Tools
2011 CMS Statistics
Web site
Contains annual booklets of information about health expenditures and the Centers for Medicare & Medicaid Services' (CMS) programs. Published in June of each year. Covers 2003 through the most currently available complete calendar year.
CMS Contacts
Web site
Provides access to the CMS.gov Contacts Database. Allows for searching by state, region, contact type, and organization.
CMS Regional Office Rural Health Coordinators
Web site
Contains a list of CMS regional rural health coordinators who provide technical, policy, and operational assistance on rural health issues.
CMS Regional Offices
Web site
Provides contact information for the CMS Regional Representatives serving 10 regions across the United States.
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program
Web site
EPSDT is the child health component of Medicaid, which finances pediatric services. Describes how EPSDT works with public health, families, managed care organizations, pediatricians, and other health providers.
Frequently Asked Questions Section 6411(a) of the Affordable Care Act
Web site
Collection of common questions covering general information on the Medicaid RAC (Recovery Audit Contractor) and operational guidance to States.
Integrated Care Resource Center
Web site
Helps States learn about best practices for delivering coordinated health care to Medicaid’s high-need, high-cost beneficiaries. The resource center is a joint technical assistance project of the Centers for Medicare & Medicaid Services (CMS) Medicare-Medicaid Coordination Office and the Center for Medicaid, CHIP, and Survey & Certification (CMCS).
Medicaid & CHIP State Health Facts
Web site
Provides current data about states' Medicaid beneficiaries, including spending, enrollment, demographics (such as age, gender, race/ethnicity), other sources of health coverage, managed care participation, and use of services.
Medicaid Benefits: Online Database
Database
Presents 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.
Medicaid/CHIP
Web site
Presents resources on Medicaid and CHIP. Covers several topics, including children, enrollment, long-term care, managed care, and low-income families.
Medicaid/SCHIP
Web site
Presents modules and tutorials on Medicaid/SCHIP. Topics include Medicaid and the Basics, Children's Coverage and SCHIP, Health Coverage to the Uninsured, and Health Care Reform.
Medicare & Medicaid Statistical Supplement
Web site
Presents annual Medicare and Medicaid Statistical Supplement reports from 2001 to the present. Provides detailed statistical information on Medicare, Medicaid, and other Centers for Medicare & Medicaid Services (CMS) programs.
MedlinePlus: Medicaid
Web site
Presents links to resources, tools and news related to Medicaid.
Monthly Medicaid Enrollment
Web site
Presents data on monthly adult and child Medicaid enrollment and percent changes.
Resources on People Dually Eligible for Medicaid and Medicare
Web site
Presents resources which examine the dual eligible population, their health care needs and spending, and ongoing efforts to coordinate care across the two programs.
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 customization of Medicaid fact sheets by comparing states to the United States or to any other state.
State Medicaid RACs At-A-Glance
Web site
Map summarizes the status of each state and territory Recovery Audit Contractor (RAC) program, based on the information submitted in its Medicaid State Plan Amendment (SPA.) During the implementation phase of these RAC programs, this website will be updated on an ongoing basis.
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.
Regulations, Forms & Other Useful Documents
5 Key Questions About Medicaid And Its Role in State/Federal Budgets and Health Reform
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Highlights key issues about Medicaid, including the structure, financing and purpose of the program, its role for low-income beneficiaries, its share of the federal budget and state budgets, and the significant implications of the coverage expansion under the Affordable Care Act. Mentions rural throughout.
Date: 05 / 2012
Basics: Medicaid Financing
Author(s): Kathryn Linehan
Sponsoring organization: National Health Policy Forum
Provides an overview of Medicaid, the Federal Medical Assistance Percentage formula, matching funds, and Disproportionate Share Hospital (DSH) Payments.
Date: 02 / 2011
CHIP Enrollment: December 2010 Data Snapshot
Sponsoring organization: Kaiser Family Foundation
Reports data on Children's Health Insurance Program (CHIP) enrollment nationally and by state.
Date: 12 / 2011
Costly Dental Destination: Hospital Care Means States Pay Dearly
Sponsoring organization: Pew Charitable Trusts
Discusses dental-related hospital visits which are fueled by the difficulty that disadvantaged people have getting regular preventive care from dentists and other types of providers. Discusses access to preventive care, Medicaid-enrolled children who do not receive dental care—not even a routine exam, a shortage of dentists in many areas of the U.S., and the fact that many dentists do not accept Medicaid-enrolled children.
Date: 02 / 2012
Driving Value in Medicaid Primary Care: The Role of Shared Support Networks for Physician Practices
Author(s): Nikki Highsmith, Julia Berenson
Sponsoring organization: Center for Health Care Strategies
Explores strategies for providing shared resources to small, under-resourced physician practices that serve a high volume of Medicaid patients.
Date: 03 / 2011
Enhanced Primary Care Case Management Programs in Medicaid: Issues and Options for States
Author(s): James M. Verdier, Vivian Byrd, Christal Stone
Sponsoring organization: Center for Health Care Strategies
Examines how five states have developed and implemented enhanced primary care case management (PCCM) programs - mostly in rural areas - building on an in-depth evaluation completed by the Mathematica Policy Research, Inc.
Date: 09 / 2009
Ensuring Access to Care in Medicaid Under Health Reform
Sponsoring organization: Kaiser Family Foundation
Examines the key issues raised in a December 2010 roundtable discussion of federal and state officials and experts convened by the Kaiser Commission on Medicaid and the Uninsured to examine important issues related to ensuring access to care in Medicaid under the Patient Protection and Affordable Care Act (ACA).
Date: 05 / 2011
Explaining Health Care Reform: What is Medicaid?
Sponsoring organization: Kaiser Family Foundation
Explains how Medicaid works both now and with health reform efforts.
Date: 06 / 2009
Explaining Health Reform: Benefits and Cost-Sharing for Adult Medicaid Beneficiaries
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides details of the benefit and cost-sharing rules that will govern the coverage available to newly eligible adults Medicaid beneficiaries. These rules include the care provided by rural health clinics and federally qualified health centers.
Date: 08 / 2010
Health Centers and Health Care Reform: Public Insurance Programs
Sponsoring organization: National Association of Community Health Centers
Describes the expansion of Medicaid, the expansion of Medicare reimbursement rates, and the maintenance of the Children's Health Insurance Program (CHIP) income eligibility levels as dictated in the Patient Protection and Affordable Care Act (PPACA).
Date: 04 / 2010
Health Centers and Medicaid
Sponsoring organization: National Association of Community Health Centers
Discusses how both Medicaid and Community Health Centers work to improve access for the medically underserved.
Date: 09 / 2011
Health Reform: What's in It?: Medicaid and Rural America
Author(s): Jon Bailey
Sponsoring organization: Center for Rural Affairs
Explains the different Medicaid programs and their importance to rural citizens. Describes Medicaid expansion under the Affordable Care Act.
Date: 02 / 2012
Key Questions About Medicaid and Its Role in State/Federal Budgets and Health Reform
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Presents several FAQs regarding Medicaid, what it does, its cost, state and federal budgets, and health reform. Discusses urban and rural communities.
Date: 01 / 2011
Medicaid and CHIP Health Reform Implementation Timeline
Sponsoring organization: Kaiser Family Foundation
Highlights the implementation dates for provisions in the new health reform law that are related to Medicaid and the Children's Health Insurance Program.
Date: 04 / 2010
Medicaid and HIV: A National Analysis
Sponsoring organization: Kaiser Family Foundation
Analyzes national enrollment and spending patterns for Medicaid enrollees with HIV. Looks at demographics, Medicaid eligibility pathways, services, and geographic distribution.
Date: 10 / 2011
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 Rural Health Panel
Presents an 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 and Supports
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides an overview of long-term care services, delivery of such services, and the large role Medicaid plays in financing long-term care.
Date: 03 / 2011
Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL (Executive Summary)
Author(s): John Holahan, Irene Headen
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Analysis, performed by the Urban Institute, shows that the expansion of Medicaid under the health reform law will significantly increase the number of people covered by the program and reduce the uninsured in states across the country, with the federal government picking up the vast majority of the cost. Explains the impact on all 50 states and the District of Columbia, and the distribution of new Medicaid enrollees and costs.
Date: 05 / 2010
Medicaid Enrollment: December 2010 Data Snapshot
Sponsoring organization: Kaiser Family Foundation
Shows enrollment in Medicaid programs nationally is 51.5 million. Discusses factors including economic changes, uninsured children, policy changes, and eligibility.
Date: 12 / 2011
Medicaid Matters: Understanding Medicaid’s Role in Our Health Care System
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides key information about the Medicaid program and its role in the health care system and state economies.
Date: 03 / 2011
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: 06 / 2010
Medicaid Reform: A Rural Perspective
Author(s): Jonathan Sprague, Gail Bellamy, Rebecca Slifkin, Pam Silberman
Sponsoring organization: National Rural Health Association
Describes 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's Role for Dual Eligible Beneficiaries
Author(s): Katherine Young, Rachel Garfield, MaryBeth Musumeci, Lisa Clemans-Cope, Emily Lawton
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines the role of Medicaid in providing health coverage to the 9 million Medicare beneficiaries who are also eligible for Medicaid. Explains how Medicare beneficiaries become eligible for Medicaid, provides national and state-by-state data on enrollment, and examines national and state-specific data on Medicaid spending for dual-eligible beneficiaries by service and eligibility group.
Date: 04 / 2012
Medicaid-Funded Long-Term Care: Toward More Home- and Community-Based Options
Author(s): Gretchen Engquist, Cyndy Johnson, Alice Lind, Lindsay Palmer Barnette,
Sponsoring organization: Center for Health Care Strategies
Outlines initial federal policy suggestions for reforming the nation’s Medicaid-funded LTSS system.
Date: 05 / 2010
Medicaid-Funded Long-Term Supports and Services: Snapshots of Innovation
Author(s): Gretchen Engquist, Cyndy Johnson, William Courtland Johnson
Sponsoring organization: Center for Health Care Strategies
Identifies high-quality and cost-effective strategies for urban and rural areas when addressing the full range of clinical and long-term supports and services (LTSS) needs of Medicaid beneficiaries.
Date: 05 / 2010
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: 06 / 2010
Medicaid’s New “Health Home” Option
Sponsoring organization: Kaiser Family Foundation
Provides key information about the new option for state Medicaid programs to provide "health home" services for enrollees with chronic conditions.
Date: 01 / 2011
Medicare and Medicaid Programs; Electronic Health Record Incentive Program (Final Rule)
Sponsoring organization: Centers for Medicare and Medicaid Services
Includes the final rule which implements the provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) (Pub. L. 111-5). This ruling provides incentive payments to eligible professionals, hospitals, and critical access hospitals (CAHs) participating in Medicare and Medicaid programs that adopt and successfully demonstrate meaningful use of certified electronic health record (EHR) technology.
Date: 07 / 2010
Medicare and Medicaid Programs; Electronic Health Record Incentive Program: Stage 2
Sponsoring organization: Centers for Medicare and Medicaid Services
Federal Register edition describes the proposed rule, which specifies Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments.
Date: 03 / 2012
National Health Expenditure Projections: 2010-2020
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents an analysis of projected national health care expenditures (NHE) through 2020. Updated annually.
Date: 01 / 2011
Patient Protection and Affordable Care Act
Sponsoring organization: U.S. Government Printing Office
Includes the entire text of the 2010 health care reform law - The Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act (ACA).
Date: 01 / 2010
Patient Protection and Affordable Care Act - Positive Steps for Rural
Sponsoring organization: National Rural Health Association
Examines the provisions in the Patient Protection and Affordable Care Act, and the subsequent Reconciliation Package that contains building blocks to improve the access to health care crisis faced by rural patients. Improvements include provisions to help resolve the workforce shortage crisis in rural areas and to eliminate long-standing payment inequities for rural providers.
Date: 04 / 2010
Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
Author(s): Andrew F. Coburn, Jennifer P. Lundblad, A. Clinton MacKinney, Timothy D. McBride, Keith J. Mueller
Sponsoring organization: Rural Policy Research Institute Rural Health Panel
Summarizes six issue areas of the Affordable Care Act (ACA) and discusses implications for access to services and improving the health status of rural residents. These issue areas are: health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
Date: 09 / 2010
Payment Reform: Creating a Sustainable Future for Medicaid
Author(s): Deborah Bachrach
Sponsoring organization: Center for Health Care Strategies
Discusses how Medicaid payment policies may be the most significant lever available to states to contain costs and improve quality. Includes discussion on FQHCs and RHCs.
Date: 05 / 2010
Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-sharing Policies in Medicaid and CHIP, 2011-2012.
Author(s): Martha Heberlein, Samantha Artiga, Jessica Stephens
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Provides results from a 50-state survey of eligibility, enrollment, renewal, and cost-sharing policies in Medicaid and CHIP. Data identify changes implemented during 2011 and present policies in place for children, pregnant women, parents, and other non-disabled adults. Includes rural information.
Date: 01 / 2012
Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey
Author(s): Kathleen Gifford, Vernon Smith, Kyke Snipes, Julia Paradise
Sponsoring organization: Kaiser Family Foundation
Provides a comprehensive look at state Medicaid managed care programs, documenting their diversity, examining how states monitor access and quality, and exploring emerging efforts to improve care, including managed long-term care and initiatives targeted toward dual eligibles.
Date: 09 / 2011
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: 10 / 2010
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.
Strengthening Primary Care to Bend the Cost Curve: The Expansion of Community Health Centers Through Health Reform
Author(s): Leighton Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara Rosenbaum
Sponsoring organization: George Washington University Department of Health Policy
Examines the impact of the Patient Protection and Affordable Care Act (PPACA) on the number of patients who will receive primary care services at community health centers and the effect of the service expansions on overall health care costs, including federal and state Medicaid expenditures.
Date: 06 / 2010
Systems of Care: Environmental Scan of Medicaid-Funded Long-Term Supports and Services
Author(s): Gretchen Engquist, Cyndy Johnson, William Courtland Johnson
Sponsoring organization: Center for Health Care Strategies
Provides an overview of the current status of the publicly funded long-term care delivery system and promote an enhanced understanding of the opportunities and obstacles for LTSS reform and re-balancing.
Date: 05 / 2010
Timeline for Health Care Reform Implementation: Health Insurance Provisions
Sponsoring organization: Commonwealth Fund
Presents a timeline, which outlines when the various health insurance provisions will go into effect, from 2010 - 2018.
Date: 04 / 2010
Uninsured: A Primer - Key Facts About Americans Without Health Insurance
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Reviews the basic profile of the uninsured population, how they receive care, the latest trends in health insurance coverage, and what the options are for increasing coverage. Includes Supplemental Data Tables.
Date: 10 / 2011
Where are States Today: Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults
Sponsoring organization: Kaiser Family Foundation
Provides an overview of Medicaid, CHIP, and state‐funded coverage eligibility levels for non‐disabled children and adults and how this coverage will be impacted by reform in 2014.
Date: 03 / 2012
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.
Dual Eligibles Individuals who are entitled to Medicare and eligible for some level of assistance from their state Medicaid program. They are among the sickest and poorest individuals covered by Medicare or Medicaid and are very low-income individuals.
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.
Medicare Conditions of Participation (CoP) CMS conditions that health care organizations must meet to participate in the Medicare and Medicaid programs. Used to improve quality and protect the health and safety of beneficiaries.
Medicare Prospective Payment System (PPS) Medicare reimbursement method in which rates for services are established in advance, based on the patient's diagnosis.
Private Pay Patients Patients who pay for their own care or whose care is paid for by their family or another private third party, such as an insurance company. The term is used to distinguish patients from those whose care is paid for by governmental programs (Medicaid, Medicare, and Veterans Administration).
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. Payment is based on a cost-related basis for outpatient physician and certain nonphysician services.
SCHIP (State Children's Health Insurance Program) A State and Federal partnership to help children without health insurance, many of whom come from working families with incomes too high to qualify for Medicaid but too low to afford private health insurance.
