March 2006

Grant Results

SUMMARY

In 2003 and 2004, a workgroup of 25 experts examined the Medicaid program and made recommendations to improve its efficiency and effectiveness. The National Academy for State Health Policy, the policy arm of the Center for Health Policy Development, convened the workgroup and produced and disseminated the following:

Key Recommendations

  • Simplify and expand Medicaid eligibility to acute and primary care and long-term care.
  • Increase program flexibility for optional populations (those groups not automatically covered, such as elderly persons not eligible for Supplemental Security Income (SSI)).
  • Improve coordination and integration with the Medicare program and private insurances.
  • Adjust current financing mechanisms.
  • Provide states with tools to manage long-term care and rebalance institutional and home and community-based care systems.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $50,000 in partial funding for this unsolicited project from January through October 2004.

 See Grant Detail & Contact Information
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THE PROBLEM

Medicaid, the country's largest health insurer, has undergone significant changes since the early 1990s, but without a systematic review of the program's structure and operations.

In 2003, the National Academy for State Health Policy, a nonprofit, nonpartisan organization that conducts health policy analysis and provides training, technical assistance and information to states, convened a bipartisan workgroup of experts with "in the trenches" experience in the Medicaid program. The Making Medicaid Work for the 21st Century Workgroup (see Appendix for membership) met twice in 2003, and selected three categories for focus:

  1. eligibility
  2. benefits and cost sharing
  3. financing and cost controls.

The Center for Health Policy Development, a nonprofit 501(c)(3) corporation, operates the academy and provides financial oversight. The academy's executive director also serves as president of the center's board of directors. More information is available online.

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THE PROJECT

Staff at the National Academy for State Health Policy:

  • Created 11 background working papers to guide workgroup discussion at its third and final meeting in May 2004.
  • Dedicated a section of the academy Web site to the Making Medicaid Work for the 21st Century project. (See the Bibliography for details.)
  • Drafted a final report of workgroup recommendations for Medicaid program improvement. (See Recommendations and the Bibliography).
  • Produced six issue briefs on topics related to the workgroup's final report (available online). (See the Bibliography for details.)

Other Funding

The David and Lucile Packard Foundation ($350,991), AARP ($50,000) and the Agency for Healthcare Research and Quality ($25,000) also provided funding for this project.

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RECOMMENDATIONS

The workgroup's final report identifies opportunities for improvement in all areas of the Medicaid program, including calls for:

  • Simplifying and expanding eligibility to acute and primary care and long-term care.
  • Increasing program flexibility for optional populations (those groups not automatically covered, such as elderly persons not eligible for Supplemental Security Income (SSI)).
  • Improving coordination and integration with the Medicare program and private insurances.
  • Adjusting current financing mechanisms.
  • Providing states with tools to manage long-term care and rebalance institutional and home and community-based care systems.

The National Academy for State Health Policy conducted related sessions at its national conference, under the umbrella title "Expanding Coverage for Adults: State Experiences and Lessons":

  1. Premium Assistance and Beyond: Working to Fill the Gap Between Public and Private Coverage.
  2. Making Medicaid Work: Reforming Long-Term Care Systems.
  3. What if Medicaid Looked Like SCHIP? (Part I: Premiums and Cost-Sharing).
    What if Medicaid Looked Like SCHIP? (Part II: Benefit Design).

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AFTER THE GRANT

Staff at the National Academy for State Health Policy held a National Health Policy Forum session on the workgroup's recommendations in Washington in February 2005. They continue to present the recommendations to state and federal agencies, task forces and commissions addressing Medicaid reform, and to elected officials and Congressional health policy staff. The National Academy for State Health Policy's 2005 Annual Health Policy Conference, held in August 2005, dedicated five sessions to the final report and its recommendations; see the Bibliography for details.

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GRANT DETAILS & CONTACT INFORMATION

Project

Task Force to Make Medicaid Work in the 21st Century

Grantee

Center for Health Policy Development/National Academy for State Health Policy (Portland,  ME)

  • Amount: $ 50,000
    Dates: January 2004 to October 2004
    ID#:  048837

Contact

Neva Kaye
(207) 874-6524
nkaye@nashp.org

Web Site

http://www.nashp.org/search/node/Making%20Medicaid%20Work%20for%20the%2021st%20Century

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Making Medicaid Work for the 21st Century Workgroup Members

Neil Bergsman
Executive Director
Maryland Department of Budget & Management
Annapolis, Md.

Steve Berman, M.D.
Professor of Pediatrics and Director
Children's Outcomes Research Program
University of Colorado School of Medicine
Denver, Colo.

Lyn Bodiford
State Affairs Coordinator
AARP
Tallahassee, Fla.

Barbara Coulter Edwards
Medicaid Director
Ohio Department of Job and Family Services
Columbus, Ohio

Mary Dewane
Consultant
Schaller Anderson, Inc.
Phoenix, Ariz.

Anne Dunkelberg
Senior Policy Analyst
Center for Public Policy Priorities
Austin, Texas

Christine Ferguson
Commissioner
Massachusetts Department of Public Health
Boston, Mass.

Len Fishman
President and CEO
Hebrew Rehabilitation Center for Aged
Boston, Mass.

Catherine Halverson
Senior Vice-President, Business Development and Government Relations
Centene Corporation
Washington, D.C.

Mary Kennedy
Vice President, Business Development
Evercare
Minnetonka, Minn.

David Lehman
Policy Advisor
Office of the Governor
Boise, Idaho

Kathy Leitch
Assistant Secretary, Aging and Disability Services Administration
Washington Department of Social and Health Services
Olympia, Wash.

Deborah Lisi-Baker
Executive Director
Vermont Center for Independent Living
Montpelier, Vt.

Cindy Mann
Research Professor
Institute for Health Care Policy and Research, Georgetown University
Washington, D.C.

Donna McDowell
Director
Bureau of Aging and Long Term Care Resources
Wisconsin Health and Family Services Department
Madison, Wis.

Jack Meyer
President
Economic Social Research Institute
Washington, D.C.

Angela Monson
State Senator
Oklahoma State Senate
Oklahoma City, Okla.

Janet Olszewski
Director
Michigan Department of Community Health
Lansing, Mich.

Robert Rubin, M.D.
Clinical Professor of Medicine
Georgetown University
Washington, D.C.

Ree Sailors
Executive Policy Advisor
Governor's Executive Policy Office
Olympia, Wash.

Dennis Smith
Director
Centers for Medicaid and State Operations
Washington, D.C.

Vernon Smith
Principal
Health Management Associates
Lansing, Mich.

Maggie Tinsman
Senator
Iowa State Senate
Des Moines, Iowa

Alan Weil
Executive Director
National Academy for State Health Policy
Portland, Maine

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Improving Long-Term Services and Supports. Portland, ME: National Academy for State Health Policy, Issue Brief #5, December 2004. Also appears online.

Medicare and Medicaid Dual Eligibles. Portland, ME: National Academy for State Health Policy, Issue Brief #6, December 2004. Also appears online.

Options for Improving the FMAP formula. Portland, ME: National Academy for State Health Policy, November 2004. Also appears online.

Options for Improving Medicaid Eligibility. Portland, ME: National Academy for State Health Policy, Issue Brief, April 2004. Also appears online.

Options for Premium Assistance Programs. Portland, ME: National Academy for State Health Policy, Issue Brief #2, November 2004. Also appears online.

State Options to Control Costs. Portland, ME: National Academy for State Health Policy, Issue Brief #4, November 2004. Also appears online.

Smith V, Kaye N, Chang D, Bonney J, Milligan C, Milne D, Mollica R and Shirk C. Making Medicaid Work for the 21st Century: Improving Health and Long-Term Care Coverage for Low-Income Americans. Portland, ME: National Academy for State Health Policy, Issue Brief, January 2005. Also appears online.

World Wide Web Sites

www.nashp.org. "Making Medicaid Work for the 21st Century," on the National Academy for State Health Policy's Web site, includes an overview of the Making Medicaid Work for the 21st Century project and links to the Making Medicaid Work for the 21st Century Workgroup's full report, a summary of the report's recommendations, six issue briefs on key topics related to the report's recommendations and other related topics. Portland, ME: National Academy for State Health Policy, March 2004.

Presentations and Testimony

Alan Weil, "The Future of Medicaid: Strategies for Strengthening America's Vital Safety Net," testimony before the United States Senate Committee on Finance, June 15, 2005, Washington. Testimony appears online.

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Report prepared by: Karyn Collins
Reviewed by: Kelsey Menehan
Reviewed by: Marian Bass
Program Officer: Pamela S. Dickson

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