This Council of State Goverments primer is designed to provide an overview of Medicaid for state legislators. This report includes an explanation of Medicaid administration, eligibility rules, enrollment, expenditures, coverage and cost-sharing.

From the report:

Medicaid is the largest health insurance program in the country, covering as many as 62 million low-income Americans over the course of a year, including one of every four children in the country. Medicaid has grown from about 10 percent of total state spending in 1987 to nearly 22 percent of total state spending in 2008, making it the top spending category for states. Medicaid, like all health care in America, is expensive— it comes with an annual price tag of more than $300 billion in combined federal and state dollars. The program is important to not only the millions of low-income Americans who receive benefits but also to the economy of each state where Medicaid funds support thousands of health-related jobs, medical education and work force development. It is incredibly complicated and different in each state, with no two Medicaid programs alike. Policies vary from state to state and the population Medicaid serves is incredibly diverse. The Medicaid program is loved by few, criticized by many and misunderstood by most. This primer will help you understand the basics and dispel some myths often associated with Medicaid. As a legislator, you come into contact with people who run the program in your state, service providers, those who are beneficiaries and those who are trying to become beneficiaries. This primer is designed to provide the information you need to help your constituents.  

Full report: Medicaid 101: A Primer for State Legislators

Council of State Goverments. (2009). Medicaid 101: a primer for states legislators.

This Employee Benefit Research Institute issue brief explores issued related to full mental health parity.

From the report:

When employers began to provide health insurance benefits to their employees and their families, they extended coverage to include mental health benefits under the same terms as other health care services. Many employers continued to add mental health benefits through the 1970s and early 1980s until cost pressures required employers to re-examine all health care benefits that were offered. They quickly found that, while only a small proportion of the beneficiaries used mental health care services, the costs associated with this care were very high. As a result, employers placed limits on mental health benefits in an attempt to make the insurance risk more manageable.

Full report: http://ebri.org/publications/ib/index.cfm?fa=ibDisp&content_id=92

Employee Benefit Research Institute. (1997). Issues in mental health care benefits: the costs of mental health parity.

Governors at the National Governors’ Association meeting have called for an increase in Medicaid funds through an increase in the Federal Medical Assistance Percentage (FMAP) i.e, the “federal match.” The FMAP helps determine the funds distributed to the state for Medicaid services. Previous House and Senate bills related to an increase are currently stuck in committee, but the Governors believe that president-elect Obama will likely include some form of increase for Medicaid in future stimulus legislation.

More information on the requests by the governors is available at http://www.nga.org

A new rule implementing the 2006 Deficit Reduction Act  allows states to impose premiums and higher co-payments for hospital care, prescriptions, and doctors’ services for those over the Federal Poverty Limit (those on TANF and SSI are exempt from the changes). The rule allows a sliding scale based on income requirements (up to a total of 5 percent of a family's income). It also allows for states to deny services to those who don’t pay the required premiums and co-payments. This may generate over a billion dollars in new revenue, though some worry that low-income individuals may forgo or delay services due to increased costs.

The rule is available at: http://edocket.access.gpo.gov/

This National Association of State Alcohol/Drug Abuse Directors presentation inventories and discusses the different components of cost offsets of substance abuse treatment by states. Several of the studies present good business cases for substance abuse treatment, showing billions of dollars in cost savings and other indirect benefits.

Full presentation: http://nasadad.org/resource.php?base_id=1564

National Association of State Alcohol/Drug Abuse Directors. (2008). An inventory of cost offset studies for state substance abuse agencies.

This new study by Nachimson Advisors for the ICD-10 Coalition questions cost projections for the transition from ICD-9 coding to ICD-10 within the CMS proposed timeframe of October 1, 2011. The ICD-10 Coalition is seeking an extension of the timeframe due to the complexity of transition and cost estimates for implementation that are potentially higher than expected.

From the report:

Total Cost Impact of ICD‐10 Mandate on Individual Provider Practices

1. For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD‐10 mandate as $83,290 per small practice.
2. For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD‐10 mandate as $285,195 per medium practice.
3. For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD‐10 mandate as $2.7 million per large practice.

Full report: The Impact of Implementing ICD-10 on Physician Practices and Clinical Laboratories (PDF | 434 KB)  

Nachimson Advisors, LLC. (2008). The impact of implementing ICD‐10 on physician practices and clinical laboratories.