Medicaid Benefit Designs for Newly Eligible Adults: State Approaches

Rosenbaum, Sara; Mehta, Devi; Dorley, Mark; Hurt, Carla; Rothenberg, Sara; Lopez, Nancy; Ely, Sara

doi:10.15868/socialsector.25032

Cited by 6 publications

(5 citation statements)

References 1 publication

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“…Although there is no similar requirement for beneficiaries who qualify based on pre-ACA eligibility standards, most state Medicaid plans offer a broader range of services than those offered by private plans. A recent review of the benchmark plans under Medicaid finds that the majority of states have chosen to match closely the benefits offered to their traditional population with those offered to the expansion populations (Rosenbaum et al, 2015). There may be some subtle, but significant, differences for some women's services, however.…”

Section: Two Years Into the Aca Coverage Expansionsmentioning

confidence: 99%

Medicaid and Women's Health Coverage Two Years into the Affordable Care Act

Ranji

Salganicoff

2015

Women's Health Issues

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Section: Two Years Into the Aca Coverage Expansionsmentioning

confidence: 99%

Medicaid and Women's Health Coverage Two Years into the Affordable Care Act

Ranji

Salganicoff

2015

Women's Health Issues

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“…Medicaid is characterized by low patient cost-sharing and coverage of a relatively expansive list of healthcare services, including mental illness services (Kaiser Family Foundation 2017). Of particular relevance to our study, comparison of plans suggests that Medicaid may provide more generous coverage for mental illness services than many private insurance plans (Garfield, Lave, and Donohue 2010;Rosenbaum et al 2015).…”

Section: Medicaid and Aca-related Expansionsmentioning

confidence: 96%

Public Insurance and Psychotropic Prescription Medications for Mental Illness

Maclean¹,

Cook²,

Carson³

2017

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Mental illnesses are prevalent in the United States and globally. Cost is a critical barrier to treatment receipt. We study the effects of recent and major eligibility expansions within Medicaid, a public insurance system for the poor in the U.S., on psychotropic prescription medications for mental illness. We estimate differences-indifferences models using administrative data on medications for which Medicaid was a third-party payer over the period 2011 to 2017. Our findings suggest that these expansions increased psychotropic prescriptions by 22.3%. We show that Medicaid, and not patients, financed these prescriptions. For states expanding Medicaid, the total cost of these prescriptions was $30.8M. Expansion effects were experienced across most major mental illness categories and across states with different levels of patient need, system capacity, and expansion scope. We find no evidence that Medicaid expansion reduced a proxy for serious mental illness: suicide.

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“…The EHB standard is both more and less generous than traditional Medicaid coverage standards. About one out of every six Medicaid enrollees is a newly eligible adult now included because of Medicaid expansion (states can and do supplement the EHB coverage floor with additional, traditional benefits) (Rosenbaum et al, 2016).…”

Section: The Us Experiencementioning

confidence: 99%

“…Genetic testing was included under a broad coverage parameter that stated simply that covered individuals would be eligible for ‘genetic consultation for genetic illnesses including blood tests’ (NHI Law, 1994d). But because the parameters of Clalit’s detailed terms of coverage already were considerably narrower than technology and medical practice dictated at the time of enactment, the legislation was followed by a post-enactment policy directive from the Health Ministry that broadened the scope of coverage through explicit language that not only set the coverage baseline in specified terms but also provided for the updating of genetic testing coverage in accordance with specified criteria (NHI Law, 1994d). This reflects a natural inclination, at least on the part of Ministry of Health, to establish an ‘up-to-date’ basket of services as the starting point.…”

Section: Israel’s Approach To Defining the Extent And Scope Of Healthmentioning

confidence: 99%

What should health insurance cover? A comparison of Israeli and US approaches to benefit design under national health reform

Nissanholtz-Gannot

Chinitz

Rosenbaum

2018

HEPL

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What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.

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Medicaid Benefit Designs for Newly Eligible Adults: State Approaches

Cited by 6 publications

References 1 publication

Medicaid and Women's Health Coverage Two Years into the Affordable Care Act

Medicaid and Women's Health Coverage Two Years into the Affordable Care Act

Public Insurance and Psychotropic Prescription Medications for Mental Illness

What should health insurance cover? A comparison of Israeli and US approaches to benefit design under national health reform

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