Continuity of Care Requirements in the Managed Medical Assistance Program

The Statewide Medicaid Managed Care (SMMC) program consists of two components: the Managed Medical Assistance (MMA) program and the Long-term Care (LTC) program. The MMA program provides medical services to infants, children and adults on Medicaid, while the LTC program provides home and community-based long-term care services to elders and adults with disabilities on Medicaid […]

Medicare Advantage Members’ Expected Out-Of-Pocket Spending For Inpatient And Skilled Nursing Facility Services

Inpatient and skilled nursing facility (SNF) cost sharing in Medicare Advantage (MA) plans may reduce unnecessary use of these services. However, large out-of-pocket expenses potentially limit access to care and encourage beneficiaries at high risk of needing inpatient and postacute care to avoid or leave MA plans. In 2011 new federal regulations restricted inpatient and […]

Health Affairs Article: At Least Half of New Medicare Advantage Enrollees Had Switched From Traditional Medicare During 2006-11

In an article in Health Affairs, Gretchen A. Jacobson and Patricia Neuman of the Kaiser Family Foundation and independent consultant Anthony Damico examined whether the 2006-2011 growth in private Medicare Advantage plans was due primarily to new beneficiaries choosing Medicare Advantage from the onset of their eligibility, or because beneficiaries enrolled in traditional Medicare were making […]

High-Cost Patients Had Substantial Rates Of Leaving Medicare Advantage And Joining Traditional Medicare

Medicare Advantage payment regulations include risk-adjusted capitated reimbursement, which was implemented to discourage favorable risk selection and encourage the retention of members who incur high costs. However, the extent to which risk-adjusted capitation has succeeded is not clear, especially for members using high-cost services not previously considered in assessments of risk selection. We examined the […]