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Making Medicaid Work for the 21st Century: Improving Health and Long-Term Care Coverage for Low-Income Americans

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This report identifies numerous opportunities for strengthening the Medicaid program and enabling it to continue to play a critical role in the country’s health care system. The report draws upon the work of a group of experts with a broad range of experience in the Medicaid program. The report’s detailed recommendations identify opportunities for improvement in all areas of the Medicaid program and include calls for simplifying and expanding eligibility; increasing program flexibility for optional populations; improving coordination and integration with the Medicare program and private insurance; adjusting current financing mechanisms; and providing states with tools to manage the long-term care system and, in the process, rebalance the institutional and home and community-based care systems.

Making Medicaid Work 1.5 MB
Overview of Recommendations 92.6 KB

 

Medicaid Family Planning Demonstrations: Design Issues and Resources for States

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Since the mid-1990s, 26 states have implemented Medicaid Section 1115 family planning demonstration waivers to help low-income women avoid unintended pregnancy and improve child and maternal health outcomes. These waivers have saved states millions of dollars. The waiver programs, which require approval from the Centers for Medicare and Medicaid Services (CMS), provide access to family planning services for individuals not otherwise eligible for Medicaid or the State Children’s Health Insurance Program (SCHIP).
This State Health Policy Briefing is the third is a NASHP series examining Medicaid family planning demonstration waivers. It explores some of the design choices states face when applying for and implementing a waiver – choices about whom the program should cover, how it should cover them, and how states can ensure that clients receive the services they need.

shpbriefing_familyplanningissues.pdf 289.6 KB

Improving Oral Health Care for Young Children

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This paper focuses on the policy, financing, and workforce challenges that must be addressed to improve access to oral health care for young children, particularly those that are underserved at present.

Until recently, little attention has been given to ensuring that the oral health needs of young children are met before they enter school. This is a serious omission, since dental problems are the most common unmet need among children.

People with low incomes, minorities and immigrants, those with special health care needs, and people in rural areas have the greatest difficulty accessing care and maintaining good oral health. Needs are particularly stark among poor children. The consequences of untreated dental problems on school readiness are clear. Children with untreated dental problems experience pain and difficulty eating and sleeping, and can have trouble adjusting socially. Learning under these circumstances can be difficult.

Serving more young children presents a host of challenges, as the current system of financing and delivering dental care is fragmented and inadequate even without expanding the target population. In addition to the financing and workforce challenges, this paper describes promising models of care and discusses options for policy makers seeking to improve access to oral health care for young children.

improving_oral_health.pdf 926 KB

 

Meeting the Health Needs of Youth Involved in the Juvenile Justice System

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Nearly 100,000 young people are in juvenile justice facilities of some sort on any given day, with more than 2 million arrested in a year. Of those in residential settings, 62 percent are minorities, 85 percent are boys, and many, if not most, lack adequate health insurance coverage. Youth in juvenile justice facilities – including detention centers, shelters, diagnostic centers, group homes, wilderness programs, residential treatment facilities and training schools (where most juveniles are committed) – suffer disproportionately from a host of mental and physical health problems. The presence and severity of health problems may help explain the behaviors that led to their involvement in the criminal justice system and make it critical they receive the appropriate medical services both in the system and upon their release. Most of those arrested do not end up at trial. Of those who are tried, about two-thirds are sentenced to probation after a trial, allowing a true opportunity for therapeutic intervention in the community. Given the preponderance of low-income youth involved with the juvenile justice system, it is likely that many who enter are enrolled in or eligible for Medicaid.
States and local governments face stiff challenges in organizing and funding services for troubled youth. One challenge is to make Medicaid work better for this population during those times an individual is not in a public institution. Another challenge is to ensure that quality and effective services are provided to individuals both during and after their involvement in the juvenile justice system. Medicaid presents unique limits and opportunities compared to state and local funding. Services provided to those involved in the juvenile justice system are impacted by these funding matters. This paper describes these limits and opportunities, and highlights a number of promising practices and service models in states.

Health and Juvenile Justice 301.1 KB

 

The North Carolina ABCD Project: A New Approach for Providing Developmental Services in Primary Care Practice

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This report details promising efforts being made in North Carolina to coordinate and strengthen the early childhood development services the state provides to low-income children and their families.
 

North Carolina ABCD 232.9 KB

 

A Medicaid Primer for Juvenile Justice Officials

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Juvenile justice agencies face a significant challenge meeting the health needs of the youth in their systems. Medicaid, which provides health coverage to more than half of all low-income children in this country, can be a vital partner in juvenile justice reform efforts. However, coordination between juvenile justice systems and state Medicaid programs can be much improved. It may help many juvenile justice officials to learn more about Medicaid and how it can be used to improve their programs and the lives of the young people they work with. The purpose of this State Health Policy Briefing is to provide those who work with system-involved youth with an introduction to Medicaid and its key concepts, as they pertain to the juvenile justice system.
Young people involved in the juvenile justice system suffer disproportionately from unmet mental and physical health needs, including mental health disorders, oral health problems, reproductive health issues, and substance abuse issues. The significant health needs of many of these adolescents may be part of the reason that led to their arrests or involvement in the juvenile justice system. If their health needs remain unaddressed, they are much less likely to live productive lives and succeed in school or work, and are more likely to face re-arrest after release.

Medicaid Primer 169.6 KB

 

State Efforts to Cover Low-Income Adults Without Children

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Most Americans assume that our health insurance safety net covers the poor, regardless of family status.  In reality, a majority of uninsured Americans are low-income, childless adults who are not eligible for public health insurance programs. Out of the approximately 47 million people who are currently uninsured in the United States, 34 percent or 16 million people, are low-income childless adults.
This state health policy monitor describes programs in 23 states that provide health insurance coverage to low-income childless adults. While nearly half of states have programs in place to serve at least some of this population, many of these programs limit enrollment and provide limited benefits. The majority of these programs are financed in part with federal dollars through Medicaid §1115 waivers, and some are financed solely through state dollars. Some states have also created “premium assistance programs” where Medicaid or SCHIP funds help enrollees pay for employer-based or private health insurance.
This state health policy monitor examines states’ initiatives that provide free or reduced-cost health coverage for childless adults, including options for financing coverage, as well as key features of programs such as eligibility rules, benefit design, and cost sharing.
 

Coverage for Childless Adults 533.3 KB

 

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