Medicaid Everyone Can Count On Public Choices for Equity and Efficiency

, by Pauly, Mark V.; Grannemann, Thomas W.

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ISBN: 9780844743110 | 0844743119
Cover: Hardcover
Copyright: 3/16/2010

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A Comprehensive policymaker's guide to the Medicaid program, Medicaid Everyone Can Count On: Public Choices for Equity and Efficiency offers unique insights into the complex interactions among stakeholders in America's state-based public health care programs. In an era of national health care reform, this volume is an invaluable resource for federal and state lawmakers and program analysts tasked with crafting policies that balance the distinct needs of taxpayers, providers and the poor.

List of Illustrations	p. xi
Acknowledgments	p. xv
Authors' Note	p. xvii
Introduction	p. 1
Keys to Understanding Medicaid	p. 11
Financing Care for the Poor in a Democracy	p. 13
Medicaid Was Made in America	p. 13
Medicaid Depends on Altruism, Not Solidarity	p. 14
Medicaid Reflects Public Choices	p. 19
Medicaid Is Tied to the U.S. Health Care System	p. 20
Medicaid Spending Is Unequal among States	p. 23
Medicaid's Roles in Our Health Care System	p. 26
Medicaid Is Both Expenditure and Revenue	p. 26
Medicaid's Roles Change Over Time	p. 36
Medicaid Embodies a Set of Implicit Promises	p. 41
Medicaid Promises as a Framework for Enlightened Policymaking	p. 45
Conclusion to Part 1: Fundamental Policy Questions	p. 47
Making and Meeting Promises to the Poor	p. 49
Ensuring Access for the Poor Population	p. 51
Disadvantaged Populations	p. 51
Interstate Equity in Eligibility and Benefits	p. 54
Differences in Benefit Levels among the States	p. 55
Equity, Efficiency, and Recipient Income	p. 67
The Questionable Value of Higher Spending	p. 73
Medicaid and Care Management	p. 76
Managing Benefits	p. 76
Cost-Sharing and Medicaid	p. 82
Acute Care Management	p. 85
Medicaid Managed Care	p. 91
Long-Term Care Management	p. 100
Concluding Note on Care Management	p. 105
Achieving High-Value Care for the Poor	p. 106
Priorities for Care	p. 107
Recommendations for Managing Eligibility and Benefits	p. 109
Conclusion to Part 2: Achieving Access, Control, and Value	p. 119
Making and Meeting Promises to Voter-Taxpayers	p. 121
Medicaid Financing as a Product of Democracy	p. 124
The Median Voter Model of Public Spending	p. 126
Medicaid Budgets	p. 131
Desirable Characteristics of Federal-State Financing	p. 134
Conclusion	p. 137
Medicaid Financing for Taxpayer Equity	p. 139
Redistribution Effects of Medicaid and CHIP	p. 139
Adjusting Federal Matching to Achieve Medicaid Equilibrium	p. 144
Federal-State Financing Options	p. 147
Conclusion	p. 154
Recommendations for Revising Federal Financing	p. 156
Rationale for Changing the Matching-Rate Structure	p. 156
Optimal Matching Rates	p. 157
Categorical Matching Rates	p. 159
Equal-Burden-for-Equal-Benefit Matching	p. 162
Countercyclical Adjustments	p. 172
Expected Effects and Advantages of the Proposed Structure	p. 176
Medicaid Financing for Accountability	p. 177
Supplemental Payments and State Financing Arrangements	p. 177
Questionable Financing Arrangements	p. 178
Program Integrity	p. 189
Conclusion	p. 193
Conclusion to Part 3: A Basic Promise: Protecting Taxpayer Interests in Medicaid	p. 194
Promises to Providers-Payment Policies and Strategies	p. 197
Provider Payment in a Democracy	p. 199
Developing a State Medicaid Provider Payment Strategy	p. 200
Payment Requirements and Objectives	p. 202
Medicaid's Relationships with Providers	p. 204
Medicaid Provider Payment Strategies	p. 209
Conclusion	p. 213
Medicaid Payment for Provider Equity	p. 215
Why States Can Set Medicaid Payment Rates Low	p. 216
Can Medicaid Shift Costs?	p. 218
Achieving an Equitable Distribution of Payments	p. 228
Conclusion	p. 231
Implementing Payment Policy	p. 233
Rate-Setting Methods	p. 233
Provider Payment Issues by Type of Provider	p. 243
Conclusion	p. 249
Gaining Control of Provider Payment	p. 250
Provider Payment for Accountability	p. 250
Recommendations for Reforming Provider Payment Methods	p. 257
Conclusion	p. 267
Conclusion to Part 4: Payment to Shape the Delivery System, of the Future	p. 269
Promises to the Near Poor-CHIP and Fiscal Federalism	p. 271
From SCHIP to CHIP-Eonomics, Politics, and Policy	p. 273
Background	p. 274
Explaining the Unexplainable	p. 277
What to Do and Why	p. 281
Crowd-Out, Take-Up, and Efficiency	p. 284
EBEB Matching and CHIP	p. 287
CHIP Renewal and Expansion in 2009	p. 288
Conclusion to Part 5: Implications of Subsidizing Coverage for the Near Poor	p. 289
Conclusion	p. 291
Key Policy Choices	p. 292
Managing the Policymaking Process	p. 296
What Is Required of Policymakers	p. 308
State Tables	p. 313
Equal-Burden-for-Equal-Benefit Matching Rates	p. 329
Examples Illustrating EBEB Possibilities	p. 331
Notes	p. 347
References	p. 359
Index	p. 371
About the Authors	p. 391
Table of Contents provided by Ingram. All Rights Reserved.

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Medicaid Everyone Can Count On Public Choices for Equity and Efficiency

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