Federalism and Health Policy

Federalism and Health Policy PDF

Author: Alan Weil

Publisher: The Urban Insitute

Published: 2003

Total Pages: 448

ISBN-13: 9780877667162

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The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

Medicaid Politics

Medicaid Politics PDF

Author: Frank J. Thompson

Publisher: Georgetown University Press

Published: 2012-09-19

Total Pages: 289

ISBN-13: 1589019350

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Medicaid, one of the largest federal programs in the United States, gives grants to states to provide health insurance for over 60 million low-income Americans. As private health insurance benefits have relentlessly eroded, the program has played an increasingly important role. Yet Medicaid’s prominence in the health care arena has come as a surprise. Many astute observers of the Medicaid debate have long claimed that “a program for the poor is a poor program” prone to erosion because it serves a stigmatized, politically weak clientele. Means-tested programs for the poor are often politically unpopular, and there is pressure from fiscally conservative lawmakers to scale back the $350-billion-per-year program even as more and more Americans have come to rely on it. For their part, health reformers had long assumed that Medicaid would fade away as the country moved toward universal health insurance. Instead, Medicaid has proved remarkably durable, expanding and becoming a major pillar of America’s health insurance system. In Medicaid Politics, political scientist Frank J. Thompson examines the program’s profound evolution during the presidential administrations of Bill Clinton, George W. Bush, and Barack Obama and its pivotal role in the epic health reform law of 2010. This clear and accessible book details the specific forces embedded in American federalism that contributed so much to Medicaid’s growth and durability during this period. It also looks to the future outlining the political dynamics that could yield major program retrenchment.

Block Granting Medicaid

Block Granting Medicaid PDF

Author: Edward Alan Miller

Publisher: Routledge

Published: 2013-11-12

Total Pages: 254

ISBN-13: 1317962036

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Medicaid is the largest grant-in-aid program in the United States. Reform in this area, therefore, provides a unique opportunity to study the intersection between federal and state policy making in an area recently characterized by substantial uncertainty deriving from the lingering effects of the Great Recession, ongoing debate over the federal budget, and implementation of the Patient Protection and Affordable Care Act. Invariably states reform the way health care is delivered, regulated, and financed within broader parameters established by federal statutes and regulations. It is critical therefore that effective strategies be put into place if both current and future health and long-term care reform efforts are to have their greatest chances at success. Rhode Island is the first state to receive permission to operate its entire Medicaid program under a global cap. As a consequence, it has entered the national consciousness as a key data point potentially supporting the block grant approach to Medicaid reform. In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.

Health-Care Utilization as a Proxy in Disability Determination

Health-Care Utilization as a Proxy in Disability Determination PDF

Author: National Academies of Sciences, Engineering, and Medicine

Publisher: National Academies Press

Published: 2018-04-02

Total Pages: 161

ISBN-13: 030946921X

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The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Health Reform Issues

Health Reform Issues PDF

Author:

Publisher:

Published: 2009

Total Pages: 2

ISBN-13:

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Leading health reform proposals in both the House and the Senate include a Medicaid expansion to help eliminate state variation in the current program and to broaden health coverage for more low-income Americans (including childless adults who are now generally barred from Medicaid coverage). Because Medicaid is a program that is jointly administered and financed by states and the federal government, changes to Medicaid will have direct impact on states. While health reform legislation could have many implications for states, this brief highlights some of the potential benefits and costs to the states associated with Medicaid expansion in the reform proposals.

Health Reform Provides New Federal Money to Help States Expand Medicaid

Health Reform Provides New Federal Money to Help States Expand Medicaid PDF

Author:

Publisher:

Published: 2010

Total Pages: 8

ISBN-13:

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Health care reform legislation recently signed into law will greatly increase the availability of health insurance and broadly impact the delivery of health care in America. This fact sheet examines how the law makes new federal dollars available to states to provide Medicaid coverage to millions of low-income adults and how special populations and situations are treated for purposes of recent changes to the Medicaid program.

Medicaid and Devolution

Medicaid and Devolution PDF

Author: Frank J. Thompson

Publisher: Brookings Institution Press

Published: 1998-06-01

Total Pages: 324

ISBN-13: 9780815722922

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How much responsibility for providing health care to the poor should be devolved from the federal government to the states? Any answer to this critical policy question requires a careful assessment of the Medicaid program. Drawing on the insights of leading scholars and top state health care officials, this volume analyzes the policy and management implications of various options for Medicaid devolution. Proponents of devolution typically express confidence that states can meet the challenges it will pose for them. But, as this book shows, the degree to which states have the capacity and commitment to use enhanced discretion to sustain or improve health care for the poor remains an open question. Their failure to attend to issues of politics, implementation, and management could lead to disappointment. Chapters focus on such topics as Medicaid financing, benefits and beneficiaries, long-term care, managed care, safety net providers, and the appropriate division of labor between the federal government and the states. The contributors are Donald Boyd, Center for the Study of the States; Lawrence D. Brown, Columbia University; James R. Fossett, Rockefeller College; Richard P. Nathan, Nelson A. Rockefeller Institute of Government, State University of New York, Albany; Michael Sparer, Columbia University; James Tallon, United Hospital Fund; and Joshua M. Weiner, the Urban Institute.