Medicaid since 1980: cost, coverage, and the shifting alliance between the federal government and the states
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Book |
| Language: | English |
| Published: |
Washington, DC
Urban Inst. Press
1994
|
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVI, 181 S. |
| ISBN: | 0877666172 |
Staff View
MARC
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| 100 | 1 | |a Coughlin, Teresa A. |e Verfasser |4 aut | |
| 245 | 1 | 0 | |a Medicaid since 1980 |b cost, coverage, and the shifting alliance between the federal government and the states |c Teresa A. Coughlin, Leighton Ku, and John Holahan |
| 264 | 1 | |a Washington, DC |b Urban Inst. Press |c 1994 | |
| 300 | |a XVI, 181 S. | ||
| 336 | |b txt |2 rdacontent | ||
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| 648 | 7 | |a Geschichte 1980-1994 |2 gnd |9 rswk-swf | |
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| 700 | 1 | |a Ku, Leighton |e Verfasser |4 aut | |
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Record in the Search Index
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| adam_text | CONTENTS
Acknowledgments vii
Foreword xv
1 The Evolution of Medicaid 1981 92: An Overview 1
The Last Decade and Medicaid 1
Organization of This Volume 5
Appendix l.A: What Is Medicaid? A Brief Guide 8
2 Medicaid Spending and Enrollment Trends,
1981 92 11
Data Sources and Methods 11
Data Sources 11
Recipients versus Enrollees 12
Data Exclusions 13
Price Index 13
Medicaid Expenditure Trends, 1981 92 14
Medicaid Spending and the Federal/State
Partnership 16
Share of Medicaid Spending for Long Term
Care Is Diminishing 17
Spending and Enrollment Trends across
Eligibility Groups, 1981 92 19
Why Are Medicaid Costs Skyrocketing? 22
Role of Recipiency Increases 24
Role of Medical Care Price Inflation 26
Role of Use and Reimbursement above Inflation 27
Role of Special Financing Programs 27
Summary 31
3 Medicaid Eligibility Policies 35
Traditional Medicaid Populations: AFDC and
SSI Enrollees and the Medically Needy 36
AFDC and Medicaid 36
SSI and Medicaid 40
The Medically Needy and Medicaid 44
Medicaid Eligibility Expansions 47
Pregnant Women and Children Eligibility
Mandates and Options 47
Qualified Medicare Beneficiary (QMB)
Mandates 54
Medicaid and Coverage of the Poor 55
Expanding Medicaid Coverage, Rising
Uninsured, Declining Employer Based
Coverage 57
Health Insurance Coverage by Select Population
Groups 61
Children 61
Adult Women 63
Noninstitutionalized Aged 63
Disabled Adults 65
Summary 65
4 Equity across States 69
Reasons States May Have Become More Similar 69
Equity of Medicaid Program Coverage 71
Equity of Program Expenditures per Recipient 76
Summary 78
5 How States Finance Medicaid Growth 81
Medicaid and State Budgets 82
Revenue Increases 85
State Efforts to Contain Medicaid Costs 86
Shifting Costs to the Federal Government 87
Medicaid Maximization 87
Special Financing Programs 88
Special Revenue Sources: Provider Taxes,
Donations, and Intergovernmental
Revenues 91
Disproportionate Share Programs 94
Uncertain Overall Impact of Special Financing
Programs 96
Summary 97
6 Long Term Care Services 101
Nursing Home Care 103
Rapid Expenditure Growth since 1990 104
Most Nursing Facility Funds Are Spent on
Non cash Assisted Elderly 106
Intermediate Care Facilities for the Mentally
Retarded 107
Institutional Mental Health Services 109
Rapid Expenditure since 1990 110
Home and Community Based Care 110
Summary 118
7 Acute and Preventive Medical Services 123
Inpatient Hospital Services 125
Reasons for Surge in Inpatient Costs 126
Accounting for Special Revenues and DSH
Payments 128
Other Changes in Hospital Policies 130
Physician, Laboratory, and Radiology Services 131
Outpatient Hospital and Clinic Services 133
Prescription Drugs 136
Early and Periodic Screening, Diagnostic, and
Treatment 138
Medicare Payments 139
Managed Care, HMOs, and Group Health 139
Other Acute and Preventive Services 142
Summary 143
8 Conclusions and Health Care Reform 147
Highlights of Major Findings 148
Program Eligibility 148
Program Payment, Services, and Delivery 150
Program Expenditures and Financing 151
Medicaid Problems and Gaps 153
State Health Care Reform Initiatives and
Medicaid 154
National Health Care Reform and Medicaid 156
The Clinton Administration Proposal 157
The Cooper/Breaux Proposal 165
The ChafeeAThomas Proposal 166
The Wellstone/McDermott Proposal 168
The Michel Proposal 169
Summary 170
Appendix A: The Medicaid Price Index 173
Appendix B: Expenditure Growth Decomposition 175
References 177
About the Authors 183
2.1 Medicaid Expenditures by Source of Payment:
1981 92 15
2.2 National Health Expenditures: Average Annual
Growth Rates by Source of Funds, 1983 1992 16
2.3 Medicaid Expenditures by Broad Service
Category: 1984 92 18
2.4 Medicaid Expenditures by Eligibility Group:
1981 92 20
2.5 Number of Medicaid Enrollees by Eligibility
Group: 1984 92 21
2.6 Percentage Distribution of Medicaid
Expenditure Growth, by Factor: 1988 92 23
2.7 Medicaid Recipient Growth and Percentage of
Total Recipient Growth, by Enrollment Group:
1988 92 25
2.8 Percentage Distribution of Medicaid
Expenditure Growth by Factor, Adjusting for
Special Financing Programs: 1988 92 28
3.1 Monthly AFDC Maximum Benefit Level for
Family of Three, by State: 1980 92 37
3.2 Average Monthly AFDC Enrollments: 1981 92 39
3.3 Monthly SSI/SSP Benefit Level for Single
Elderly Person Living Alone, by State:
1980 92 41
3.4 Number of Persons Receiving Federally
Administered SSI Payments: 1981 92 43
3.5 Monthly Medically Needy Need Standard for
Family of Four, by State: 1980 92 (constant
1992 dollars) 45
3.6 Major Federal Expansions of Medicaid
Eligibility: 1984 90 48
3.7 Percentage Distribution of U.S. Population by
Type of Health Care Insurance Coverage
(Hierarchical), Excluding Cover Sheet
Children: 1984 91 58
3.8 Percent Distribution of U.S. Population by
Type of Health Care Insurance Coverage
(Hierarchical), Including Cover Sheet
Children: 1988 91 60
4.1 Ratio of Medicaid Recipients to Persons in
Poverty, Selected Years 72
4.2 Summary Measures of Medicaid Coverage
among States: 1984 and 1991 74
4.3 Summary Measures of Medicaid Expenditures
per Recipient in Category among States: 1984
and 1991 77
5.1 Distribution of Shares of State Budgets by
Function and Funding Source 83
5.2 Revenues Received by States from Special
Revenues (Provider Taxes, Donations, and
Intergovernmental Transfers [IGTs]) by DHHS
Region: 1985 92 92
5.3 Federal and State Medicaid Spending Growth,
1988 92: Including and Excluding Special
Revenues (Provider Taxes, Donations, and
Intergovernmental Transfers) 93
5.4 Medicaid Disproportionate Share Payments for
Acute and Mental Health Hospitals by DHHS
Region: 1989 92 95
6.1 Medicaid Long Term Care Expenditures by
Type of Service and Eligibility Group:
1984 92 102
6.2 Medicaid Nursing Facility Expenditures by
Eligibility Group and Cash Assistance Status:
1984 92 105
6.3 Medicaid Expenditures for Intermediate Care
Facilities for the Mentally Retarded, by
Eligibility Group: 1984 92 108
6.4 Medicaid Mental Health Expenditures by
Eligibility Group, 1984 92 111
6.5 Inpatient Mental Health Expenditures and
Growth Rates, by State: 1984 92 112
6.6 Medicaid Home and Community Based Care
Expenditures, by Type of Service:
1984 92 114
6.7 Medicaid Expenditures for Home and
Community Based Care by Eligibility Group:
1984 92 115
6.8 Community Based Long Term Care
Expenditures, by State and Type of
Expenditure: 1992 119
7.1 Total Acute and Preventive Care: Medicaid
Expenditures by Eligibility Group 124
7.2 Hospital Inpatient: Medicaid Expenditures by
Eligibility Group 127
7.3 Hospital Inpatient Expenditures, 1990 and
1992: Effect of Exclusions for Special
Revenues and DSH 129
7.4 Physician/Laboratory and Radiology: Medicaid
Expenditures by Eligibility Group 132
7.5 Hospital Outpatient and Clinic: Medicaid
Expenditures by Eligibility Group 135
7.6 Prescription Drugs: Medicaid Expenditures by
Eligibility Group 137
7.7 EPSDT and Payments to Medicare and HMOs:
Medicaid Expenditures by Eligibility
Group 140
7.8 Other Acute and Preventive Care: Medicaid
Expenditures by Eligibility Group 144
8.1 Summary Assessments of Major National
Health Care Reform Proposals as They Relate
to Medicaid and Low Income Persons as of
January 1994 158
8.2 How Current Medicaid Recipients Would Be
Covered for Acute and Preventive Health Care
Under the Clinton Proposal, the Health
Security Act 162
1.1 Medicaid Expenditures, Enrollees, and Rates
of Growth: 1981 92 3
3.1 Changes in Health Insurance Patterns for
Children and Adult Women: 1988 91 62
3.2 Changes in Health Insurance Patterns for
Noninstitutionalized Aged and Disabled
Adults: 1988 91 64
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| institution | BVB |
| isbn | 0877666172 |
| language | English |
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| owner_facet | DE-12 DE-188 |
| physical | XVI, 181 S. |
| publishDate | 1994 |
| publishDateSearch | 1994 |
| publishDateSort | 1994 |
| publisher | Urban Inst. Press |
| record_format | marc |
| spelling | Coughlin, Teresa A. Verfasser aut Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states Teresa A. Coughlin, Leighton Ku, and John Holahan Washington, DC Urban Inst. Press 1994 XVI, 181 S. txt rdacontent n rdamedia nc rdacarrier Geschichte 1980-1994 gnd rswk-swf Medicaid (DE-588)4488856-9 gnd rswk-swf Medicaid (DE-588)4488856-9 s Geschichte 1980-1994 z DE-604 Ku, Leighton Verfasser aut Holahan, John Verfasser aut HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=006465175&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Coughlin, Teresa A. Ku, Leighton Holahan, John Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states Medicaid (DE-588)4488856-9 gnd |
| subject_GND | (DE-588)4488856-9 |
| title | Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states |
| title_auth | Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states |
| title_exact_search | Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states |
| title_full | Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states Teresa A. Coughlin, Leighton Ku, and John Holahan |
| title_fullStr | Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states Teresa A. Coughlin, Leighton Ku, and John Holahan |
| title_full_unstemmed | Medicaid since 1980 cost, coverage, and the shifting alliance between the federal government and the states Teresa A. Coughlin, Leighton Ku, and John Holahan |
| title_short | Medicaid since 1980 |
| title_sort | medicaid since 1980 cost coverage and the shifting alliance between the federal government and the states |
| title_sub | cost, coverage, and the shifting alliance between the federal government and the states |
| topic | Medicaid (DE-588)4488856-9 gnd |
| topic_facet | Medicaid |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=006465175&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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