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