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List of Illustrations xi
Acknowledgments xv
Authors' Note xvii
Introduction 1
Part I Keys to Understanding Medicaid 11
1 Financing Care for the Poor in a Democracy 13
Medicaid Was Made in America 13
Medicaid Depends on Altruism, Not Solidarity 14
Medicaid Reflects Public Choices 19
Medicaid Is Tied to the U.S. Health Care System 20
Medicaid Spending Is Unequal among States 23
2 Medicaid's Roles in Our Health Care System 26
Medicaid Is Both Expenditure and Revenue 26
Medicaid's Roles Change Over Time 36
Medicaid Embodies a Set of Implicit Promises 41
Medicaid Promises as a Framework for Enlightened Policymaking 45
Conclusion to Part 1: Fundamental Policy Questions 47
Part II Making and Meeting Promises to the Poor 49
3 Ensuring Access for the Poor Population 51
Disadvantaged Populations 51
Interstate Equity in Eligibility and Benefits 54
Differences in Benefit Levels among the States 55
Equity, Efficiency, and Recipient Income 67
The Questionable Value of Higher Spending 73
4 Medicaid and Care Management 76
Managing Benefits 76
Cost-Sharing and Medicaid 82
Acute Care Management 85
Medicaid Managed Care 91
Long-Term Care Management 100
Concluding Note on Care Management 105
5 Achieving High-Value Care for the Poor 106
Priorities for Care 107
Recommendations for Managing Eligibility and Benefits 109
Conclusion to Part 2: Achieving Access, Control, and Value 119
Part III Making and Meeting Promises to Voter-Taxpayers 121
6 Medicaid Financing as a Product of Democracy 124
The Median Voter Model of Public Spending 126
Medicaid Budgets 131
Desirable Characteristics of Federal-State Financing 134
Conclusion 137
7 Medicaid Financing for Taxpayer Equity 139
Redistribution Effects of Medicaid and CHIP 139
Adjusting Federal Matching to Achieve Medicaid Equilibrium 144
Federal-State Financing Options 147
Conclusion 154
8 Recommendations for Revising Federal Financing 156
Rationale for Changing the Matching-Rate Structure 156
Optimal Matching Rates 157
Categorical Matching Rates 159
Equal-Burden-for-Equal-Benefit Matching 162
Countercyclical Adjustments 172
Expected Effects and Advantages of the Proposed Structure 176
9 Medicaid Financing for Accountability 177
Supplemental Payments and State Financing Arrangements 177
Questionable Financing Arrangements 178
Program Integrity 189
Conclusion 193
Conclusion to Part 3: A Basic Promise: Protecting Taxpayer Interests in Medicaid 194
Part IV Promises to Providers-Payment Policies and Strategies 197
10 Provider Payment in a Democracy 199
Developing a State Medicaid Provider Payment Strategy 200
Payment Requirements and Objectives 202
Medicaid's Relationships with Providers 204
Medicaid Provider Payment Strategies 209
Conclusion 213
11 Medicaid Payment for Provider Equity 215
Why States Can Set Medicaid Payment Rates Low 216
Can Medicaid Shift Costs? 218
Achieving an Equitable Distribution of Payments 228
Conclusion 231
12 Implementing Payment Policy 233
Rate-Setting Methods 233
Provider Payment Issues by Type of Provider 243
Conclusion 249
13 Gaining Control of Provider Payment 250
Provider Payment for Accountability 250
Recommendations for Reforming Provider Payment Methods 257
Conclusion 267
Conclusion to Part 4: Payment to Shape the Delivery System, of the Future 269
Part V Promises to the Near Poor-CHIP and Fiscal Federalism 271
14 From SCHIP to CHIP-Eonomics, Politics, and Policy 273
Background 274
Explaining the Unexplainable 277
What to Do and Why 281
Crowd-Out, Take-Up, and Efficiency 284
EBEB Matching and CHIP 287
CHIP Renewal and Expansion in 2009 288
Conclusion to Part 5: Implications of Subsidizing Coverage for the Near Poor 289
Conclusion 291
Key Policy Choices 292
Managing the Policymaking Process 296
What Is Required of Policymakers 308
Appendix 1 State Tables 313
Appendix 2 Equal-Burden-for-Equal-Benefit Matching Rates 329
Examples Illustrating EBEB Possibilities 331
Notes 347
References 359
Index 371
About the Authors 391
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Add Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency, A comprehensive policymaker's guide to the Medicaid program, Medicaid Everyone Can Count On offers unique insights into the complex interactions among stakeholders in America's state-based public health care programs. In an era of national health care ref, Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency to the inventory that you are selling on WonderClubX
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Add Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency, A comprehensive policymaker's guide to the Medicaid program, Medicaid Everyone Can Count On offers unique insights into the complex interactions among stakeholders in America's state-based public health care programs. In an era of national health care ref, Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency to your collection on WonderClub |