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States have been seeking federal waivers since the early 1990s to use managed care approaches to integrate the delivery of acute & long-term-care services for certain dual eligiblesÓ -- low-income Medicare beneficiaries who also quality for full Medicaid benefits. Dual eligibles often receive their Medicare & Medicaid benefits from two different sets of providers. This report determines: (1) the status & key features of state initiatives to integrate care for dual-eligible beneficiaries; & (2) factors that have contributed to the length of the waiver negotiation process & implementation time frames.
A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.
The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

Dual Eligibles

United States. Congress. House. Committee on Energy and Commerce. Subcommittee on Health

Published: 2012

Total Pages: 340


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Identifying ways to link Medicare and Medicaid data is a critical step toward integrating care for dual eligibles. Without access to Medicare data, state Medicaid agencies have only a limited picture of the dual eligible population. The availability of linked Medicare and Medicaid data can help highlight areas where integration can make a difference, such as identifying ways to reduce service fragmentation and avoidable utilization. Uncovering these opportunities can help build the case to state and federal policymakers for encouraging enrollment of additional dual eligibles into integrated care programs. This technical assistance brief provides practical information about the types of Medicare data available, how to access these data, and how to use the data to better understand the dual eligible population and uncover opportunities to improve care. The brief: * Outlines Medicare data available through the Centers for Medicare & Medicaid Services (CMS) and the Research Data Assistance Center (ResDAC); * Explains the process for obtaining Medicare data from ResDAC; * Describes the CMS Coordination of Benefits Agreement (COBA) and how it can be used to obtain Medicare claims data; * Provides an overview of how Medicare and Medicaid data can be linked; and * Examines the value of integrated data to support improvements in care for duals.