State legislators attending the fourth annual CSG Medicaid Policy Academy June 17-19, in Washington, D.C., learned how critical Medicaid funding can be to services for vulnerable persons. Dr. Jeffery Brenner, a 2013 winner of a MacArthur Foundation genius award, challenged the group to rationalize the health care system. He described how his project in Camden, N.J. has reduced costs and improved care for patients suffering from a complex set of chronic diseases. Health care workers visit patients in their residences and seek to evaluate not just medical needs but social and emotional needs as well. 

Oregon’s coordinated care organizations (CCOs), a new coordinated care and payment model authorized by the state’s legislature in 2012, have lowered ER visits and hospitalizations.

The federal government has approved a Medicare waiver for Maryland intended to reduce hospital spending, Stateline reports today. Maryland is already the only state to set uniform prices for all hospitals. The same medical procedure costs the same in every hospital in the state regardless of the insurer, including Medicare and Medicaid. This has been true since 1974.

The Medicare waiver is how Maryland can set Medicare hospital rates – otherwise it would be subject to federal rules on rates. If the waiver succeeds in holding down costs, Maryland will continue to set its own Medicare hospital rates, currently higher than those in other states.

Many have heard the concern that there are not enough physicians to cover the additional 30 million people that will have health insurance under the Affordable Care Act. One solution states are considering is to give nurse practitioners more autonomy.

Nurses that have advanced degrees in family medicine already have full practice in 17 states. Full practice...

Colorado began using a “medical homes” model within the last year – providing case management and care coordination for a selected subgroup of 128,000 Medicaid enrollees. The reform was begun without any additional funding because officials were convinced that generated savings would immediately cover the extra costs of the medical homes. Regional contractors receive $12 per patient per month to oversee the medical homes in seven Colorado regions. They pass on a per patient per month fee to primary care physicians to provide care coordination, case management, and prevention services.

On June 27-29, approximately 30 CSG members gathered in Washington, D.C. for the first-ever Medicaid Policy Academy to learn more about Medicaid and how states can improve health outcomes for enrollees and, at the same time, run a more cost efficient program. Besides hearing from the chief federal administrator of Medicaid, Cindy Mann, Director of the Center for Medicaid and CHIP Services at DHHS, attendees listened to a panel of state policymakers explain reforms to their programs in Kansas, Oklahoma, Iowa and Georgia. Other speakers identified opportunities for reform in behavioral health, long-term care and managed care.

The meeting date coincided with the June 28 Supreme Court’s decision on the Affordable Care Act. The next day, Lisa Soronen, executive director of the State and Local Legal Center, dissected the decision and what it means for states in the coming years. Her presentation was available as a free webinar to all CSG members.

See all the presentations from the Medicaid Policy Academy below.

Providing care to patients eligible for both Medicare and Medicaid - "dual eligibles" - has proven problematic. Not only does their care tend to be more costly, it is often difficult to efficiently traverse the two programs, leading to disjointed care. However, the Center for Medicare and Medicaid Services has created two innovative strategies to improve the coordination of care and financing for dual eligible patients.