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Medicaid 101: What You Need to Know

Friday, March 01, 2013

A March 1 briefing, Medicaid 101: What You Need to Know, was especially helpful to congressional staff members and others new to the issue, but it was also a useful review for anyone dealing with Medicaid issues, particularly as many states prepare to expand their programs.

Medicaid is administered by states within broad federal rules and the program is jointly financed by the states and the federal government. Today, Medicaid provides health care coverage to over 60 million low-income individuals, including families, people with disabilities and seniors. More low-income uninsured (primarily adults) are expected to gain coverage through an expansion of the program under the Patient Protection and Affordable Care Act (ACA). The ACA provides 100 percent federal financing for new coverage between 2014 and 2016, and then federal financing for this group phases down to 90 percent by 2020 and beyond. Under the current Medicaid program, the federal government pays for about 57 percent of costs.

This “Medicaid 101” answered basic questions about the program.

What is Medicaid and what is its role in the health care system? Who is eligible and what benefits does it cover? How is the program administered? How much does Medicaid cost and how is it financed? How does the ACA affect the program? What approaches are states adopting to transform the program to meet current and future health care needs of a low income, vulnerable population?

Robin Rudowitz, associate director of the Kaiser Commission on Medicaid and the Uninsured, explained the basic coverage and financing structure of Medicaid as well as changes under the ACA. 

Barbara Edwards, director of the Disabled and Elderly Health Programs Group at the Centers for Medicare and Medicaid,  discussed how Medicaid is administered and key priorities for the program going forward.

Charles Milligan, deputy secretary for health care financing at the Maryland Department of Health and Mental Hygiene, spoke about how Maryland is preparing for its Medicaid expansion, and approaches the state is adopting to improve the program.

Bill Hazel, Virginia’s secretary of Health and Human Resources, discussed how Virginia is transforming its Medicaid program to improve quality and reduce health care costs.

Barbara Lyons of Kaiser and Ed Howard of the Alliance co-moderated.

The event was sponsored by the nonpartisan Alliance for Health Reform and Kaiser Commission on Medicaid and the Uninsured.

Contact: Marilyn Werber Serafini (202)789-2300

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Full Transcript (Adobe Acrobat PDF), 3/1/2013
Full Webcast/Podcast: Full Webcast

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Rudowitz Presentation (Adobe Acrobat PDF), 3/1/2013
Edwards Presentation (Adobe Acrobat PDF), 3/1/2013
Milligan Presentation (Adobe Acrobat PDF), 3/1/2013
Hazel Presentation (Adobe Acrobat PDF), 3/1/2013

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 3/1/2013
Speaker Biographies (Adobe Acrobat PDF), , 3/1/2013
Selected Experts List (Adobe Acrobat PDF), , 3/1/2013
Materials list (Adobe Acrobat PDF), , 3/1/2013

Offsite Materials (briefing documents saved on other websites)

Faces of Medicaid., Kaiser Commission on Medicaid and the Uninsured, 2/1/2013
Medicaid/CHIP Participation Among Children and Parents (Adobe Acrobat PDF),Urban Institute and Robert Wood Johnson Foundation, 12/1/2013
Medicaid-Eligible but Not Enrolled? ACA a Likely Stimulus, American Medical News, 2/18/2013
Medicaid: 3 Issues to Watch in 2013, Kaiser Commission on Medicaid and the Uninsured, 2/1/2013
Medicaid: A Primer, Kaiser Commission on Medicaid and the Uninsured, 2/1/2013
Medicaid Moving Forward: Opportunities for Achieving Improvements in Care and Program Efficiency, Centers for Medicare and Medicaid Services, 2/21/2013
Expanding Medicaid: The Smart Decision for Maryland, Health Affairs Blog, 8/29/2012
Questions and Answers: Medicaid and the Affordable Care Act (Adobe Acrobat PDF),, 2/1/2013
In Medicaid, a New Health-Care Fight, The Wall Street Journal, 2/10/2013
The Basics: Medicaid Financing.” (Adobe Acrobat PDF),ational Health Policy Forum and The George Washington University, 2/13/2013
The State Innovation Models Are Announced!, Once in a Weil Blog on National Academy for State Health Policy, 2/25/2013
Where Each State Stands on ACA’s Medicaid Expansion, The Advisory Board Company, 2/20/2013
After the Supreme Court Decision: The Implications of Expanding Medicaid for Uninsured Low-Income Midlife Adults, AARP Public Policy Institute, 2/4/2013
Health Policy Brief: Care for Dual Eligibles (Adobe Acrobat PDF),Health Affairs, 6/13/2013
The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis (Adobe Acrobat PDF),Kaiser Commission on Medicaid and the Uninsured and The Urban Institute, 11/26/2013
Medicaid Expansion: New Patients, New Challenges, Price Waterhouse Cooper Health Research Institute, 10/1/2012
State Innovation Models Initiative, Centers for Medicare and Medicaid Services, 2/21/2012
State Medicaid Directors Driving Innovation: Payment Reform, National Association of Medicaid Directors, 2/25/2013
The Oregon ACO Experiment – Bold Design, Challenging Execution, The New England Journal of Medicine, 2/13/2013
About Half of the States Are Implementing Patient-Centered Medical Homes for Their Medicaid Populations, Health Affairs, 11/5/2012



Traditional public-pay providers are familiar with submitting claims to Medicaid and CHIP, but are not familiar with submitting commercial claims and need technical assistance with credentialing, rate setting/negotiations, creating a business model and payment reform looking forward to 2014, Charles Milligan of Maryland's Department of Health and Mental Hygiene said a March 1 Alliance briefing, Medicaid 101: What You Need to Know.  

Behavioral health will be an important issue with the expansion Medicaid population, and CMS is making a big push to integrate behavioral health with physical health care, Barbara Edwards of CMS said at a March 1 Alliance briefing, Medicaid 101: What You Need to Know.


The inappropriate use of the health system, inadequate provider reimbursement, uncompensated care and discrepancy between payers are causing waste in the health care system, William Hazel of Virginia's Department of Health and Human Resources said at a March 1 Alliance briefing, Medicaid 101: What You Need to Know.


States are changing provider payments in Medicaid rather than eligibility, and are also expanding managed care, coordinating care and focusing on dual eligibles - beneficiaries enrolled in both Medicaid and Medicare, Robin Rudowitz of the Kaiser Commission on Medicaid and the Uninsured said at a March 1 Alliance briefing, Medicaid 101: What You Need to Know.



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