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Related Guides on this Topic

You may also want to see these guides on related topics: Medicare and Medicare Part D Prescription Drug Benefit

Introduction

Medicaid is the 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. The Medicaid program serves an estimated 52 million individuals with a combined state and federal price tag of over $320 billion in fiscal year 2005.

In rural America, changes in Medicaid policy will have implications for people, health care providers, and communities. Medicaid is a critical source of insurance coverage in rural America, filling gaps in both Medicare coverage and the availability of private insurance. Health care providers, especially those who serve large percentages of Medicaid patients, rely on Medicaid payments to cover the costs of treating those patients. Federal and state Medicaid dollars also contribute to rural economic development by generating health care jobs and other businesses and services.

Source: Medicaid in 2006: A Trip Down the Yellow Brick Road?, National Health Policy Forum, 2006 and Medicaid and Its Importance to Rural Health, Rural Policy Research Institute, 2006.

Frequently Asked Questions

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.
Sponsoring organization: Centers for Medicare & Medicaid Services

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.
Sponsoring organization: Health Resources and Services Administration

Home & Community Based Services
Web site
Assists states in improving the overall quality of services provided to Medicaid recipients, provides states with experience in quality assessment and improvement systems, and helps develop effective methods to utilize quality 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.
Sponsoring organization: Centers for Medicare & Medicaid Services

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.
Sponsoring organization: Kaiser Family Foundation

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 and by benefit. Lists coverage for various services, including dental.
Sponsoring organization: Kaiser Family Foundation

Medicare and Medicaid at 40
Web site
Resources that examine how Medicare and Medicaid came into existence and how they have evolved over the past 40 years. Includes documentaries and extended interviews with key policymakers and government officials examining the origins of Medicare and Medicaid, new interactive historical timelines, and a chart pack of key information and statistics.
Sponsoring organization: Kaiser Family Foundation

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.
Sponsoring organization: Rural Health Research Gateway

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.
Sponsoring organization: Kaiser Family Foundation

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.
Sponsoring organization: North Carolina Rural Health Research and Policy Analysis Center (Cecil G. Sheps Center)

Funding


Inactive Funding

Inactive Funding Opportunities - Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.

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

Journals

Health Care Financing Review
Seeks to contribute to an improved understanding of the Medicare and Medicaid programs and the U.S. health care system by presenting information and analyses on a broad range of health care financing and delivery issues. Sponsoring organization: Centers for Medicare & Medicaid Services

Organizations

Centers for Medicare & Medicaid Services (CMS)
Federal government
Runs the Medicare and Medicaid programs - two national health care programs that benefit about 75 million Americans. Part of the U.S. Department of Health and Human Services.

Kaiser Commission on Medicaid and the Uninsured
Nonprofit/Foundation
Provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured.

National Association of State Medicaid Directors (NASMD)
National organization
A bipartisan, professional, nonprofit organization of representatives of state Medicaid agencies (including the District of Columbia and the territories). Since 1979, NASMD has been affiliated with the American Public Human Services Association (APHSA).

Research Data Assistance Center (ResDAC)
Federal government
Provides free assistance to academic and non-profit researchers interested in using Medicare, Medicaid, SCHIP, and Medicare Current Beneficiary Survey (MCBS) data for research.

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.

Contacts

For questions about CMS regulations:
CMS Regional Rural Representatives

Article Searches & Bibliographies

RAC Documents Search: Medicaid

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Page last updated 5/14/2008
Topic last reviewed 8/13/2007

News
May 6, 2008 -- Changes for Long-Term Care Hospitals Required by Certain Provisions of the Medicare, Medicaid, SCHIP Extension Act of 2007: 3-Year Delay in the Application of Payment Adjustments for Short Stay Outliers and Changes to the Standard Federal Rate

May 5, 2008 -- Department of Health and Human Services; Notice of Semiannual Regulatory Agenda

Apr 30, 2008 -- Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician; Self-Referral Rules; Comment Request

Apr 25, 2008 -- Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2009; Proposed Rule; Comment Request

Apr 24, 2008 -- Important NPI Information for ALL Providers – Medicare and Non-Medicare

Apr 23, 2008 -- President Poised to Veto Medicaid Bill

Apr 22, 2008 -- CMS Funds 20 States to Help Medicaid Patients Escape the Need for Emergency Room Services

Apr 17, 2008 -- Medicare Program; Modification to the Weighting Methodology Used to Calculate the Low-Income Benchmark Amount; Correction of Final Rule

Apr 15, 2008 -- OIG Refines Self-Disclosure Protocol

Apr 11, 2008 -- MedPAC Recommendations Would Improve Hospital-based SNF Funding

Apr 4, 2008 -- Medicaid Program: Home and Community-Based State Plan Services; Proposed Rule

Apr 1, 2008 -- Thousands More Medicaid Enrollees Could Get Home and Community-Based Care Under New Rule

Apr 1, 2008 -- Medicare and Medicaid Programs; Quarterly Listing of Program Issuances--October Through December 2007

Mar 28, 2008 -- Medicare and Medicaid Programs; Approval of the Joint Commission for Continued Deeming Authority for Home Health Agencies; Final Notice

Mar 28, 2008 -- Medicare and Medicaid Programs; Approval of the Community Health Accreditation Program for Continued Deeming Authority for Home Health Agencies; Final Notice

Mar 26, 2008 -- Medicare and State Health Care Programs: Fraud and Abuse; Issuance of Advisory Opinions by OIG; Interim Final Rule with Comment Period

Mar 24, 2008 -- Study: Physicians Drop Medicaid Patients When Practice Income Drops

Events
May 28, 2008
2008 Physician Quality Reporting Initiative (PQRI) National Provider Conference Call with Question & Answer Session
Centers for Medicare & Medicaid Services
3:30 p.m. – 5:00 p.m., EDT To register for the call participants need to go to: http://www2.eventsvc.com/palmettogba/052808
Registration will close at 3:30 p.m. EDT on May 27, 2008, or when available space has been filled.
Conference Call Only

About this Page
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Developed by:
Holly Gabriel
holly@raconline.org

Contributors:
Michelle Goodman and Caroline Cochran, Office of Rural Health Policy



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