Medicaid and Medicare Disproportionate Share Hospital programs
Congress created the Disproportionate Share Hospital (DSH) program in the early 1980s to help hospitals offset the costs of providing care to low-income individuals. Medicaid and Medicare each have a distinct DSH program, with a unique structure and financing mechanism. In addition to giving a brief overview of the Medicaid and Medicare Disproportionate Share Hospital programs, this document will: Discuss …
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An introduction to health care payment reform: Research foundations, implementation, operational strengths and challenges
Policymakers across the country are currently engaged in discussions on how to improve the way that health care providers are paid for the services they deliver. These discussions involve how to shift payment systems away from traditional fee for services and toward rewarding providers that achieve excellent outcomes and deliver value to their patients. While both private and public payers …
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Emerging health insurance products in an era of health reform
At least in part in response to the health coverage changes of the Affordable Care Act (ACA), many health plans are making significant changes to products that they plan to offer in the employer and individual market. While insurers were already moving away from paying for volume and toward paying for value prior to health reform, the ACA has been …
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Employee cost-sharing for health insurance in Michigan and the United States
This brief reports on trends in health insurance premiums and cost-sharing among private-sector employers in Michigan and the United States from 2002 to 2012, and provides a focused look at high-deductible health plans by employer size. From 2002 through 2012, average total premiums in the United States increased by approximately 80 percent. While employer cost-control efforts in the 1990s could …
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Private health insurance in Michigan and the U.S.: Declines in employer-sponsored insurance
More than 500,000 people in Michigan lost their private health insurance from 2008 to 2011. The primary reason for the decline in private insurance in Michigan and in the nation was the erosion of employer-sponsored insurance (ESI), the most common way that Americans get private coverage. From 1999 to 2011, the proportion of individuals covered by ESI decreased by approximately …
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Federally qualified health centers: Are they effective?
In 1964, the Office of Economic Opportunity established federally qualified health centers (FQHCs), which were initially called neighborhood health centers, as part of President Lyndon B. Johnson’s “War on Poverty.” The legislative goals for neighborhood health centers were to: Provide comprehensive, high-quality health services. Be accessible to low-income residents. Be responsive to patient needs. Offer employment, education and social assistance. …
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Affordable Care Act funding: An analysis of grant programs under health care reform
The Patient Protection and Affordable Care Act (ACA) is a comprehensive law with the potential to affect the health of Americans in many ways. This issue brief focuses on ACA grants that were awarded during a shortened fiscal year 2010 (March 23, 2010 to September 30, 2010) and fiscal year 2011 (October 1, 2010 to September 30, 2011). This brief …
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Medicaid eligibility in Michigan: 40 ways to qualify for government-supported medical assistance
Medicaid Eligibility Before the Affordable Care Act Under federal rules governing the Medicaid program, individual states have broad discretion to expand Medicaid eligibility beyond federally-mandated categories. In Michigan, there are no fewer than 40 different ways to qualify for Medicaid or other government-supported medical assistance. Eligibility requirements vary widely among the eligibility categories, and eligibility determinations are made based on …
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Medicaid eligibility, enrollment, and outreach practices across the U.S.
The Patient Protection and Affordable Care Act of 2010 (ACA) expands Medicaid eligibility to all individuals at or below 133 percent of poverty (138 percent with the five percent income disregard) beginning on January 1, 2014. The law will have the greatest impact on low-income childless adults – a group that has been largely excluded from the Medicaid program under …
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Guide to state requirements and policy choices in the Affordable Care Act
The Patient Protection and Affordable Care Act of 2010 (ACA) requires the establishment of significant new state-level structures by the year 2014. This document summarizes major ACA requirements and policy choices for states between now and 2014.* The two most significant ACA requirements for state implementation between now and 2014 are: To establish health insurance exchanges for individuals and small …
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