Regulations, Forms & Other Useful Documents
2006 CMS Statistics
Sponsoring organization: Centers for Medicare & Medicaid Services
Summary information about health expenditures and Centers for Medicare & Medicaid Services (CMS)
programs. Includes data on populations served by Medicare and Medicaid, Medicare providers, and expenditures.
Date: 2006
Enrolling Children in Medicaid and SCHIP: Insights from Focus Groups with Low-Income Parents
Author(s): Michael Perry, Julia Paradise
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Explores low-income parents’ knowledge of Medicaid and SCHIP, their interest in enrolling their children, and the factors that pose barriers to their participation.
Date: 05 / 2007
Enrolling Uninsured Low-Income Children in Medicaid and SCHIP
Sponsoring organization: Kaiser Family Foundation
Outlines issues in outreach and enrollment for Medicaid and SCHIP. Provides a profile of eligible but uninsured children, discusses the greatest barriers to enrollment, and offers strategies to improve enrollment.
Date: 01 / 2007
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
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
Impact of Part D on Dual Eligibles Who Spend-Down to Medicaid
Author(s): Barbara Coulter Edwards, Sandy Kramer, Linda Elam
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Explores the inter-relationship of Medicare prescription drug coverage and Medicaid spend-down for the medically needy.
Date: 04 / 2007
Initial Assessment of the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients
Author(s): Peter Shin, Brad Finnegan, Lauren Hughes, Sara Rosenbaum
Sponsoring organization: George Washington Department of Health Policy
Presents information on the documentation requirements for Medicaid applicants and recipients that makes them document both their citizenship or legal U.S. residence and proof of their personal identity. These requirements have caused a nationwide disruption in coverage for health center patients.
Date: 05 / 2007
Low Medicaid Spending Growth Amid Rebounding State Revenues: Results from a 50-State Medicaid Budget Survey State Fiscal Years 2006 and 2007
Author(s): Vernon Smith, Kathleen Gifford, Eileen Ellis, Amy Wiles
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Presents findings from a survey (of Medicaid officials from all 50 states and the District of Columbia) about changes in Medicaid spending, enrollment and policies for state fiscal years 2006 and 2007.
Date: 10 / 2006
Medicaid 1915(c) Home and Community-Based Service Programs: Data Update
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last two decades and the focus of Medicaid policy debates recently. While the majority of Medicaid long-term care dollars go toward institutional care, the national percentage of Medicaid spending on HCBS has more than doubled from 1992 to 2003.
Date: 12 / 2006
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 and Long-Term Care Services
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Medicaid is the nation's major source of financing for long-term care services, covering services for both elderly and non-elderly persons in institutional settings and in homes and other community-based settings.
Date: 07 / 2006
Medicaid At-a-Glance, 2005: A Medicaid Information Source
Sponsoring organization: Centers for Medicare & Medicaid Services
Provides general information regarding the Medicaid program's eligibility groups, mandatory state plan services, Federal poverty level charts, and a chart which details the optional state plan services that states have elected to include under their plans and managed care waivers.
Medicaid Enrollment and Spending Trends
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Discusses Medicaid spending growth. From 2000 to 2004, Medicaid spending growth adjusted to
changes in the overall economy and rose by 12% annually between 2000 and 2002, and then slowed to 7.6% from 2002 to 2004 as the economy improved following the 2001 recession.
Date: 05 / 2006
Medicaid Enrollment in 50 States
Author(s): Eileen R. Ellis, Vernon K. Smith
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Focuses on national trends in Medicaid enrollment as well as trends by state and by category of enrollment.
Date: 12 / 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: 03 / 2006
Medicaid Program at a Glance, Fact Sheet
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides an overview of Medicaid. Discusses who is covered by Medicaid and describes the services that Medicaid covers. Medicaid is the nation's major public health insurance program for low-income Americans, financing health and long-term care services for over 55 million people, including children and many of the sickest and poorest in our nation.
Date: 03 / 2007
Medicaid Third-Party Liability: Federal Guidance Needed to Help States Address Continuing Problems
Sponsoring organization: Government Accountability Office
On the basis of self-reported health coverage information from the Census Bureau's annual Current Population Surveys covering the 2002 through 2004 time period, an average of 13 percent of respondents who reported having Medicaid coverage for the entire year also reported having private health coverage at some time during the same year.
Date: 09 / 2006
Medicaid's Long-Term Care Beneficiaries: An Analysis of Spending Patterns
Author(s): Anna Sommers, Mindy Cohen, Molly O'Malley
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Includes an Executive Summary and an Issue Brief. This analysis of spending patterns of Medicaid's long-term care users (LTC) reveals that the 7% of Medicaid beneficiaries using LTC account for over half (52%) of all Medicaid spending. Medicaid's LTC users not only use LTC services, but they also use the program's acute care services more intensively than non-LTC users.
Date: 11 / 2006
Medicaid's Role for Women
Sponsoring organization: Kaiser Family Foundation
Discusses significant changes to the Medicaid program which could reshape coverage for nearly 19 million women who rely on the program. Focuses on recent federal and state policies, including the federal Deficit Reduction Act and state waiver programs, and their impact on low-income women, who make up approximately 70% of Medicaid's adult beneficiaries.
Date: 10 / 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: 03 / 2007
New Requirements for Citizenship Documentation in Medicaid
Sponsoring organization: Kaiser Family Foundation
Provides information on the new federal requirement that all U.S. citizens and nationals applying for or renewing their Medicaid coverage provide documentation of their citizenship status and examines the implications for Medicaid beneficiaries and the states.
Date: 03 / 2007
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
Profiles of Medicaid's High Cost Populations
Author(s): Jeffrey S. Crowley, Molly O'Malley
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines the role that Medicaid plays in addressing six populations (preterm birth babies, foster care children, individuals with spinal cord and traumatic brain injuries, individuals with mental illness, individuals with intellectual and developmental disabilities, and people with Alzheimer's disease) with serious health needs resulting in high costs.
Date: 12 / 2006
Profiles of Nursing Home Residents on Medicaid
Author(s): Claudia Williams, James Rosen, Molly O'Malley
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
According to a recent industry survey, the average cost of a private nursing home bed in the U.S. was just over $6,000 a month in 2005. This high cost makes nursing home services affordable for only the wealthiest Americans or those with private long-term care insurance. Medicaid, a federal and state funded health care program, covers nursing home care for low-income elderly or disabled individuals who meet income and asset standards.
Date: 07 / 2006
State Fiscal Conditions and Medicaid
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Summarizes the relationship of Medicaid with state budgets and updates the current fiscal situation in the states and how it is affecting Medicaid programs.
Date: 11 / 2007
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 & 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
Understanding the Recent Changes in Medicaid Spending and Enrollment Growth Between 2000-2004
Author(s): John Holahan, Mindy Cohen
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Analyzes Medicaid enrollment and spending trends for the years 2000-2004. Rising enrollment and health care inflation produced most of Medicaid's spending increases during the period. Even with a stronger economy, however, Medicaid's enrollment pressures remain due to demographic trends and continued declines in employer sponsored insurance.
Date: 05 / 2006
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.
