Program Integrity: How Much Money Can Combating Health Care Fraud and Abuse Save?

Headlines regularly call attention to pockets of fraudulent activity in the health care area–scams that amount to millions and potentially billions of dollars. The stories typically focus on catching the “crooks” but not so much on efforts to prevent fraud, waste and abuse in health care programs. Both types of efforts are important. With continued concerns about rising health care costs and the current focus on deficit reduction, how much money can be saved and put to better use by reducing waste, abuse and outright fraud?

Integrating Care for Dual Eligibles: What Do Consumers Want?

The 9 million beneficiaries dually eligible for Medicare and Medicaid are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of spending in both programs. Many deficit reduction plans under recent discussion have recognized the need to improve care for this population and provide care in a more cost-effective way.

Inside Deficit Reduction: What it Means for Medicaid

Medicaid currently provides health and long-term care to 68 million Americans, and the Patient Protection and Affordable Care Act would significantly expand Medicaid beginning in 2014. As a countercyclical program, Medicaid typically faces increased enrollment at the same time that states are looking to cut their budgets. Although the Budget Control Act of 2011 exempts safety-net programs like Medicaid from across-the-board cuts, Medicaid has remained a keenly debated topic in discussions of how to reduce the deficit.

Medicaid Innovations: Can Managed Care Cut Costs and Improve Value?

According to a recent survey, a number of states have expressed interest in expanding managed care approaches within their Medicaid programs. But while managed care may present an opportunity for better delivery of care, it presents challenges within certain populations and geographic areas.

50 Million Uninsured: The Faces Behind the Headlines

According to figures released last month by the U.S. Census Bureau, some 50 million Americans lacked health insurance in 2010. That number is almost a million higher than for 2009, though the percentage of people uninsured remained largely unchanged.

Inside Deficit Reduction: What It Means for Health Care

After much heated debate on the U.S. debt limit, the Budget Control Act of 2011, containing more than $900 billion in spending reductions over 10 years, was passed on August 2. The members of the Super Committee created by that law are hard at work, and the process is in gear to achieve at least $1.2 trillion in additional deficit reduction — either through Congress adopting the committee’s recommendations or through further automatic spending cuts.

Strengthening Medicaid with Health Information Technology: Are Providers & States Up to the Challenge?

Under the American Recovery and Reinvestment Act of 2009, providers can receive Medicare and Medicaid payment incentives when they adopt electronic health records and demonstrate their “meaningful use.” Additionally, the Patient Protection and Affordable Care Act requires states to establish a website by 2014 for Medicaid beneficiaries to electronically enroll and renew coverage. Yet many challenges remain so that health information technology (HIT) can help the Medicaid program operate more effectively.

Preventing Chronic Disease: The New Public Health

There is a national epidemic of chronic disease. Though it does not get the news coverage devoted to floods and tornadoes, it deserves attention and is starting to get it. There is a groundswell of activity in local communities to support healthier lifestyles and help people make long-lasting and sustainable changes that can reduce their risk for chronic diseases. A number of provisions in the health reform law are aimed directly at improving population health by addressing conditions where Americans live, learn, work, and play – at their schools, worksites, restaurants and more.

Keeping Coverage Continuous: Smoothing the Path between Medicaid and the Exchange

When fully implemented, the Patient Protection and Affordable Care Act will increase the number of insured Americans through two primary strategies – expanding Medicaid and providing insurance through state-based insurance exchanges. As an individual’s household income exceeds the maximum for Medicaid eligibility, he or she will be eligible for subsidies to buy coverage through an exchange, up to a household income of 400 percent of the federal poverty level (FPL). This switch in eligibility also works in reverse. If a person’s household income shrinks below 133 percent of the FPL, he or she will become eligible for Medicaid.

The State of Children’s Health, Care and Coverage

Although the rise in unemployment in this recession has resulted in lost health insurance coverage for many adults, a record 90 percent of children now have coverage – one-third of whom are covered by public programs, Medicaid and CHIP. About 7.5 million children remain uninsured, including 5 million who are eligible for Medicaid and CHIP but not enrolled.

Medicaid: A Primer on the Federal-State Partnership

Medicaid will play a major role in extending coverage to millions of uninsured people in 2014 through provisions in the Patient Protection and Affordable Care Act. More than 16 million newly qualified individuals are expected to enroll as a result of the law.

Trends in Health Insurance Coverage in the U.S.: The Impact of the Economy

The rising number of uninsured, who they are and how they might obtain health insurance coverage were much debated during the consideration and passage of health reform in the last year. In the meantime, rising unemployment rates and an economic recession have exacerbated the declines in health insurance coverage. According to the Current Population Survey, 50 million Americans were uninsured for all of 2009. The Medicaid and CHIP programs have offered a safety net of coverage for some of those facing financial hardship and have helped to prevent more people from being uninsured. Even as they continue to face severely strained budgets, states are enrolling record numbers of beneficiaries in Medicaid.

Health Reform Implementation: When Sausage-Making Moves Downtown

Now that the Patient Protection and Affordable Care Act is law, what’s happening behind the scenes (as well as in public) to implement it? This briefing, cosponsored by the Alliance and the Robert Wood Johnson Foundation, provided an overview of federal policymaking and the efforts by stakeholders and others to affect final policies pertaining to the health reform law.