Long Term Services and Support: Payment

Medicaid Managed Care: Background, Issues and Options

Abstract: 

This Research & Policy brief was prepared for the Health Care Forum of the Policy Leaders Academy, a nonpartisan educational program for Maine Legislators.

The brief defines managed care, discusses state goals for and common models of managed care, and describes design decisions that state Medicaid agencies face.

Suggested citaion:

Fralich, J. T. (2011). Medicaid managed care: Background, issues, and options. Portland, ME: University of Southern Maine, Muskie School of Public Service

Publication Type: 
Research and Policy Brief
Publish Date: 
January 14, 2011
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/DA/Medicaid-Managed-Care_Brief_Fralich_2011.pdf

Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. Chartbook.

Abstract: 

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services.  This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010.  This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on members considered full benefit as well as those who are partial benefit members.  Partial benefit members are also know as Qualified Medicare Beneficiaries, Specified Low Income Medicare Beneficiaries; Qualified Individuals; and Qualified Disabled and Working Individuals.  Individuals who are dually eligible for MaineCare and Medicare typically have multiple chronic conditions, high medical and long term care costs, and low income. Medicare covers hospital, medical, skilled long term care and pharmacy services while Medicaid pays for behavioral health, community based long term services and supports and nursing home services. The integration of services and benefits for people who are dually eligible is a challenge for states and the federal government. As states move to introduce value based purchasing initiatives through health homes, accountable care communities and other managed care efforts, the need to coordinate services and align incentives between the Medicaid and Medicare programs becomes increasingly critical. Many states are involved in dual eligible demonstrations to improve the integration of services, benefits and care.

Suggested Citation:

McGuire C, Gressani T, Bratesman S, Fralich J, Griffin E.  Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2012.


Publication Type: 
Report
Publish Date: 
October 30, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/DualEligible-Chartbook-SFY2010.pdf

Children and Adults With Long Term Services and Support Needs: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. Chartbook.

Abstract: 

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services. An earlier report provided a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008 to 2010. Both reports were prepared as part of the Maine State Profile Tool grant funded by the Centers for Medicare & Medicaid Services. This second report analyzes the characteristics, use and expenditure patterns of sub-populations of long term service users including adults with mental illness, adults with brain injury, adults with developmental disabilities, older adults and adults with disabilities and children with mental illness and children with developmental disabilities. The report includes information on MaineCare-only members and members who are dually eligible for MaineCare and Medicare. Dually eligible members in this report are those considered full benefit members.

Suggested Citation:

McGuire C, Bratesman S, Gressani T, Fralich J, Griffin E.  Children and Adults With Long Term Services and Support Needs: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; December 2012.

Publication Type: 
Report
Publish Date: 
December 1, 2012
URL: 
http://muskie.usm.maine.edu/Publications/DA/MaineCare-Medicare-analysis-Children-Adults-LTSS-SFY2010.pdf
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