Tools
Centers for Medicare & Medicaid Services Regional Offices
Web site
Locator and contact information for the CMS Regional Representatives serving 10 regions across the United States.
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program
Web site
A tool designed to help Medicaid and state maternal and child health (MCH) agencies identify opportunities for working together to ensure children's access to and receipt of the full range of EPSDT program services.
Home & Community Based Services
Web site
Assists states in improving the overall quality of services provided to Medicaid recipients, provides states with assessment and improvement systems, and helps develop effective methods to utilize implementation and improvement strategies. Allows states to request and provide homemaker/home health aide services, personal care services, adult day health, case management, and respite care.
KaiserEDU
Web site
Detailed resource lists and tutorials on health policy and public health topics, with links to publications, data, and organizations. Topics covered include Medicare, Medicaid, the uninsured, quality of care, and more. Designed for health policy students and faculty.
Medicaid Benefits: Services Covered, Limits, Copayments and Reimbursement Methodologies for 50 States, District of Columbia and the Territories
Database
State-by-state information on Medicaid benefits, searchable by state, benefit, and type of health care provider. Lists coverage for various services including dental, mental, and public health, Rural Health Clinics (RHCs), Federally Qualified Health Centers (FQHCs), and long term care services.
Medicare Improvements for Patients and Providers Act of 2008 (MIPPA)
Print publication
Provides the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) that passed by both Houses.
Rural Health Research: Medicaid and S-CHIP
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of Medicaid and S-CHIP, produced by the Office of Rural Health Policy's funded rural health research centers.
State Medicaid Fact Sheets
Web site
Allows you to customize your Medicaid fact sheet by comparing your state to the United States or to any other state.
State Profiles of Medicaid and SCHIP in Rural and Urban Areas
Web site
Provides state-level data from a range of sources on Medicaid and SCHIP, with an emphasis on program characteristics relevant to rural areas.
State Profiles of Mental Health and Substance Abuse Services in Medicaid
Web site
Consists of a summary of each state's coverage of behavioral health in Medicaid and in the State Children's Health Insurance Program (SCHIP).
Regulations, Forms & Other Useful Documents
CMS Issues Proposed Changes in Conditions of Participation Requirements and Payment Provisions for Rural Health Clinics and Federally Qualified Health Centers
Sponsoring organization: Centers for Medicare and Medicaid Services
Proposed rule to update certification and participation regulations and payment provisions for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs).
Date: 06 / 2008
Coverage and Cost Impacts of Expanding Medicaid
Author(s): Bowen Garrett, John Holahan, Allison Cook, Irene Headen, Aaron Lucas
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
This paper estimates that 49 million Americans are uninsured in 2009 and analyzes several options of expanding Medicaid to cover more low-income uninsured populations.
Medicaid to cover more low-income uninsured populations.
Date: 05 / 2009
Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession
Author(s): Vernon K. Smith, Kathleen Gifford, Eileen Ellis
Sponsoring organization: Kaiser Family Foundation
Dissects annual 50-state survey, which finds that the number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs despite increased financial help from the federal government through the American Recovery and Reinvestment Act (ARRA).
Date: 09 / 2009
Harnessing Technology to Improve Medicaid and SCHIP Enrollment and Retention Practices
Author(s): Beth Morrow, Dawn Horner
Sponsoring organization: Children's Partnership
Reports on extensive research to determine how information technology can be applied to increase coverage of children in Medicaid and SCHIP. Documents promising practices undertaken and identifies additional actions that can occur at the federal and state level to use these tools to benefit the administration of public programs.
Date: 05 / 2007
Headed for a Crunch: An Update on Medicaid Spending, Coverage and Policy Heading into an Economic Downturn
Author(s): Vernon Smith, Kathleen Gifford, Eileen Ellis, Robin Rudowitz, Molly O’Malley, Caryn Marks
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2008 and 2009. Includes references to rural.
Date: 09 / 2008
Health Care and Medicaid – Weathering the Recession
Author(s): Diane Rowland
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines the recession’s impact on health coverage and state Medicaid programs, which face growing demand and enrollment at the same time that states are confronting severe budget crises.
Date: 03 / 2009
Health Centers and Rural Clinics: State and Federal Implementation Issues for Medicaid's New Payment System
Sponsoring organization: Government Accountability Office
Reviews states' implementation of
the prospective payment
system (PPS) for Medicaid
payments to Federally Qualified
Health Centers (FQHCs) and Rural
Health Clinics (RHCs). Includes recommendations for CMS on guidance and oversight for states.
Date: 06 / 2005
Health Coverage in a Period of Rising Unemployment
Author(s): Karyn Schwartz
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Reviews the public and private options available to help people maintain coverage if they become unemployed cannot get employer-sponsored coverage through a spouse. Examines COBRA, non-group insurance and Medicaid.
Date: 12 / 2008
Impact of Medicaid and SCHIP on Low-Income Children's Health
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Reviews the literature and examines the impact of Medicaid and SCHIP on coverage, access to care and health for the nation's low-income children.
Date: 02 / 2009
Impact of Medicaid Cuts on Rural Communities (2005)
Author(s): Pam Silberman, Matt Rudolf, Laura Brogan, Stephanie Poley, Rebecca Slifkin, Charity Moore
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Discusses impact of Medicaid changes on rural areas, such as cutting or freezing provider payments, cutting eligibility or service coverage, reducing pharmacy benefits, adding recipient cost-sharing, or changing the program structure.
Date: 08 / 2005
Medicaid and Its Importance to Rural Health
Author(s): Keith J. Mueller, Andrew F. Coburn, A. Clinton MacKinney, Timothy D. McBride, Rebecca T. Slifkin, Mary Wakefield
Sponsoring organization: Rural Policy Research Institute (RUPRI) Rural Health Panel
Overview of the impact that Medicaid has on rural health. Covers the role of Medicaid in rural areas as a source of health insurance, as a revenue source for rural providers, and as a contributor to the community by supporting its health care system and local economy.
Date: 05 / 2006
Medicaid in 2006: A Trip down the Yellow Brick Road?
Author(s): Jennifer Ryan
Sponsoring organization: National Health Policy Forum
Explores the continuing evolution of the Medicaid program on several fronts. It discusses the benefits and cost-sharing flexibility that is included in the Deficit Reduction Act of 2005 (DRA) and examines the implications of these provisions for states, beneficiaries, and providers.
Date: 05 / 2006
Medicaid in a Crunch: A Mid-Fiscal Year 2009 Update on State Medicaid Issues in a Recession
Author(s): Vernon Smith, Eileen Ellis, Barbara Edwards, Robin Rudowitz
Sponsoring organization: Kaiser Family Foundation
This report provides a mid fiscal-year 2009 update on key state Medicaid issues, including the impacts of the economic downturn, based on the perspectives of leading Medicaid directors.
Date: 01 / 2009
Medicaid Program At A Glance
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides an overview of the Medicaid program, the populations that it serves, and the services that it covers.
Date: 11 / 2008
Medicaid Reform: A Rural Perspective
Author(s): Jonathan Sprague, Gail Bellamy, Rebecca Slifkin, Pam Silberman
Sponsoring organization: National Rural Health Association
Issue paper describing the characteristics of rural populations and other rural-specific considerations related to Medicaid. Addresses Medicaid payment policy, eligibility, scope of benefits and other considerations. Includes policy recommendations.
Date: 05 / 2007
Medicaid: A Primer
Sponsoring organization: Kaiser Family Foundation
Examines the structure of Medicaid, who the program covers, what services it provides and spending. Includes tables examining the state-to-state variation in eligibility, enrollment and spending for Medicaid enrollees.
Date: 12 / 2008
Medicare and Medicaid Participating Facilities: CMS Needs to Reexamine Its Approach for Funding State Oversight of Health Care Facilities
Sponsoring organization: Government Accountability Office
Reports on a survey and complaint investigation done by the states on the Medicaid program.
Date: 02 / 2009
Myths About the Medicaid Program and the People It Helps
Sponsoring organization: AARP Public Policy Institute
Addresses common misconceptions about Medicaid, a program that serves as an effective safety net for those who are unable to pay for health and long-term care.
Date: 11 / 2008
Physician Pay-for-Performance in Medicaid: A Guide for States
Author(s): Karen LLanos, Joanie Rothstein, Mary Beth Dyer, Michael Bailit
Sponsoring organization: Center for Health Care Strategies
Offers actionable steps to help states design and implement physician-level P4P strategies.
Date: 03 / 2007
Rising Unemployment, Medicaid and the Uninsured
Author(s): John Holahan
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines how increases in the unemployment rate for 2009 changes health coverage and the financial implications for state budgets affecting Medicaid/SCHIP funding.
Date: 01 / 2009
Role of Medicaid in State Economies: A Look at the Research
Author(s): Caryn Marks, Robin Rudowitz, Alicia Carbaugh
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Reports on findings from 29 studies in 23 states analyzing the role Medicaid plays in state and local economies. Includes reference to rural.
Date: 01 / 2009
Screening for Eligibility in Medicaid and the State Children’s Health Insurance Program (SCHIP)
Author(s): Cheryl Fish-Parcham
Sponsoring organization: Families USA
Lists and describes screening questions to be used as a reference to help determine whether someone may qualify for Medicaid or SCHIP coverage. Contains information about where to find federal and state-specific information.
Date: 06 / 2008
Shaping Medicaid and SCHIP Through Waivers: The Fundamentals
Author(s): Cynthia Shirk
Sponsoring organization: National Health Policy Forum
Examines the use of program waiver authorities to test new approaches to the delivery of and payment for health care and long-term care services.
Date: 07 / 2008
State Medicaid Agencies’ Initiatives on Health Information Technology and Health Information Exchange
Sponsoring organization: U.S. Department of Health and Human Services
Assesses state Medicaid agencies’ initiatives on health information technology (HIT) and health information exchange (HIE).
Date: 08 / 2007
State Medicaid Manual, Part 6, Section 6301 and 6302: Payment for Services, Rural Health Clinic Reimbursement
Sponsoring organization: Centers for Medicare and Medicaid Services
Covers Rural Health Clinic (RHC) Medicaid reimbursement, and lists RHC financial intermediaries.
State Profiles of Medicaid and SCHIP in Rural and Urban Areas
Author(s): Jennifer King, Leslie Geiger, Pam Silberman, Rebecca Slifkin
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)
Provides national and state-level data comparing Medicaid enrollment and expenditures in rural and urban counties.
Date: 08 / 2007
Terms & Acronyms
CMS (Centers for Medicare and Medicaid Services) Federal agency responsible for the Medicare and Medicaid programs. Part of the U.S. Department of Health & Human Services.
Critical Access Hospital (CAH) Rural hospital that provides essential services to a community and receives cost-based reimbursement from Medicare. Requirements include a maximum of 25 beds (swing or acute care) and a maximum 96 hour average length of stay for acute care patients.
Federally Qualified Health Center (FQHC) FQHCs include all organizations receiving grants under section 330 of the Public Health Service Act, certain tribal organizations, and FQHC Look-Alikes. FQHCs benefit from enhanced reimbursement from Medicare and Medicaid under the prospective payment system.
Medicaid Federal assistance program that helps pay for medically necessary services for needy and low income individuals. The program uses state and federal funds to compensate medical providers serving these populations.
Medicare Federal health care insurance program for most adults age 65 and older and certain disabled individuals. It pays for long term care under limited circumstances and for limited periods of time.
Prospective Payment System (PPS) Medicare reimbursement method in which rates for services are established in advance, based on the patient's diagnosis.
Rural Health Clinic (RHC) Clinic certified to receive special Medicare and Medicaid reimbursement. RHCs must be located in underserved rural areas and provide primary care services. RHCs use a team approach of physicians, nurse practitioners, physician assistants, and certified nurse midwives to provide services.
