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Almost half of all Americans over the age of 65 will rely on nursing home (NH) care at some point in their lives, & 2 in 3 NH residents have their care covered at least in part by Medicaid. Under Medicaid, states set NH payment rates & the Fed. Gov't. reimburses a share of state spending. In light of concerns about the adequacy of NH resources, this report examine how state Medicaid programs determine NH payment rates & whether these payment methods or rates have changed given recent state fiscal pressures. State & NH industry officials in 19 states were interviewed & documentation about nursing home payment rates & methods were reviewed, including state methods to determine nursing home per diem rates for FY1998 through 2004. Tables.
Medicaid Nursing Home Payments: States' Payment Rates Largely Unaffected by Recent Fiscal Pressures
In 1965, the United States government enacted legislation to provide low-income individuals with quality health care and related services. Initially viewed as the friendless stepchild of Medicare, Medicaid has grown exponentially since its inception, becoming a formidable force of its own. Funded jointly by the national government and each of the fifty states, the program is now the fourth most expensive item in the federal budget and the second largest category of spending for almost every state. Now, under the new, historic health care reform legislation, Medicaid is scheduled to include sixteen million more people. Laura Katz Olson, an expert on health, aging, and long-term care policy, unravels the multifaceted and perplexing puzzle of Medicaid with respect to those who invest in and benefit from the program. Assessing the social, political, and economic dynamics that have shaped Medicaid for almost half a century, she helps readers of all backgrounds understand the entrenched and powerful interests woven into the system that have been instrumental in swelling costs and holding elected officials hostage. Addressing such fundamental questions as whether patients receive good care and whether Medicaid meets the needs of the low-income population it is supposed to serve, Olson evaluates the extent to which the program is an appropriate foundation for health care reform.
Medicaid is the largest grant-in-aid program in the United States. Reform in this area, therefore, provides a unique opportunity to study the intersection between federal and state policy making in an area recently characterized by substantial uncertainty deriving from the lingering effects of the Great Recession, ongoing debate over the federal budget, and implementation of the Patient Protection and Affordable Care Act. Invariably states reform the way health care is delivered, regulated, and financed within broader parameters established by federal statutes and regulations. It is critical therefore that effective strategies be put into place if both current and future health and long-term care reform efforts are to have their greatest chances at success. Rhode Island is the first state to receive permission to operate its entire Medicaid program under a global cap. As a consequence, it has entered the national consciousness as a key data point potentially supporting the block grant approach to Medicaid reform. In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.
This is the first book that looks at public health, as much art as science. The author draws on real examples with a "behind the scenes" look at the strategy and action that must be undertaken to make public health really work.
ÔThe Elgar Companion to Health Economics is a comprehensive and accessible look at the field, as seen by its leading figures.Õ Ð Joseph Newhouse, Harvard Medical School, US Acclaim for the first edition: ÔThis Companion is a timely addition. . . It contains 50 chapters, from 90 contributors around the world, on the topical and policy-relevant aspects of health economics. . . there is a balanced coverage of theoretical and empirical materials, and conceptual and practical issues. . . I have found the Companion very useful.Õ Ð Sukhan Jackson, Economic Analysis and Policy ÔThis encyclopedic work provides interested readers with an authoritative and comprehensive overview of many, if not all, of the current research issues in health economics. Highly recommended. Upper-level undergraduates and above.Õ Ð R.M. Mullner, Choice This comprehensive collection brings together more than 50 contributions from some of the most influential researchers in health economics. It authoritatively covers theoretical and empirical issues in health economics, with a balanced range of material on equity and efficiency in health care systems, health technology assessment and issues of concern for developing countries. This thoroughly revised second edition is expanded to include four new chapters, while all existing chapters have been extensively updated. The Elgar Companion to Health Economics, Second Edition intends to take an audience of advanced undergraduates, postgraduates and researchers to the current frontier of research by providing concise and readable introductions to key topics.