Medicaid Crash Course

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The Medicaid Crash Course © is an in-depth whitepaper that covers all major topics in the Medicaid industry in a way that allows the reader to get up to speed quickly.

Transcript of Medicaid Crash Course

  • Learn 90% of What You Need to Know to Succeed in the Medicaid Industry in Under 90 Minutes

    %FPL

    MEDICAID CRASH COURSE

    MostlyMedicaid.combrought to you byMM

  • NOTE: The info below gives you an idea of the basic content and features of the Medicaid Crash Course. See the sneak peek for the actual table of contents and excerpts from different parts of the book.

    SKIP to the Sneak PEEK

    Order your copy of the Medicaid Crash Course now

    What is the Medicaid Crash Course ?

    The Medicaid Crash Course is an in-depth whitepaper that covers all major topics in the Medicaid industry in a way that allows the reader to get up to speed quickly.

    Who is the Medicaid Crash Course designed for?

    People working in the Medicaid industry for less than 3 years. The main audience includes consultants, doctors, analysts, government officials, business owners, IT professionals and others.

    How is this different from information I can get from other sources like the Kaiser Family Foundation, Urban Institute, and other sources?

    There are many, many great sources of information about Medicaid out there. The main value of the crash course is:

    1. It covers a broad array of topics, in depth IN ONE PLACE, saving you a lot of time searching and piecing together different concepts

    2. It is FACT-BASED, NOT ADVOCACY FOCUSED. The vast majority of information about Medicaid is driven by particular agendas (whether to increase or decrease spending, coverage, etc). Very little information is focused on what you need to know from a basic information stand-point. The Crash Course acknowledges that the Medicaid profession really is an industry, with people and groups that benefit politically and financially.

    3. It GETS RIGHT TO THE POINT, with the RIGHT BALANCE of DETAIL and BIG PICTURE.

  • How does it cover so much ground, and still communicate information effectively? Do you think the claim Learn 90% of what you need to know to succeed in the Medicaid Industry in Under 90 minutes is true?

    The Crash Course is designed using several important features to engage the reader and make conceptual understanding easier. And yes, we do think the claim is true.

    SKIP to the Sneak PEEK

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    KEY FEATURES of the MEDICAID CRASH COURSE

    Features of the Crash Course

    ?

    Question-based format

    Focus on Main Concepts

    Visual presentation of

    information

    Links to Further Reading

    Fly-outs and

    Sidebars Discussion of Key

    Players Section

    Summaries Topical Index

    Question format for easy, but in-depth understanding of a broad range on industry topics

  • All of the information is presented in an easy to understand question format. The 6 major questions covered are:

    1. What is Medicaid?

    2. Who can get Medicaid?

    3. What is the difference between Medicaid and Medicare?

    4. What is the State Childrens Health Insurance Program?

    5. What is the history of Medicaid?

    6. What are the big issues in Medicaid today?

    Main concepts

    The main concepts needed to understand the topics are introduced early in each question. The discussion builds off of these concepts to help the reader quickly engage with the material, to retain more of the information and to be able to think for themselves about the issues.

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  • Visual presentation of information and concepts

    A picture is worth more than a 1,000 words and the Crash Course uses pictures throughout to help communicate more information clearly.

    Fly-outs and sidebars

    Sometimes you may want to finish off the main topic being discussed

    and sometimes you may want to wander off into related info. The fly-outs and sidebars bring in related information in a way that allows you to choose how to deep to go.

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  • Key players

    Where appropriate, the key players involved in any one topic are identified. It is helpful to know who gains or loses in any issue to fully understand the issue.

    Further reading

    No one can write a document that tells you everything about any subject. After each major section, we provide you a list of links that allow you to easily explore more about the topics that are interesting to you. With the foundational concepts and understanding you get from the Medicaid Crash Course, you will be equipped to build upon your new-found Medicaid expertise.

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  • Summaries

    Instead of just diving into any major topic, there are insightful summaries at the beginning of each section to help prepare you to learn.

    Index

    Maybe you dont want to read it all in one sitting the topic index at the back allows you to read at your pace and serves as a reference tool even after you are done.

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  • Disagreements in the industry

    Ever wonder how things could be as cut and dry in the Medicaid industry as some folks would have you think? Thats because theyre not. Medicaid is complex. It helps to hear both sides of a story, and thats what the Disagreements in the Industry sections help you do.

  • Table of Contents Q1: What is Medicaid? .3

    Main Concepts .4

    How Medicaid Works in 2 Easy Steps ..5

    Types of services covered by Medicaid ..6

    Key Players ..9

    Disagreements in the Medicaid Industry .10

    Further Reading for What is Medicaid? .11

    Q2: What is the difference between MediCAID and MediCARE? ...12

    MediCARE vs. MediCAID: Differences in Who and What is Covered ..13

    One program vs. 50+ programs 14

    Medicare Part D Program .14

    Dual eligibles ...15

    Key Players .......16

    Disagreements in the Industry ....18

    Further Reading for What is the Difference Between Medicaid and Medicare? ..19

    Q3: Who can get Medicaid? 20

    Aid categories / Eligibility groups ...21

    Retro-active eligibility .21

    Federal Poverty Level (FPL) 22

    Key Players ..23

    Disagreements in the Industry ...23

    Further Reading for Who Can Get Medicaid? 24

    Q4: What is the State Childrens Health Insurance Program

    (S-CHIP / SCHIP)? .25

    Balanced Budget Act of 1997 (BBA) 25

    FPL flexibility .26

    Branding .26

  • Expansion of Medicaid vs. separate program 26

    S-CHIP Reauthorization Act of 2009 (CHIP-RA) 27

    Key Players ..27

    Use of tobacco to funds 27

    Enrollment freezes .28

    Expansion Attempts in 2007 28

    Crowding out .29

    Further Reading for What is S-CHIP? ..29

    Q5: What is the history of Medicaid? .30

    Timeline of Major Events in History of Medicaid: 1965 - 2008 31

    Initiatives to expand to pregnant women and children .32

    Initiatives to increase services paid for by Medicaid ..33

    Initiatives to replace institutional services with community-based services ...34

    Initiatives to Expand Medicaid Under Health Reform ..35

    Further Reading for What is the History of Medicaid? ..36

    Q6: What are the big issues in Medicaid today? ...37

    Value (Quality Cost) 38

    Issue #1 - Making Managed Care Work for the Medicaid Population .39

    Issue # 2 Rewarding performing providers and punishing non-performing providers (Pay for Performance (PFP) in Medicaid) .41

    Issue #3 Managing Chronic Conditions in the Medicaid Population .44

    Issue #4- Getting the Most Bang for the Medicaid Buck (ROI) ..49

    Issue # 5 Stopping the Fraud and Waste in Medicaid ...52

    Issue #6 Understanding and Managing the Impact of Health Reform on

    Medicaid/CHIP ..63

    Further Reading for the What are the Big Issues in Medicaid Today? 68

  • EXCERPTED FROM Question 1: What is Medicaid? Main Concepts While there is a lot to know about Medicaid, if you keep in mind these 3 concepts, you will be able to grasp most of the issues you may encounter in the Medicaid industry:

    the People who are covered by

    Medicaid

    Eligibility is the reason a person

    receives insurance from Medicaid.

    Eligible people get coverage either

    due to their poverty or disability

    status.

    the Providers who render services

    to Medicaid members

    Physicians, nurses, hospitals, local

    community mental health agencies, foster homes, home health and durable medical equipment

    companies these are all providers of Medicaid services (just to name a few). Medical

    professionals and companies have an option of whether they will participate in the Medicaid

    insurance program, and many select not to because of lower reimbursement rates and higher

    regulatory and administrative burdens.

    Order your copy of the Medicaid Crash Course now

  • Types of services covered by Medicaid

    Medicaid covers most of the same types of services that private health insurance covers It often

    covers more things than private health insurance, depending on

    the state. The big buckets usually used to classify Medicaid

    spending are Long Term Care, Acute Care and Administrative Services.

    Medicaid consumed an average of 21% of state budgets in 2010.

    Long term care relates to nursing homes as well as services for members who may live in an institutional facility (such as for mental health/d