In a recent Scattergood Foundation report, LDI Senior Fellow Dominic Sisti and I tackle the curious case of the “institutions for mental diseases” (IMD) exclusion in Medicaid. For non-elderly adults, the national IMD exclusion prevents Medicaid from paying for inpatient care in institutions with more than 16 beds that primarily provide care for persons with “mental diseases” other than dementia or intellectual disabilities.
On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”
Abstract [from journal]
We study spillover effects of the largest ever increase in Medicaid primary care reimbursement rates on behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014 through the Affordable Care Act. We apply differences-in-differences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher...
The adequacy of “narrow network” plans offered on the Affordable Care Act (ACA) Marketplaces continues to be a concern in the wake of exclusions of some high-cost providers and the incidence of “surprise medical bills” even in facilities that are in-network.
The evidence on the positive effects of Medicaid expansion on coverage, access, utilization, and financial security is substantial and growing.
Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.
A survey of state legislators revealed clear partisan differences in Medicaid reform priorities and policy preferences that states are pursuing in Section 1115 waiver applications. While there was some agreement across parties on broad goals for the Medicaid program, such as reducing health care spending and increasing affordability of health care, there was little consensus on specific policy changes needed to meet these goals.
[cross-posted from the Health Cents blog on philly.com]
In a push to encourage “personal responsibility,” the Centers for Medicare and Medicaid Services (CMS) has approved work requirements as a condition for receiving Medicaid benefits in four states - Kentucky, Indiana, Arkansas, and most recently New Hampshire, with applications from other states pending.
Shift in U.S. Payer Responsibility for the Acute Care of Violent Injuries After the Affordable Care Act: Implications for Prevention
Abstract [from journal]
Background: Investment in violence prevention programs is hampered by lack of clearly identifiable stakeholders with a financial stake in prevention. We determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in...