Archive for the ‘Medicare and Medicaid’ Category

State Discretion Over Medicaid Coverage for Mental Health and Addiction Services

April 17, 2015 Comments off

State Discretion Over Medicaid Coverage for Mental Health and Addiction Services
Source: Psychiatric Services

Approximately one-third of adults who enroll in Medicaid because of a disability have a serious mental illness. Arguably, this population stands to benefit from insurance coverage that complies with the Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA and the Affordable Care Act (ACA) do not guarantee such coverage for this beneficiary group; however, they provide a variety of mechanisms by which states may provide parity-compliant coverage for mental health and substance use disorder treatment. This column explains key interactions between the MHPAEA, the ACA, and the Medicaid program that permit states to determine whether and how to provide parity-consistent coverage to beneficiaries with disabilities.

Medicare’s Income-Related Premiums: A Data Note

April 2, 2015 Comments off

Medicare’s Income-Related Premiums: A Data Note
Source: Kaiser Family Foundation

A pressing debate in current Medicare policy circles is how to cover the cost of repealing and replacing Medicare’s Sustainable Growth Rate (SGR) formula for physician payments. As part of this discussion, some policymakers have proposed to increase Medicare premiums for higher-income beneficiaries—an idea that also has been raised in the context of proposals to reduce federal spending. Under current law, most Medicare beneficiaries pay the standard monthly premium, which is set to cover 25 percent of Part B and Part D program costs, while the relatively small share of beneficiaries (around 6 percent in 2015) with incomes above $85,000 for single people and $170,000 for married couples are required to pay higher premiums for Medicare Part B and Part D—ranging from 35 percent to 80 percent of program costs, depending on their incomes.

Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees

April 2, 2015 Comments off

Utilization Patterns and Out-of-Pocket Expenses for Different Health Care Services Among American Retirees
Source: Employee Benefit Research Institute

Executive Summary

  • This study separates the more predictable health care expenses in retirement for older Americans (ages 65 and above) from the less predictable ones. Based on utilization patterns and expenses, doctor visits, dentist visits and usage of prescription drugs are categorized as recurring health care services. Overnight hospital stays, overnight nursing-home stays, outpatient surgery, home health care and usage of special facilities are categorized as non-recurring health care services.
  • The data show that recurring health care costs remain stable throughout retirement. The average annual expenditure for recurring health care expenses among the Medicare-eligible population was $1,885. Assuming a 2 percent rate of inflation and 3 percent rate of return, a person with a life expectancy of 90 would require $40,798 at age 65 to fund his or her recurring health care expenses. This does not include recurring expenses like insurance premiums or over-the-counter medications.
  • Usage and expenses of non-recurring health care services go up with age. Nursing-home stays in particular can be very expensive. For people ages 85 and above, the average and the 90th percentile of nursing-home expenses were $24,185 and $66,600 during a two year period, respectively.
  • Nursing-home stays, home health care usage, and overnight hospital stays are much higher in the period preceding death. More than 50 percent in every age group above age 65 received in-home health care from a medically trained person before death. For those ages 85 and above, 62.3 percent had overnight nursing-home stays before death and 51.6 percent were living in a nursing home prior to death.
    Some recurring and non-recurring expenses were also much higher before death.
  • Usage of recurring health care services generally go up with income and usage of non-recurring health care services—except outpatient surgery and special facilities—goes down with income.
  • The top income quartile spent significantly more on nursing-home and home health care expenses than the rest. This could be a result of Medicaid coverage for the lower-income, lower-asset groups.
  • Women above 85 have significantly higher nursing-home usage than men. The rest of the differences between men and women are small.

Medicaid and Intergenerational Economic Mobility

April 2, 2015 Comments off

Medicaid and Intergenerational Economic Mobility
Source: Institute for Research in Poverty (University of Wisconsin)

Previous research demonstrates that the Medicaid expansions of the 1980s and 1990s had lasting effects on the health, education and labor market outcomes of children. Yet to date there has been no direct test of the effect of Medicaid expansions on intergenerational economic mobility. Using new commuting zone level estimates of economic mobility for children born between 1980 and 1993, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this policy change on mobility outcomes. Regression models using simulated state-year specific eligibility criteria as an instrument for expanding coverage demonstrate that increasing the proportion of women aged 15–44 eligible for Medicaid is associated with a reduction in the correlation between the income ranks of parents and their children in adulthood. We further find the Medicaid expansions increased the probability that children born to low-income parents experience absolute upward mobility. These findings suggest early exposure to health insurance may be a key policy lever for promoting intergenerational mobility and economic opportunity.

Annual Report of the Departments of Health and Human Services and Justice: Health Care Fraud and Abuse Control Program FY 2014

March 26, 2015 Comments off

Annual Report of the Departments of Health and Human Services and Justice: Health Care Fraud and Abuse Control Program FY 2014 (PDF)
Source: U.S. Department of Health and Human Services/U.S. Department of Justice

During Fiscal Year (FY) 2014, the Federal government won or negotiated over $2.3 billion in health care fraud judgments and settlements , and it attained additional administrative impositions in health care fraud cases and proceedings. As a result of these efforts, as well as those of preceding years, in FY 2014, approximately $3.3 billion returned to the Federal government or paid to private persons. Of this $3.3 billion, the Medicare Trust Funds3 received transfers of approximately $1.9 billion during this period, and over $523 million in Federal Medicaid money was similarly transferred separately to the Treasury as a result of these efforts. The HCFAC account has returned over $27.8 billion to the Medicare Trust Funds since the inception of the Program in 1997.

In FY 2014, the Department of Justice (DOJ) opened 924 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 496 cases involving 805 defendants. A total of 734 defendants were convicted of health care fraud-related crimes during the year. Also in FY 2014, DOJ opened 782 new civil health care fraud investigations and had 957 civil health care fraud matters pending at the end of the fiscal year. In FY 2014, the FBI investigative efforts resulted in over 605 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 142 health care fraud criminal enterprises.

CRS — Mandatory Spending Since 1962 (March 18, 2015)

March 25, 2015 Comments off

Mandatory Spending Since 1962 (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Federal spending is divided into three broad categories: discretionary spending, mandatory spending, and net interest. Mandatory spending is composed of budget outlays controlled by laws other than appropriation acts, including federal spending on entitlement programs. Entitlement programs such as Social Security and Medicare make up the bulk of mandatory spending. Other mandatory spending programs include Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), unemployment insurance, some veterans’ benefits, federal employee retirement and disability, and Supplemental Nutrition Assistance Program (SNAP). In contrast to mandatory spending, discretionary spending is provided and controlled through appropriations acts. Net interest spending is the government’s interest payments on debt held by the public, offset by interest income that the government receives.

New Hepatitis C Treatments: Considerations and Potential Strategies for States

March 24, 2015 Comments off

New Hepatitis C Treatments: Considerations and Potential Strategies for States
Source: National Governors Association

The National Governors Association Center for Best Practices (NGA Center) convened an expert roundtable to discuss the opportunities and challenges presented by new hepatitis C virus (HCV) treatments and other pharmaceutical therapies known as high-impact drugs. Such drug treatments share the common characteristics of being more effective than prevailing drug therapies, often resulting in a change in clinical practice that includes treating many more people and being much more expensive. Experts participating in the roundtable included state health care leaders, scientists, national health care experts, subject-matter experts from insurance and pharmaceutical companies, Medicaid and corrections legal experts, and senior staff from the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Veterans Affairs (VA). This paper summarizes the expert roundtable discussion supplemented by NGA Center research to flesh out the background information and strategies discussed.


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