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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Kaiser Commission on Medicaid and the Uninsured
    Reference Type: Report
    Year: 2009

    As states adopted their budgets for fiscal year 2010, the effects of the economic recession, including rising unemployment, sharp declines in state revenues and higher demands for public programs, including Medicaid, left them facing severe budget shortfalls. Enhanced federal Medicaid funds from the American Recovery and Reinvestment Act (ARRA) were critical in helping states to address these funding gaps and preserve Medicaid eligibility. Jointly financed and administered by the federal government and states, Medicaid provides affordable and comprehensive health and long-term care coverage to 60 million low-income Americans. Looking ahead, the dominant issues for state Medicaid programs are the lingering effects from the economic recession as well as the prospects for a greater role for Medicaid as part of health reform. (author abstract)

    As states adopted their budgets for fiscal year 2010, the effects of the economic recession, including rising unemployment, sharp declines in state revenues and higher demands for public programs, including Medicaid, left them facing severe budget shortfalls. Enhanced federal Medicaid funds from the American Recovery and Reinvestment Act (ARRA) were critical in helping states to address these funding gaps and preserve Medicaid eligibility. Jointly financed and administered by the federal government and states, Medicaid provides affordable and comprehensive health and long-term care coverage to 60 million low-income Americans. Looking ahead, the dominant issues for state Medicaid programs are the lingering effects from the economic recession as well as the prospects for a greater role for Medicaid as part of health reform. (author abstract)

  • Individual Author: Hearne, Jane
    Year: 2005

    Medicaid is a means-tested entitlement program that is largely designed and administered by states under broad federal rules. The programs are jointly financed by federal and state funds. Federal contributions to each state are based on a state's willingness to finance covered medical services and a matching formula. The Centers for Medicare and Medicaid Services (CMS), within the U.S. Department of Health and Human Services (HHS), is responsible for federal oversight of the program. In FY2003, preliminary federal and state spending on Medicaid reached $275.5 billion, exceeding Medicare payments, net of premiums, by over $15 billion. 

    Medicaid coverage for non-elderly, non-disabled adults and children is provided to people who qualify through a number of pathways, some of which are required under federal law, others are optional for states. State programs are required to provide coverage to families based on welfare program rules in effect in 1996. Coverage for children goes beyond those often very low financial criteria through a combination of other mandatory and...

    Medicaid is a means-tested entitlement program that is largely designed and administered by states under broad federal rules. The programs are jointly financed by federal and state funds. Federal contributions to each state are based on a state's willingness to finance covered medical services and a matching formula. The Centers for Medicare and Medicaid Services (CMS), within the U.S. Department of Health and Human Services (HHS), is responsible for federal oversight of the program. In FY2003, preliminary federal and state spending on Medicaid reached $275.5 billion, exceeding Medicare payments, net of premiums, by over $15 billion. 

    Medicaid coverage for non-elderly, non-disabled adults and children is provided to people who qualify through a number of pathways, some of which are required under federal law, others are optional for states. State programs are required to provide coverage to families based on welfare program rules in effect in 1996. Coverage for children goes beyond those often very low financial criteria through a combination of other mandatory and optional pathways. Low income pregnant women can also receive Medicaid coverage through both mandatory and optional pathways. In addition, a number of other optional pathways exist for special groups of people who are not considered disabled because they do not have a disability as defined under the Supplemental Security Income (SSI) program rules. Some of those groups include, for example, certain women with breast or cervical cancer, uninsured individuals diagnosed with tuberculosis, people who become impoverished by their medical costs, and certain immigrants. 

    Variation across the state-based programs is the rule. Income eligibility levels and services covered vary, and the method for, and amount of, reimbursement for services differ from state to state. Medicaid is targeted to individuals with low-income, but not all of the poor are eligible, and not all of those who are covered are poor. For Medicaid-covered children and families, primary and acute care is often delivered through managed care organizations, while elderly enrollees and those with disabilities more often obtain such care on a fee-for-service basis. In recent years, more and more states have implemented a variety of major program changes using special waiver authority. 

    This report describes federal Medicaid eligibility rules for children and adults but does not address eligibility pathways for individuals qualifying on the basis of having a disability or for persons who are age 65 and over. This report is one of a number of CRS reports on Medicaid and will be updated periodically. (author abstract)

     

  • Individual Author: Deal, Lisa W.; Shiono, Patricia H.
    Reference Type: Journal Article
    Year: 1998

    In recent years, states have increasingly turned to managed care arrangements for financing and delivering health services to Medicaid beneficiaries. In 1996, approximately 40% of all Medicaid recipients were enrolled in some form of managed care. The rapid escalation of managed care in this population has been fueled by states' desire to slow the growth of Medicaid expenditures and by the trend toward managed care enrollment in the private health insurance industry. The effect of managed care on cost containment in the Medicaid program may be limited, however, because 85% to 90% of Medicaid managed care enrollees are women of childbearing age and children, who together account for 69% of Medicaid recipients, but only 26% of program costs. Nonetheless, the increase in managed care enrollment in this population may have a profound impact on health service delivery and health outcomes for U.S. children, approximately 20% of whom received health benefits through the Medicaid program in 1995.

    In the future, the proportion of Medicaid-eligible children enrolled in managed care...

    In recent years, states have increasingly turned to managed care arrangements for financing and delivering health services to Medicaid beneficiaries. In 1996, approximately 40% of all Medicaid recipients were enrolled in some form of managed care. The rapid escalation of managed care in this population has been fueled by states' desire to slow the growth of Medicaid expenditures and by the trend toward managed care enrollment in the private health insurance industry. The effect of managed care on cost containment in the Medicaid program may be limited, however, because 85% to 90% of Medicaid managed care enrollees are women of childbearing age and children, who together account for 69% of Medicaid recipients, but only 26% of program costs. Nonetheless, the increase in managed care enrollment in this population may have a profound impact on health service delivery and health outcomes for U.S. children, approximately 20% of whom received health benefits through the Medicaid program in 1995.

    In the future, the proportion of Medicaid-eligible children enrolled in managed care will likely increase as a result of recent legislation that relaxed the requirement that states seek federal approval prior to mandating managed care enrollment for Medicaid beneficiaries. More states are relying on fully capitated arrangements as the preferred type of managed care for Medicaid recipients, despite the relative lack of experience many of these plans have in serving this low-income population. Moreover, managed care organizations have few incentives to enroll chronically ill or disabled children with higher-than-average expected costs. Without mechanisms in place that adequately adjust capitated rates to account for these higher-cost enrollees, managed care organizations may lose money, and children with the greatest health care needs may be under-served. As mandatory managed care enrollment for Medicaid recipients increases nationwide, states should carefully monitor changes in program costs and quality as well as implications for the delivery of pediatric health services and health outcomes. (author abstract)

  • Individual Author: Ellis, Eileen R.; Roberts, Dennis; Rousseau, David M.; Schwartz, Tanya
    Reference Type: Report
    Year: 2009

    In 2006 and early 2007 enrollment trends were affected by improving economic conditions and also by the citizenship documentation requirements of the Deficit Reduction Act of 2005 (DRA) which were effective as of July 1, 2006. When state officials were surveyed in the summer of 2007, thirty-seven Medicaid directors indicated that these new requirements contributed to slower growth or declining Medicaid enrollment in their state, at least on a temporary basis.3 In previous Medicaid enrollment reports we noted that children were affected more than adults by the enrollment reduction that occurred in the second half of 2006.4 Subsequently the enrollment of children increased at about the same rate as the enrollment of adults (including parents, pregnant women, and aged and disabled individuals). As a result, enrollment of adults in Medicaid rose by 2.9% from June 2008 to June 2006 while enrollment of children increased by only 1.8% percent over that same period.

    Enrollment of aged and disabled individuals in Medicaid increased by 2.5%, from June 2007 to June 2008 according to...

    In 2006 and early 2007 enrollment trends were affected by improving economic conditions and also by the citizenship documentation requirements of the Deficit Reduction Act of 2005 (DRA) which were effective as of July 1, 2006. When state officials were surveyed in the summer of 2007, thirty-seven Medicaid directors indicated that these new requirements contributed to slower growth or declining Medicaid enrollment in their state, at least on a temporary basis.3 In previous Medicaid enrollment reports we noted that children were affected more than adults by the enrollment reduction that occurred in the second half of 2006.4 Subsequently the enrollment of children increased at about the same rate as the enrollment of adults (including parents, pregnant women, and aged and disabled individuals). As a result, enrollment of adults in Medicaid rose by 2.9% from June 2008 to June 2006 while enrollment of children increased by only 1.8% percent over that same period.

    Enrollment of aged and disabled individuals in Medicaid increased by 2.5%, from June 2007 to June 2008 according to data from the 46 states that could separate out this group. During this period, enrollment of families, children and pregnant women increased by 3.2% in these same 46 states. Because economic conditions and Medicaid eligibility policies differ significantly among the states, some states were expanding coverage, while a few restricted eligibility standards or enrollment processes. As national Medicaid enrollment rose by 3.0% from June 2007 to June 2008, individual state enrollment ranged from a 3% decline to an 11% increase. Future reports in this series will likely show continued national Medicaid enrollment growth. As the recession deepened, unemployment rose from 5.6% in June of 2008 to 9.4% in July of 2009, leading to a projected rise both in the uninsured and in the number of individuals eligible for and enrolled in state Medicaid programs. (author abstract)

  • Individual Author: Ku, Leighton; Coughlin, Teresa A.
    Reference Type: Report
    Year: 1997

    When the dust settled in the 104th Congress, the major changes to Medicaid came not from the highly visible proposals to block grant or cap the program, but from welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193). Since attention focused on the ill-fated Medicaid block grant proposal, the welfare reform-related changes came as a surprise to many. While the welfare reform law does not change how Medicaid delivers health care nor alter its entitlement status, it reduces the number of people covered and lowers federal expenditures.

    Medicaid is the joint federal-state health insurance program for low-income families, senior citizens, and people with disabilities. In 1995, 41 million people were insured by Medicaid at a cost of $151 billion. The Congressional Budget Office (CBO) estimated that the new law would lower federal spending on Medicaid by about 1 percent in the year 2002 compared to previous projections, and save a total of $4 billion over six years (1996 to 2002)....

    When the dust settled in the 104th Congress, the major changes to Medicaid came not from the highly visible proposals to block grant or cap the program, but from welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193). Since attention focused on the ill-fated Medicaid block grant proposal, the welfare reform-related changes came as a surprise to many. While the welfare reform law does not change how Medicaid delivers health care nor alter its entitlement status, it reduces the number of people covered and lowers federal expenditures.

    Medicaid is the joint federal-state health insurance program for low-income families, senior citizens, and people with disabilities. In 1995, 41 million people were insured by Medicaid at a cost of $151 billion. The Congressional Budget Office (CBO) estimated that the new law would lower federal spending on Medicaid by about 1 percent in the year 2002 compared to previous projections, and save a total of $4 billion over six years (1996 to 2002).1 These savings will lower the federal deficit and reduce the pressure for further Medicaid spending cuts.

    This policy brief discusses the four principal changes made to Medicaid eligibility by the welfare reform legislation:

    • Decoupling welfare and Medicaid eligibility;
    • Narrowing Medicaid eligibility for disabled children in the Supplemental Security Income (SSI) program;
    • Terminating access to Medicaid for some legal immigrants because they lose SSI; and
    • Barring most future legal immigrants from Medicaid.

    It also reviews how the new provisions may potentially affect key parties—state and local governments, health care providers, and beneficiaries. Critical decisions will be made by state legislatures and executive agencies in the next several months as they implement the changes in federal rules. (author abstract)

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