Children in the child welfare system typically have extensive health care needs, including significant behavioral and chronic physical health issues. Vulnerable to frequent disruptions in living situations, these children often experience fluctuating access to health ca... more
To provide more integrated, coordinated care for its residents dually eligible for Medicare and Medicaid, Ohio is operating MyCare Ohio, a capitated model demonstration under the Financial Alignment Initiative offered by the Centers for Medicare & Medicaid Services.... more
State Medicaid programs can contract directly with Medicaid managed care organizations (MCOs) to deliver health services to enrollees, with MCOs currently covering 69 percent of all Medicaid enrollees nationally. These organizations and their provider networks can be im... more
As Medicaid completes its transformation from a welfare program to the nation's largest health insurance purchaser, it must refocus efforts to build a strong and robust primary care system. Health care reform legislation passed in 2010 requires reimbursement for Medicai... more
The Affordable Care Act (ACA) presents a new opportunity for Medicaid programs to develop health homes for patients with multiple chronic conditions and/or severe mental illness. Through health homes, Medicaid can reimburse for critical services: comprehensive care mana... more
The Center for Health Care Strategies' Regional Quality Improvement (RQI) initiative was designed to leverage Medicaid's significant purchasing power to improve chronic illness care through partnerships with commercial insurers, employers, providers, and consumer organi... more
Integrating care for dual eligibles offers a significant opportunity to improve care and control rising health care costs, but progress in this area has been slow. This policy brief explores alternative strategies to integrate care for this high-need, high-cost populati... more
Health care systems across the U.S. are increasingly focused on opportunities to achieve greater health equity. Cultivating meaningful relationships with their surrounding communities and involving community members in program and policy decision-making is integral for... more
Between 1997 and 2002, the George Washington University School of Public Health and Health Services (GWU) published Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts. This first national analysis of Medicaid managed care contracts ... more
The National Health Plan Collaborative (NHPC) created this toolkit of resources, lessons, best practices, and case studies to help other health plans reduce racial and ethnic health disparities. The toolkit shares what NHPC members have done to develop and test new meth... more
As states explore the health home opportunities presented by the Affordable Care Act (ACA), they may want to consider the use of Care Management Entities (CMEs) as behavioral health home providers for children and youth with Serious Emotional Disturbances (SED). CMEs se... more
This issue brief examines the CMS targeted case management rule, issued December 4, 2007, in the context of people with complex health needs who receive community-based care management services. Following a brief overview of the case management amendments contained in t... more
