Hello Sunshine Project folks,

I just sent around a summary (posted below again) of some of the highlights from a
new Kaiser Commission report. However, we also wanted to point out to this group
some of the report findings of particular interest regarding Medicaid managed care.

Note from the report (p.49) the large increase in the number of states that are
enrolling beneficiaries who are elderly or have a disability. This population tends to
use more Medicaid services and often requires services that managed care plans
may be reluctant to provide.

From the appendix A-8, p. 84: It looks like all of the states that our project group
represents (except New Hampshire) uses HEDIS or “similar performance measures”
to measure health plan performance, and all of our states use CAHPS or a similar
measure to survey Medicaid beneficiaries. All of our states’ Medicaid directors,
except New Hampshire, report making some MCO performance data publicly
available. Most of the states in our group report using pay-for-performance or an
intent to implement it during FY 2009 (both good and bad aspects to this).

You may find other aspects of this Kaiser report to be helpful in your work.

Summary of some points from the report:

The Kaiser Commission on Medicaid and the Uninsured has issued a new report,
Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy
Heading into an Economic Downturn. You may find the report interesting and
helpful in your work. It is available online at:
http://www.kff.org/medicaid/upload/7815.pdf

Some highlights that you might find interesting:

• Though states are looking at a downturn in the economy, most states are not,
as yet, cutting back on eligibility or services. In FY 2008, about half the
states expanded eligibility standards and implemented changes to simplify
the application and renewal process. For FY 2009, a little over 20 states
expect to expand eligibility and/or implement program simplifications.
• The number of Medicaid beneficiaries is slowly rising after a couple of years
of flat or declining enrollment.
• In half of the states, the DRA citizenship and identity documentation
requirements have resulted in “significant or moderate” increases in
application backlogs or Medicaid denials due to inability of applicants or
beneficiaries to obtain the documentation. Many states have seen an
increased administrative burden or needed to redirect staff from other
agency activities in order to comply with the requirements.
• Three states (Wisconsin, Maryland, and Maine) report using the DRA
provisions that allow states an option to impose premiums on beneficiaries.
Four states (Illinois, Iowa, Louisiana, and North Dakota) are offering premium-
based Medicaid for disabled children using the Family Opportunity Act
provisions. A number of other states also have premium programs under
other provisions, and two states have eliminated premiums.
 • In FY 2008, three states raised co-payments or imposed new ones, while four
states reduced or eliminated co-payments. In FY 2009, three states are
planning to reduce or eliminate co-payments. Four states (Delaware,
Kentucky, Minnesota, and Wisconsin) reported making the co-payment
requirements enforceable (as allowed under the DRA), while a fourth state
(Nevada) plans to do so in FY 2009.
• Six states have used the DRA to replace the basic, traditional Medicaid
package of benefits with a scaled-back, “benchmark” package for some of
the Medicaid beneficiaries in their states.
• About 2/3 of the states have or will implement cost containment measures on
prescription drugs, largely through preferred drug lists and greater use of
prior authorization.
• States are increasing enrollment of aged or disabled beneficiaries into Medi-
Cal managed care plans. By the end of FY 2009, the number of states
enrolling these populations into managed care will have increased from five
to 28 states. Several states are requiring mandatory enrollment for groups
that were previously exempt.
• Only two states (Alaska and Wyoming) report having no form of Medicaid
managed care. In order to measure the quality of care delivered by managed
care organizations, 45 states use HEDIS or similar state-developed measures
(including states with PCCM programs), and by FY 2009, 44 states will be
using CAHPS or similar measures. However, only 34 states currently report
making at least some of that data public, and an additional six states plan to
do so in the next fiscal year.
• States are increasingly using pay-for-performance incentive payments for at
least some provider groups. The number of states using P4P has almost
doubled in the last two years.
• Most states do not require health plans participating in Medicaid to be
accredited by an organization such as NCQA.
• Over 2/3 of the states report problems of access to specialty care and dental
care.

Randy Boyle
National Health Law Program
Los Angeles office