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Medicaid is the federal assistance health insurance program that covers health and long-term services for needy and low income individuals. The program uses state and federal funds to compensate medical providers serving these populations. States design and administer their own programs within federal rules. The Medicaid program serves nearly 60 million people with services totaling $339 billion in fiscal year 2008.

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.

Sources

Medicaid in 2006: A Trip Down the Yellow Brick Road?, National Health Policy Forum, 2006; Medicaid and Its Importance to Rural Health, Rural Policy Research Institute, 2006; The Medicaid Program at a Glance, Kaiser, 2010.

Related Guides

Frequently Asked Questions

 

Tools

2011 CMS Statistics
Web site
Contains annual booklets of information about health expenditures and the Centers for Medicare & Medicaid Services' (CMS) programs. Booklets cover years from 2003 through 2011.
Sponsoring organization: U.S. Department of Health and Human Services

2011 Medicare Health and Drug Plans by State
Web site
Presents a page for each state containing fast facts, important dates, number of plans, and data regarding plan costs and coverage.
Sponsoring organization: Centers for Medicare and Medicaid Services

CMS Contacts
Web site
Provides access to the CMS.gov Contacts Database. Allows for searching by state, region, contact type, and organization.
Sponsoring organization: Centers for Medicare and Medicaid Services

CMS Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs
Web site
Provides information about the Electronic Health Record (EHR) incentive programs (HITECH programs) offered by Centers for Medicare and Medicaid Services. Includes the definition of "Meaningful Use" that outlines the requirements needed to receive EHR incentive payments.
Sponsoring organization: Centers for Medicare and Medicaid Services

CMS Regional Offices
Web site
Provides contact information for the CMS Regional Representatives serving 10 regions across the United States.
Sponsoring organization: Centers for Medicare and Medicaid Services

Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program
Web site
Discusses EPSDT, 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.
Sponsoring organization: Health Resources and Services Administration

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.
Sponsoring organization: Centers for Medicare and Medicaid Services

Health IT - Meaningful Use Resources
Web site
Resource devoted to helping hospital leaders better understand the Medicare and Medicaid electronic health records incentive programs and their associated "meaningful use" requirements.
Sponsoring organization: American Hospital Association

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).
Sponsoring organization: Centers for Medicare and Medicaid Services

List of CMS Regional Office and Other External Entity Contacts
Web site
Lists regional contacts for reaching experts on the HITECH (Health Information Technology for Economic and Clinical Health) Act.
Sponsoring organization: Centers for Medicare and Medicaid Services

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.
Sponsoring organization: Kaiser Family Foundation

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.
Sponsoring organization: Kaiser Family Foundation

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.
Sponsoring organization: Kaiser Family Foundation

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.
Sponsoring organization: Kaiser Family Foundation

MedlinePlus: Medicaid
Web site
Presents links to resources, tools and news related to Medicaid.
Sponsoring organization: National Library of Medicine

Monthly Medicaid Enrollment
Web site
Presents data, as of June 2010, on monthly adult and child Medicaid enrollment and percent changes.
Sponsoring organization: Kaiser Family Foundation

Research Data Assistance Center
Research instrument
A Centers for Medicare and Medicaid Services (CMS) contractor that provides free assistance to academic, government and non-profit researchers interested in using Medicare and/or Medicaid data for their research.
Sponsoring organization: University of Minnesota

Rural Health Clinics Center
Web site
Provides links to manuals, billing codes, enrollment and certification information, legislation, regulations, and contacts related to Medicare and Medicaid services in the rural health clinics.
Sponsoring organization: Centers for Medicare and Medicaid Services

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 customization of Medicaid fact sheets by comparing states to the United States or to any other state.
Sponsoring organization: Kaiser Family Foundation

State Medicaid RACs At-A-Glance
Web site
Map summarizes the status of each state and territory 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.
Sponsoring organization: Centers for Medicare and Medicaid Services

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

Iowa Home and Community Based Services Rent Subsidy Program
A rent subsidy program to aid people receive services under a federal Medicaid waiver program called home and community-based service (HCBS) and who are at risk of nursing facility placement.

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

2011 Physician Fee Schedule
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents a corrected Relative Value Unit (RVU) for 2011 that incorporates the changes included in the Medicare and Medicaid Extenders Act of 2010 that was signed into law by President Obama on December 15, 2010.
Date: 12 / 2010

Aging Out of Medicaid: What Is the Risk of Becoming Uninsured?
Author(s): Karyn Schwartz, Anthony Damico
Sponsoring organization: Kaiser Family Foundation
Examines data from 2003 to 2007 that demonstrate the challenges young adults face in finding and keeping coverage once they turn 19.
Date: 03 / 2010

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

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
Estimates that 49 million Americans were uninsured in 2009 and analyzes several options of expanding 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
Presents the results from a 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

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

Explaining Health Reform: Eligibility and Enrollment Processes For Medicaid, CHIP, and Subsidies in the Exchanges
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Summarizes key requirements that states face under health reform to construct coordinated and consumer-friendly enrollment systems that help people understand their coverage options, and that use electronic data-matching and online processes to minimize the burdens of application and renewal, create a “no wrong door” system, ensure that people obtain the appropriate coverage, and support seamless transitions between Medicaid, CHIP, and subsidized coverage in the Exchanges.
Date: 08 / 2010

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 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 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
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

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: 09 / 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 Beneficiaries and Access to Care
Sponsoring organization: Kaiser Family Foundation
Summarizes Medicaid beneficiaries' experience in obtaining access to care, a subject that is of keen interest in view of the planned expansion of the program.
Date: 04 / 2010

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 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
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 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-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 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

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

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

National Health Expenditure Projections 2009-2019
Sponsoring organization: Centers for Medicare and Medicaid Services
Presents an analysis of projected national health care expenditures (NHE) through 2019.
Date: 02 / 2010

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

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
Provides actionable steps to help states design and implement physician-level P4P strategies.
Date: 03 / 2007

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

Realizing Health Reform's Potential: Maintaining Coverage, Affordability, and Shared Responsibility When Income and Employment Change
Author(s): Pamela Farley Short, Katherine Swartz, Namrata Uberoi, Deborah Graffe
Sponsoring organization: Commonwealth Fund
Describes four policy challenges related to the Affordable Care Act's (ACA) health insurance exchanges and subsidies: adjusting premium and cost-sharing subsidies when incomes change; coordinating eligibility for premium credits, Medicaid, and the Children’s Health Insurance Program (CHIP); encouraging and facilitating continuous coverage; and minimizing transitions between individual and small-business exchanges.
Date: 05 / 2011

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 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 Agencies Prepare for Health Care Reform While Continuing to Face Challenges from the Recession
Sponsoring organization: Kaiser Commission on Medicaid and the Uninsured
Examines how Medicaid agencies are preparing for a lead role in implementing health reform while continuing to deal with the impact of the recession.
Date: 08 / 2010

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

State Roles in Delivery System Reform
Sponsoring organization: National Governor's Association
Outlines the evidence in health system reforms, and the opportunities for governors to lead these efforts. Provides tools and levers available to states to create a more efficient and effective health care system in both rural and urban environments and in accordance with the Affordable Care Act.
Date: 2010

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.
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

Journals

Medicare & Medicaid Research Review (MMRR)
Peer-reviewed, online journal reporting data and research that informs current and future directions of the Medicare, Medicaid, and Children's Health Insurance programs. The journal seeks to examine and evaluate health care coverage, quality and access to care for beneficiaries, and payment for health services. Sponsoring organization: Centers for Medicare and Medicaid Services

Organizations

Centers for Medicare and Medicaid Services (CMS)
Federal government
Operates the Medicare and Medicaid programs - two national health care programs that benefit millions of Americans. Part of the U.S. Department of Health and Human Services. Website includes access to research, statistics and data related to their programs.

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.

Medicaid and CHIP Payment and Access Commission (MEDPAC)
Federal government
A non-partisan congressional agency that advises the U.S. Congress on Medicaid and CHIP (Children's Health Insurance Program) policy, including issues on payment, access to care, and health care reform. Includes statistical reports.

National Association of Medicaid Directors (NAMD)
National organization
Represents and supports the Medicaid Directors in all 50 states, territories and the District of Columbia.

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. Staffed by a consortium of epidemiologists, public health specialists, health services researchers, biostatisticians, and health informatics specialists from the University of Minnesota.

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.

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.

Contacts

For technical, policy, and operational assistance on rural health issues including CMS regulations
CMS Regional Rural Representatives

Article Searches & Bibliographies

RAC Documents Search: Medicaid

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Page last updated 2/2/2012
Topic last reviewed 3/7/2011

News
Feb 2, 2012 -- Medicaid Program; Covered Outpatient Drugs

Feb 1, 2012 -- Transportation Service for Medicaid Enrollees Surpasses 857,000 Rides in First Six Months

Jan 30, 2012 -- Affordable Care Act Will Save States and Taxpayers $17.7 Billion on Prescription Drugs

Jan 18, 2012 -- Medicaid Program; Disproportionate Share Hospital Payments - Uninsured Definition

Jan 12, 2012 -- Electronic Banking Could Save Health System $4.5 Billion

Jan 10, 2012 -- Growth in U.S. Health Spending Remains Slow in 2010

Jan 5, 2012 -- Medicaid Squeeze Could Squeeze Some Rural Hospitals to Death

Jan 4, 2012 -- CMS's Proposed Hospital Staffing Revisions Get Cool Reception

Jan 4, 2012 -- Medicaid Program: Initial Core Set of Health Care Quality Measures for Medicaid-Eligible Adults

Jan 4, 2012 -- Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical Center Payment; Hospital Value-Based Purchasing Program; Physician Self-Referral; and Patient Notification Requirements in Provider Agreements; Corrections

Jan 4, 2012 -- HHS Releases Final Medicaid Quality Measures

Dec 29, 2011 -- Connecticut Drops Insurers from Medicaid

Dec 22, 2011 -- Federal Health Reform Comes to Rural Counties

Dec 16, 2011 -- Medicare and Medicaid Programs; Quarterly Listing of Program Issuances - July Through September 2011

Dec 16, 2011 -- Medicare Program; First Semi-Annual Meeting of the Advisory Panel on Hospital Outpatient Payment (HOP - Formerly Known as the Advisory Panel on Ambulatory Payment Classification Groups - APC Panel)-February 27, 28, and 29, 2012

Dec 15, 2011 -- Physician Assistants Look to Expand EHR Incentive Eligibility

Dec 12, 2011 -- Next CMS Webinar on Health Care Innovation Challenge Tuesday

Events
Feb 9, 2012
Simplified But Not Simple: Tackling Health Reform's Eligibility and Enrollment Challenge
National Academy for State Health Policy
2:30 - 4:00 PM Eastern
Webinar
Contact:
  Amanda Richardson


Feb 14, 2012
Medicare Program; Town Hall Meeting on FY 2013 Applications for New Medical Services and Technology Add-On Payments Under the Hospital Inpatient Prospective Payment System
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
Baltimore, MD
Contact:
  Michael Treitel
  410.786.4552
  michael.treitel@cms.hhs.gov


Mar 22, 2012
THE Consortium: Medicare Fraud & Abuse Plan Updates Post-EHR
Colorado Rural Health Center
12:00 PM Mountain
Webinar

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Funding for this project was supported by Grant Number U56RH05539 from the Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services. The contents of this website are solely the responsibility of the authors and do not necessarily represent the official views of the funder.