl":"https://doi.org/10.13016/M2X921N95","url":null,"abstract":"ISSUE: Medicare does not cover homeand community-based services (HCBS) that help beneficiaries function independently at home. The financial burden of uncovered personal care services puts beneficiaries with physical or cognitive impairment at risk of nursing home placement. GOAL: Analyze trends in paid and unpaid personal care and expenditures under a model Medicaid Community First Choice (CFC) program in Maryland. METHODS: Trends were analyzed using Maryland Medicaid claims data and standardized assessment information. Quantitative analysis was supplemented by interviews with Maryland officials and experts. FINDINGS: Maryland introduced CFC in 2014. By the end of 2016, enrollment had reached 11,573. The majority of participants were over age 65 (55%) and dually eligible for both Medicare and Medicaid (65%). Expenditures per person per year were stable at $21,000 between 2014 and 2016. Mean hours of paid personal assistance per participant averaged 29 hours per week, with slightly higher levels of utilization for dually eligible enrollees than for Medicaid-only enrollees. Weekly mean hours of informal support declined slightly. Unpaid informal care continued at a high rate, even though payment is permitted for personal care from family members and other previously unpaid caregivers. CONCLUSION: Maryland’s experience points to: a targeted benefit that will augment support from family members and other unpaid caregivers, a stable per-person cost, and increased take-up rates of eligible enrollees over time. KEY TAKEAWAYS Medicare does not cover homeand community-based services to help people function independently at home, which can put beneficiaries with physical or cognitive impairment at risk of being placed in nursing homes. Maryland implemented the Community First Choice benefit, authorized by the Affordable Care Act, to cover homeand community-based long-term services under Medicaid. The benefit has supplemented — rather than substituted for — informal support from family and other caregivers and has resulted in stable per-person spending since it was launched in 2014. ISSUE BRIEF JUNE 2018 Designing a Medicare Help at Home Benefit: Lessons from Maryland’s Community First Choice Program Karen Davis, Amber Willink, Ian Stockwell, Kaitlyn Whiton, Julia Burgdorf, and Cynthia Woodcock","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"79 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85303102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-Based Marketplaces Outperform Federally-Facilitated Marketplaces.","authors":"Jane M Zhu,&nbsp;Daniel Polsky,&nbsp;Yuehan Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In response to regulatory changes at the federal level, states that run their own marketplaces have taken steps to stabilize their individual markets. In this comparison of state-based and federally-facilitated marketplaces from 2016-2018, we find that SBMs had slower premium increases (43% vs. 75%), and fewer carrier exits, than FFMs. The total population participating in FFMs declined by 10%, while the enrolled population in SBMs remained largely stable, increasing by 2%. We find that the performance of the ACA marketplaces varies by state and appears to cluster around marketplace types.</p>","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"22 1","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36300596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the decline of narrow networks on the 2017 ACA marketplaces.","authors":"Daniel Polsky,&nbsp;Janet Weiner,&nbsp;Yuehan Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The prevalence of narrow provider networks on the ACA Marketplace is trending down. In 2017, 21% of plans had narrow networks, down from 25% in 2016. The largest single factor was that 70% of plans from National carriers exited the market and these plans had narrower networks than returning plans. Exits account for more than half of the decline in the prevalence of narrow networks, with the rest attributed to broadening networks among stable plans, particularly among Blues carriers. The narrow network strategy is expanding among traditional Medicaid carriers and remains steady among provider-based carriers and regional/local carriers.</p>","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"21 9","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35652950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrow Networks on the Individual Marketplace in 2017.","authors":"Daniel Polski,&nbsp;Janet Weiner,&nbsp;Yuehan Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow\u0000networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based\u0000marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid\u0000coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at\u000027% and 30%. We also find large differences in narrow networks by state and by plan type.</p>","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"21 8","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35397079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stabilizing individual health insurance markets with subsidized reinsurance.","authors":"Scott E Harrington","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Subsidized reinsurance represents a potentially important tool to help stabilize individual health insurance markets. This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. It summarizes specific state initiatives and Congressional proposals that include subsidized reinsurance. It compares approaches to each other and to more direct subsidies of individual market enrollment. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers' risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.</p>","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"21 7","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35422599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March--June 2017.","authors":"S. Collins, Munira Z. Gunja, M. Doty","doi":"10.15868/SOCIALSECTOR.28211","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.28211","url":null,"abstract":"Issue\u0000After Congress's failure to repeal and replace the Affordable Care Act, some policy leaders are calling for bipartisan approaches to address weaknesses in the law’s coverage expansions. To do this, policymakers will need data about trends in insurance coverage, reasons why people remain uninsured, and consumer perceptions of affordability.\u0000\u0000\u0000Goal\u0000To examine U.S. trends in insurance coverage and the demographics of the remaining uninsured population, as well as affordability and satisfaction among adults with marketplace and Medicaid coverage.\u0000\u0000\u0000Methods\u0000Analysis of the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017\u0000\u0000\u0000Findings and Conclusions\u0000The uninsured rate among 19-to-64-year-old adults was 14 percent in 2017, or an estimated 27 million people, statistically unchanged from one year earlier. Uninsured rates ticked up significantly in three subgroups: 35-to-49-year-olds, adults with incomes of 400 percent of poverty or more (about $48,000 for an individual), and adults living in states that had not expanded Medicaid. Half of uninsured adults, or an estimated 13 million, are likely eligible for marketplace subsidies or the Medicaid expansion in their state. Four of 10 uninsured adults are unaware of the marketplaces. Adults in marketplace plans with incomes below 250 percent of poverty are much more likely to view their premiums as easy to afford compared with people with higher incomes. Policies to improve coverage include a federal commitment to supporting the marketplaces and the 2018 open enrollment period, expansion of Medicaid in 19 remaining states, and enhanced subsidies for people with incomes of 250 percent of poverty or more.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"337 1","pages":"1-21"},"PeriodicalIF":0.0,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76584784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?","authors":"S. Hayes, P. Riley, D. Radley, D. McCarthy","doi":"10.15868/SOCIALSECTOR.28158","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.28158","url":null,"abstract":"ISSUE: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care. GOAL: Assess the effect of the ACA’s major coverage expansions on disparities in access to care among adults. METHODS: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System. FINDINGS AND CONCLUSIONS: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider. Disparities were narrower, and the average rate on each of the three indicators for whites, blacks, and Hispanics was lower in both 2013 and 2015 in states that expanded Medicaid under the ACA than in states that did not expand. Among Hispanics, disparities tended to narrow more between 2013 and 2015 in expansion states than nonexpansion states. The ACA’s coverage expansions were associated with increased access to care and reduced racial and ethnic disparities in access to care, with generally greater improvements in Medicaid expansion states.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"52 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2017-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90826839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicare Beneficiaries' High Out-of-Pocket Costs: Cost Burdens by Income and Health Status.","authors":"C. Schoen, K. Davis, Amber Willink","doi":"10.15868/SOCIALSECTOR.27426","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.27426","url":null,"abstract":"ISSUE: Fifty-six million people--17 percent of the U.S. population--rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs. GOAL: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries’ out-of-pocket costs by income and health status. METHODS: Spending estimates based on the Medicare Current Beneficiary Survey.\u0000FINDINGS AND CONCLUSION: More than one-fourth of all Medicare beneficiaries--15 million people--spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services. Beneficiaries with incomes below 200 percent of the poverty level (just under $24,000 for a single person) and those with multiple chronic conditions or functional limitations are at significant financial risk. Overall, beneficiaries spent an average of $3,024 per year on out-of-pocket costs. Financial burdens and access gaps highlight the need to approach reform with caution. Already-high burdens suggest restructuring cost-sharing to ensure affordability and to provide relief for low-income beneficiaries.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"14 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89854999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}