Medicaid Everyone Can Count On Public Choices for Equity and Efficiency

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  • Edition: 1st
  • Format: Hardcover
  • Copyright: 2010-03-16
  • Publisher: AEI Press

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A Comprehensive policymaker's guide to the Medicaid program, Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency 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 reform, this volume is an invaluable resource for federal and state lawmakers and program analysts tasked with crafting policies that balance the distinct needs of taxpayers, providers and the poor.

Table of Contents

List of Illustrationsp. xi
Acknowledgmentsp. xv
Authors' Notep. xvii
Introductionp. 1
Keys to Understanding Medicaidp. 11
Financing Care for the Poor in a Democracyp. 13
Medicaid Was Made in Americap. 13
Medicaid Depends on Altruism, Not Solidarityp. 14
Medicaid Reflects Public Choicesp. 19
Medicaid Is Tied to the U.S. Health Care Systemp. 20
Medicaid Spending Is Unequal among Statesp. 23
Medicaid's Roles in Our Health Care Systemp. 26
Medicaid Is Both Expenditure and Revenuep. 26
Medicaid's Roles Change Over Timep. 36
Medicaid Embodies a Set of Implicit Promisesp. 41
Medicaid Promises as a Framework for Enlightened Policymakingp. 45
Conclusion to Part 1: Fundamental Policy Questionsp. 47
Making and Meeting Promises to the Poorp. 49
Ensuring Access for the Poor Populationp. 51
Disadvantaged Populationsp. 51
Interstate Equity in Eligibility and Benefitsp. 54
Differences in Benefit Levels among the Statesp. 55
Equity, Efficiency, and Recipient Incomep. 67
The Questionable Value of Higher Spendingp. 73
Medicaid and Care Managementp. 76
Managing Benefitsp. 76
Cost-Sharing and Medicaidp. 82
Acute Care Managementp. 85
Medicaid Managed Carep. 91
Long-Term Care Managementp. 100
Concluding Note on Care Managementp. 105
Achieving High-Value Care for the Poorp. 106
Priorities for Carep. 107
Recommendations for Managing Eligibility and Benefitsp. 109
Conclusion to Part 2: Achieving Access, Control, and Valuep. 119
Making and Meeting Promises to Voter-Taxpayersp. 121
Medicaid Financing as a Product of Democracyp. 124
The Median Voter Model of Public Spendingp. 126
Medicaid Budgetsp. 131
Desirable Characteristics of Federal-State Financingp. 134
Conclusionp. 137
Medicaid Financing for Taxpayer Equityp. 139
Redistribution Effects of Medicaid and CHIPp. 139
Adjusting Federal Matching to Achieve Medicaid Equilibriump. 144
Federal-State Financing Optionsp. 147
Conclusionp. 154
Recommendations for Revising Federal Financingp. 156
Rationale for Changing the Matching-Rate Structurep. 156
Optimal Matching Ratesp. 157
Categorical Matching Ratesp. 159
Equal-Burden-for-Equal-Benefit Matchingp. 162
Countercyclical Adjustmentsp. 172
Expected Effects and Advantages of the Proposed Structurep. 176
Medicaid Financing for Accountabilityp. 177
Supplemental Payments and State Financing Arrangementsp. 177
Questionable Financing Arrangementsp. 178
Program Integrityp. 189
Conclusionp. 193
Conclusion to Part 3: A Basic Promise: Protecting Taxpayer Interests in Medicaidp. 194
Promises to Providers-Payment Policies and Strategiesp. 197
Provider Payment in a Democracyp. 199
Developing a State Medicaid Provider Payment Strategyp. 200
Payment Requirements and Objectivesp. 202
Medicaid's Relationships with Providersp. 204
Medicaid Provider Payment Strategiesp. 209
Conclusionp. 213
Medicaid Payment for Provider Equityp. 215
Why States Can Set Medicaid Payment Rates Lowp. 216
Can Medicaid Shift Costs?p. 218
Achieving an Equitable Distribution of Paymentsp. 228
Conclusionp. 231
Implementing Payment Policyp. 233
Rate-Setting Methodsp. 233
Provider Payment Issues by Type of Providerp. 243
Conclusionp. 249
Gaining Control of Provider Paymentp. 250
Provider Payment for Accountabilityp. 250
Recommendations for Reforming Provider Payment Methodsp. 257
Conclusionp. 267
Conclusion to Part 4: Payment to Shape the Delivery System, of the Futurep. 269
Promises to the Near Poor-CHIP and Fiscal Federalismp. 271
From SCHIP to CHIP-Eonomics, Politics, and Policyp. 273
Backgroundp. 274
Explaining the Unexplainablep. 277
What to Do and Whyp. 281
Crowd-Out, Take-Up, and Efficiencyp. 284
EBEB Matching and CHIPp. 287
CHIP Renewal and Expansion in 2009p. 288
Conclusion to Part 5: Implications of Subsidizing Coverage for the Near Poorp. 289
Conclusionp. 291
Key Policy Choicesp. 292
Managing the Policymaking Processp. 296
What Is Required of Policymakersp. 308
State Tablesp. 313
Equal-Burden-for-Equal-Benefit Matching Ratesp. 329
Examples Illustrating EBEB Possibilitiesp. 331
Notesp. 347
Referencesp. 359
Indexp. 371
About the Authorsp. 391
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