November 2009
New York State Department of Health AIDS Institute
Lewin contact: Joel Menges
The Lewin Group, in collaboration with the New York State Department of Health AIDS Institute, conducted an evaluation of New York State’s Medicaid HIV Special Needs Plan program. The study focused on the following impact areas: inpatient hospital costs and utilization, prescription drug costs and utilization, trends in overall medical costs, and the program’s effect on cost and HIV SNP enrollees’ service utilization compared to Medicaid spending had the HIV SNP initiative not been implemented.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
July 2009
Minnesota Department of Human Services
Lewin contact: Kathy Kuhmerker
The Minnesota Department of Human Services (DHS), Disability Services Division contracted with The Lewin Group to conduct a study of the infrastructure of the State’s Medical Assistance State Plan Personal Care Assistance (PCA) program. Lewin partnered with the University of Minnesota’s Institute on Community Integration on this study.
This final report analyzes the drivers of Medical Assistance expenditures in the State’s PCA program and provides recommendations to strengthen the program. While the study focuses primarily on PCA State Plan services, important considerations include how other Medical Assistance Programs (e.g., home and community-based waiver programs) provide PCA services, and the interaction between those program requirements and the PCA State Plan program.
Three interim reports were also developed for this project and are posted on this website as well:
- Interim Report #1 (dated March 31, 2009) provided a national scan of PCA programs, analyses of Minnesota PCA program enrollment and expenditure data, findings from interviews with State officials in Minnesota and other states with PCA programs, findings from stakeholder interviews, and preliminary recommendations for the State.
- Interim Report #2 (dated June 24, 2009) included findings from a series of 14 focus groups, conducted by the
University of Minnesota’s Institute on Community Integration, with recipients of PCA services and PCA workers in a variety of Minnesota Medical Assistance programs offering PCA services. The purpose of conducting these focus groups was to hear from workers about their experiences providing PCA services and from service recipients about their experiences receiving PCA services. - Interim Report #3 (dated June 25, 2009) presented provider agency perspectives and related recommendations to strengthen and improve provider-related components of the program based on a survey of PCA provider agencies. This report also included analyses of the types of living arrangements .
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
July 2009
Medicaid Health Plans of America (MHPA); Association for Community Affiliated Plans (ACAP)
For MHPA and ACAP, The Lewin Group assessed the financial impact and administrative burden that out-of-network claims pose in Medicaid managed care. The report examined Medicaid non-emergency out-of-network payment policies in Arizona, California, Florida, Georgia, Maryland, Nebraska, New Jersey, New York, Pennsylvania, Tennessee, Texas and Wisconsin.
Client Area: Associations
Expertise Area: Medicaid and CHIP
June 2009
Lewin contact: Paul Hogan
Expertise Area: Medicaid and CHIP, Medicare
June 2009
Pharmaceutical Research and Manufacturers of America (PhRMA)
PhRMA commissioned an evaluation of the degree to which changes in rebates for Medicare/Medicaid dual eligibles would create "spillover" impacts on the Part D premiums charged to other Medicare beneficiaries. Ingenix Consulting staff conducted modeling of various scenarios and Lewin staff prepared the written report. Our analyses estimate that if dual eligibles' prescriptions are paid for at Medicaid prices, additional costs will be imposed on Part D participants who are not dual eligibles. These increased monthly costs per beneficiary are estimated to range from $8 - $16, which constitutes an increase of 25% - 50% in the Part D premiums paid by non-dual eligibles.
Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare
June 2009
Minnesota Department of Human Services
Lewin contact: Kathy Kuhmerker
The Minnesota Department of Human Services (DHS), Disability Services Division contracted with The Lewin Group to conduct a study of the infrastructure of the State’s Medicaid State Plan Personal Care Assistance (PCA) program. This study analyzes the drivers of Medical Assistance expenditures in the State’s PCA program and provides recommendations to inform legislation to strengthen the PCA program.
This report is the last of several interim reports that Lewin submitted to DHS, in addition to a comprehensive final report. This report focuses on provider agency perspectives and related recommendations to strengthen and improve provider-related components of the program, and analyses of the types of living arrangements in which individuals receive PCA services and related recommendations.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
June 2009
Minnesota Department of Human Services
Lewin contact: Kathy Kuhmerker
The Minnesota Department of Human Services (DHS), Disability Services Division contracted with The Lewin Group to conduct a study of the infrastructure of the State’s Medicaid State Plan Personal Care Assistance (PCA) program. This study analyzes the drivers of Medical Assistance expenditures in the State’s PCA program and provides recommendations to inform legislation to strengthen the PCA program.
This report is the second of several interim reports that Lewin submitted to DHS, in addition to a comprehensive final report. This second report includes findings from a series of 14 focus groups, conducted by the University of Minnesota’s Institute on Community Integration, with recipients of PCA services and PCA workers in a variety of Minnesota Medical Assistance programs offering PCA services. The purpose of conducting these focus groups was to hear from workers about their experiences providing PCA services, and from service recipients about their experiences receiving PCA services. This report provides: a description of the methodology used to obtain this data (through the focus groups); findings from several topical areas such as services delivered/received, quality of services, wages/benefits, education/training, and family members as PCA workers; a summary of focus group participants’ recommended key changes to improve the Minnesota PCA program; and interim recommendations to improve and strengthen Minnesota’s PCA program.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
March 2009
Minnesota Department of Human Services
Lewin contact: Kathy Kuhmerker
The Minnesota Department of Human Services (DHS), Disability Services Division contracted with The Lewin Group to conduct a study of the infrastructure of the State’s Medicaid State Plan Personal Care Assistance (PCA) program. This study analyzes the drivers of Medical Assistance expenditures in the State’s PCA program and provides recommendations to inform legislation to strengthen the PCA program.
This report is the first of several interim reports that Lewin submitted to DHS, in addition to a comprehensive final report. This first report includes findings from a national scan of PCA programs, analysis of Minnesota PCA program enrollment and expenditure data, interviews with state officials in Minnesota and other states with PCA programs, stakeholder interviews, and initial recommendations for the State.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
March 2009
America's Health Insurance Plans (AHIP)
Lewin contact: Joel Menges
In 2004, America’s Health Insurance Plans engaged The Lewin Group to synthesize existing research on the savings achieved when states have implemented Medicaid managed care programs. This report is an update of the 2004 report, and includes both studies from the previous report and studies that have been released since 2004. In all, The Lewin Group reviewed 24 studies. The studies reviewed were identified and selected by America’s Health Insurance Plans and Lewin and include federally required independent assessments, studies commissioned by the federal and state governments, private foundations, and researchers, and one health plan-funded study. Studies are grouped into three categories: state studies, which examine states’ cost savings in their overall Medicaid managed care programs; targeted Medicaid managed care studies, which assess savings in Medicaid managed care programs targeted to specific populations; and specific service studies, which analyze Medicaid managed care program savings for specific services.
Client Area: Associations
Expertise Area: Medicaid and CHIP
November 2008
Association for Community Affiliated Plans; Medicaid Health Plans of America
Lewin contact: Joel Menges
This study addresses two questions. First, what are the financial implications of enrolling the dual eligible population into the capitated/integrated MCO setting on a comprehensive scale? This report estimates the cost impacts of serving dual eligibles in the capitated setting in each state across a fifteen year timeframe, demonstrating the impacts on Medicaid and Medicare spending, state and federal spending, and overall taxpayer outlays across the two programs.
Second, what are the key program design features and public policy issues that need to be addressed to achieve substantially larger-scale use of the capitated model for the dual eligible population? The report describes the barriers that have prevented more widespread enrollment of dual eligibles into MCOs, and outlines the specific policy-making opportunities to overcome these barriers.
Client Area: Associations
Expertise Area: Medicaid and CHIP
October 2008
California HealthCare Foundation; The California Endowment
Lewin contact: Lisa Chimento
The California HealthCare Foundation and The California Endowment engaged The Lewin Group to conduct an assessment of One-e-App, an electronic application and enrollment system that allows applicants to apply for multiple public programs through a single application process. The assessment focused on evaluating and demonstrating the benefits of One-e-App both qualitatively and quantitatively. This report presents a summary of the assessment’s background, Lewin’s approach to the analysis, key analytic findings, key implementation considerations, and policy and operational considerations promoting One-e-App’s optimal use.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
October 2007
Association of Community Affiliated Health Plans (ACAP)
Lewin contact: Joel Menges
The Lewin Group was engaged to provide a discussion of the programmatic issues involved in the use of a "carve-in" versus a "carve-out" approach for pharmacy benefits within capitated Medicaid managed care programs. To address this issue, Lewin interviewed a variety of key stakeholders including Medical Directors and Pharmacy Directors from managed care organizations in both carve-in and carve-out states, as well as representatives who could provide insight into the state Medicaid agency, provider, and pharmacy perspectives.
Client Area: Associations
Expertise Area: Medicaid and CHIP
July 2007
Association for Community Affiliated Plans (ACAP)
Lewin contact: Joel Menges
The Lewin Group was engaged by the Association of Community Affiliated Plans to study the role of Medicaid and Medicaid health plans in reforms to cover the uninsured. This paper discusses the experiences of two programs that provide and/or subsidize coverage directly: The Massachusetts-run Commonwealth Care Health Insurance Program, which links eligible residents with approved insurance plans and helps them pay for the plans, and the county-administered children’s health initiatives (CHIs) in California, which cover low-income children who are not eligible for Medicaid or SCHIP. This report, based on discussions with Medicaid health plans that participate in these programs, discusses the use of Medicaid health plans as vehicles for expansion efforts in state and county health coverage expansion reform initiatives. This paper presents case studies of their experiences and lessons learned for both health plans and for purchasers.
Client Area: Associations
Expertise Area: Health Reform, Medicaid and CHIP
March 2007
New Mexico Medical Review Association
Lewin contact: Joel Menges
This report conveys the findings of the Independent Assessment of the access, quality, and cost-effectiveness of health care services delivered under New Mexico’s Behavioral Health Collaborative. This report fulfills the requirement of the Centers for Medicare and Medicaid Services (CMS) that state Medicaid authorities arrange for an independent assessment of a state’s 1915(b) waiver programs. The Lewin Group has reviewed the access- and quality-related state contractual requirements, ValueOptions’ proposal to the State of New Mexico, Managed Care Audit, ValueOptions’ provider network, selected reports, provider satisfaction survey, national performance standards and MHSIP performance, ValueOptions’ Quality Management Program, and various financial reports.
Based on the comprehensive review of submitted reports and data related to consumer and provider satisfaction, the program is off to a strong start in some respects and a challenging start in others. ValueOptions and the Interagency Behavioral Health Purchasing Collaborative have implemented a behavioral health system that is designed to not only provide access to quality health services, but also integrate other non-medical health member needs. The State of New Mexico has set extensive and specific requirements for performance, which ValueOptions has already met or appears to be making significant progress towards. New Mexico’s behavioral health system meets CMS guidelines and requirements in terms of access, quality, and cost-effectiveness.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP, Mental Health and Substance Abuse
March 2007
North Carolina Health and Wellness Trust Fund; University of North Carolina at Chapel Hill
Lewin contact: Joel Menges
This report explores the history of the North Carolina Health Choice for Children program over the past decade. The report also summarizes the perspectives of several key stakeholders and experts about the about the issues that will be discussed at the federal and state levels during the SCHIP reauthorization process.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
February 2007
New Mexico Medical Review Association
Lewin contact: Joel Menges
This report conveys the findings of the Independent Assessment of the quality, access, and cost-effectiveness of health care services delivered under the New Mexico Medicaid Managed Care program, Salud! This report fulfills the requirement of the Centers for Medicare and Medicaid Services (CMS) that state Medicaid authorities arrange for an independent assessment of a state’s 1915(b) waiver programs.
The Lewin Group has reviewed the quality- and access-related state contractual requirements, each Salud! health plan’s quality improvement program, member and provider survey activities, HEDIS® and CAHPS® performance, provider network, and member materials, and various financial reports. The State of New Mexico has created a favorable environment for quality, access, and cost-effectiveness to occur in each of the three MCOs. Thus, the program clearly meets CMS guidelines and requirements in terms of quality, access, and cost-effectiveness.
Client Area: Associations
Expertise Area: Medicaid and CHIP
January 2007
Connecticut Association of Health Plans
Lewin contact: Joel Menges
Lewin assessed the performance of Connecticut's HUSKY Program, a capitated Medicaid initiative operated through contracts with four health plans. The study was coordinated through the Connecticut Association of Health Plans. The study's purpose is to provide objective information about the HUSKY Program and to compare the policy alternatives of retaining HUSKY versus adopting a "managed fee-for-service" model of coverage.
The study finds the HUSKY Program to be successful (above national Medicaid managed care norms) on several key fronts -- delivering large-scale cost savings to taxpayers, fostering access to physician and preventive care services (e.g., EPSDT), and achieving high rates of enrollee satisfaction. The study concludes with a broad set of policy recommendations to strengthen HUSKY going forward, including a sharp increase in underlying Medicaid physician/dentist fee schedules to address the core problem that many "front-line" practitioners are reluctant to serve the State's poverty population.
Client Area: Associations
Expertise Area: Medicaid and CHIP
November 2006
Medicaid Health Plans of America
Lewin contact: Joel Menges
The potential benefits of managed care have led many States to consider expansions in capitated Medicaid programs to the extent that they are consistent with state health care policy goals and specific market and political conditions. However, current Medicaid hospital reimbursement calculations only include fee-for-service Medicaid utilization, which places significant barriers to expanded use of capitated Medicaid managed care contracting in some states. States considering expanding Medicaid managed care must balance any potential benefits against the risk of losing substantial Federal Upper Payment Limit (UPL) funds that play an increasingly important role in supporting the public health care sector, including public safety net hospitals.
This report explores Medicaid UPL issues and recommends a policy solution to preserve existing federal funds flow to support public safety net and other providers while also removing barriers to the expansion of Medicaid managed care. The recommended policy change would remove an unintended barrier to managed care expansion, which would in turn allow policy makers to evaluate more clearly the costs and benefits of their Medicaid contracting strategies and make policy choices according to what works best for their state.
Client Area: Associations
Expertise Area: Medicaid and CHIP
April 2006
The Medicaid Health Plans of America and the Association of Community Affiliated Plans
Lewin contact: Joel Menges
National Medicaid expenditures have risen at an average of 8.2 percent annually since 1995, outpacing states' revenue growth and placing enormous pressure on states to implement effective cost containment programs. The Medicaid Health Plans of America and the Association of Community Affiliated Plans jointly engaged The Lewin Group to quantify the savings that can be realized through state Medicaid agencies entering into capitation contracting with Medicaid managed care organizations. The report found, among other key points, that up to $83 billion can be saved over ten years if the capitation model were immediately applied to all appropriately suited Medicaid funds.
Client Area: Associations
Expertise Area: Medicaid and CHIP
February 2006
Alaska Department of Health and Social Services
Lewin contact: John Sheils
In April 2005 the Alaska Department of Health and Social Services (ADHSS) contracted with the Lewin Group and ECONorthwest to develop a long-term forecasting model of Medicaid spending for the State of Alaska. This document describes the steps undertaken in the development of the forecasting model and provides details on the projected growth in enrollment, utilization, and spending on Alaska’s Medicaid program through 2025.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
February 2006
Delaware Governor's Commission on Community-Based Alternatives for Individuals with Disabilities
Lewin contact Lisa Chimento
The Delaware Governor's Commission on Community-Based Alternatives for Individuals with Disabilities commissioned The Lewin Group to review and analyze the challenges and opportunities the State may face when undertaking a Money Follows the Person or “rebalancing” initiative. In essence, the study seeks to evaluate the manner in which Medicaid recipients access Medicaid benefits—either in institutions or in the community—and whether there exist policies or procedures that favor institutional placement over home and community-based services. It also reviews State initiatives on rebalancing and models the potential financial impact of Delaware’s adoption of a Money Follows the Person program.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
January 2006
Association for Community Affiliated Plans; Medicaid Health Plans of America
Lewin contact: Lisa Chimento
The Association for Community Affiliated Plans and the Medicaid Health Plans of America retained The Lewin Group to conduct a study of the ways that states have implemented rules from the Balanced Budget Act of 1997 regarding actuarial soundness, in order to identify both best practices and continuing areas of concern. Lewin developed a survey to gather information from states and health plans on current rate-setting practices. This report presents the results of the survey.
Client Area: Associations
Expertise Area: Medicaid and CHIP
May 2005
Illinois Commission on Government Forecasting and Accountability
Lewin contact: Joel Menges
Lewin Group to perform an actuarial assessment of the cost-effectiveness and feasibility of various approaches to expanding the use of managed care in the State's Medicaid program. The report presents a series of recommendations for expanding capitated managed care in some areas of the state and managed fee-for-service, including Primary Care Case Management, disease management and complex care coordination, in other areas. The objective of the project was to explore and identify Medicaid managed care approaches that will both save money and strengthen the quality of coverage beneficiaries receive.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
May 2005
Pennsylvania Coalition of Medical Assistance Managed Care Organizations
In 2003, in a major policy shift, the Pennsylvania Department of Public Welfare (DPW) terminated the planned statewide expansion of the HealthChoices program, the state’s large-scale capitated mandatory managed care program for Medical Assistance recipients. In early March of 2005, Pennsylvania began phasing in its new ACCESS Plus program, an enhanced primary care case management program, in the counties without mandatory capitated managed care, including those previously scheduled for HealthChoices expansion. The Pennsylvania Coalition of Medical Assistance Managed Care Organizations (the Coalition) was formed by the seven physical health managed care organizations that contract with the Commonwealth of Pennsylvania to provide services to recipients enrolled in the HealthChoices program. Given the state’s recent policy reversal and the fact that, like most other states, Pennsylvania continues to seek out options for reducing expenditures and gaining efficiencies, the Coalition desired an independent assessment of the value of the HealthChoices Program to help inform the continuing debate about the future direction of the state’s Medical Assistance program. Toward this end, the Coalition commissioned The Lewin Group to conduct a comparative evaluation of Pennsylvania’s HealthChoices Program and Fee-for-Service Program, focusing on four areas that contribute to a health care program’s overall value: its cost-effectiveness, its impact on access, the quality of services provided, and the program’s focus on and approaches to serving individuals with special needs.
Client Area: Associations
Expertise Area: Medicaid and CHIP
May 2005
Indiana Family and Social Services Administration
Lewin contact: Joel Menges
The Indiana Division of Disabilities, Aging, and Rehabilitative Services and the Office of Medicaid Policy and Planning contracted with The Lewin Group to study the impact of Senate Enrolled Act (SEA) 493, which makes significant changes in the State’s long term care (LTC) programs for individuals of advanced age and persons with disabilities. The study focused on the impact of changes to the State’s Section 1915(c) Aged and Disabled Medicaid Home and Community-Based Services Waiver.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
January 2005
Texas Health and Human Services Commission
Lewin contact: Joel Menges
Lewin assisted Texas' Health and Human Services Commission (HHSC – the state's Medicaid agency) in designing the detailed mechanisms by which cost performance would be measured. The contractor's administrative fees are 80% at risk for cost performance, and 20% at risk for quality performance. Lewin evaluated vendors' price bids and then worked extensively with HHSC to develop and negotiate the measurement criteria with the selected contractor.
Lewin has also developed appropriate algorithms for identifying patients in each targeted disease category, specifying situations where persons will be excluded from the program, and designing and negotiating all aspects of HHSC's financial relationship with its disease management contractor.
Client Area: State and Local Governments
Expertise Area: Chronic Disease / Cost of Illness, Medicaid and CHIP
November 2004
United Hospital Fund
Lewin contact: Lisa Chimento
As part of an effort to identify ways to expand and strengthen public health insurance coverage, the United Hospital Fund, with the support of the Altman Foundation, commissioned The Lewin Group to study the process for applying for public health insurance programs in New York City and determine how automation might improve that process.
Results of the analysis show that an automated application process could speed up the current application processing time by over one week and help applicants access medical care sooner by decreasing the transition time between agencies, reducing errors, and limiting duplication of effort. Automation would also save enrollment organizations and their staff one hour or more every day by improving process efficiencies.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
September 2004
Texas Health and Human Services Commission
Lewin contact: Lisa Chimento
The Texas Health and Human Services Commission retained The Lewin Group to assist in developing appropriate out-of-network payment rates and related policies, in accordance with the requirements of HB 2292, 78th Legislature. In Texas, considerable time and energy, on behalf of state staff, health plans, providers and other stakeholders, have been focused on out-of-network usage and reimbursement in the STAR and STAR+PLUS programs for the past several years. Lewin's objective was to take what the state had already learned, understand the successes and shortcomings, and develop a solution to move the program forward in a positive direction.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
July 2004
America’s Health Insurance Plans (AHIP)
America’s Health Insurance Plans (AHIP) engaged The Lewin Group to synthesize existing research on the savings achieved when states have implemented Medicaid managed care programs. The Lewin Group reviewed 14 studies, which included federally required independent assessments and studies commissioned by the federal and state governments and private foundations. The studies are grouped into three categories: 1) state studies, which examine states’ cost savings in their overall Medicaid managed care programs; 2) targeted Medicaid managed care studies, which assess savings in Medicaid managed care programs targeted to specific populations; and 3) specific service studies, which analyze Medicaid managed care program savings for specific services.
Client Area: Associations
Expertise Area: Medicaid and CHIP
May 2004
California HealthCare Foundation
Lewin contact: Lisa Chimento
In the current economic climate, California’s counties struggle with the need to provide health coverage to low-income individuals and families in the face of sharp budget cuts. How can a county ensure that its most vulnerable residents gain access to the appropriate public health insurance program? Three California counties – Alameda, San Mateo, and Santa Clara – have gone beyond state requirements, not only in expanding eligibility for coverage, but also in creating a more seamless process for enrollment in county programs, Medi-Cal, and Healthy Families.
The report, prepared by The Lewin Group, explores the policy, operational, and other considerations of implementing partnerships among county agencies, health plans, and other community stakeholders to change and improve the process for enrolling families into public health care programs.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
April 2004
Association for Community Affiliated Plans (ACAP)
Lewin contact: Lisa Chimento
The Medicare Modernization Act of 2003 (MMA) has important consequences for dual eligible beneficiaries as well as Medicaid managed care plans. ACAP commissioned this report to provide member health plans with a better understanding of the Act's implications for their current Medicaid business -- as well as a roadmap to explore the possibility of expanding into Medicare managed care.
Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare
January 2004
Texas Health and Human Services Commission
Lewin contact: Joel Menges
The Lewin Group developed a comprehensive set of cost estimates for potential expansion of Texas' Medicaid managed care programs. The study included a projection of potential savings as a result of implementing various managed care expansion options, as well as a geographic analysis of potential expansion regions. The study also took into account the potential effects managed care expansion would have on other programs and benefits, such as pharmacy.
Throughout the project, the Lewin team gathered input from various stakeholder groups, including hospitals, physicians, managed care plans, the PCCM vendor and State staff responsible for administering the current program to understand the concerns these groups have about the structure of the current program and their ideas for improving it. HHSC has relied heavily on the report in shaping its managed care expansion plans.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
November 2003
Center for Health Care Strategies
Lewin contact: Joel Menges
In a project jointly funded by the State of Arizona and the Center For Health Care Strategies (CHCS), The Lewin Group assessed whether it would be best for AHCCCS (Arizona's Medicaid program) to continue to purchase all prescription drugs through its capitated managed care program, or whether the State's interests would be better served by "carving out" prescription drugs and paying for AHCCCS medications on a fee-for-service basis.
Through aggressively managing the volume and mix of drugs, Arizona has achieved the lowest per capita pharmacy costs of any Medicaid program. While drug-specific prices would be more favorable under a carve-out due to the Federal rebate program, Lewin's projections are that a carve-out would result in a net increase in overall pharmacy spending. Taking the responsibility for pharmacy costs out of the hands of at-risk health plans is expected to lead to diminished cost-effectiveness in managing the volume and mix of prescribed drugs.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
June 2003
California HealthCare Foundation
Lewin contact: Lisa Chimento
The Medi-Cal Policy Institute commissioned The Lewin Group to study various ways in which the process for families applying for Medi-Cal, California's Medicaid program, could be simplified. To apply for Medi-Cal, many applicants must provide documentation of their assets and income, which can serve as a barrier to successful completion of the application process.
Through interviews with county eligibility workers, advocates, state staff and others, Lewin developed several alternatives for simplifying both the assets and income tests. For five of these options, Lewin developed estimates of medical costs and administrative savings associated with the implementation of these initiatives. The results of the analyses are summarized in an issue brief, as well as in two detailed reports addressing each of the assets and income options. A technical report on the cost modeling is also included.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
May 2003
Association of Community Affiliated Health Plans
A coalition of Medicaid Focused Health Plans contracted with The Lewin Group to analyze the impacts of allowing Medicaid managed care organizations (MCOs) to have access to the Medicaid drug rebate on a voluntary basis. Since its inception in 1991, the federal rebate program has applied only to Medicaid fee-for-service programs. Currently, Medicaid MCOs must enter into separate negotiations with drug manufacturers, either directly or through their contracting pharmacy benefits managers (PBMs), in order to obtain rebates. The proposal being explored would allow participating health plans to continue to pay for the ingredient costs of drugs as they do currently, but rebates would no longer be a negotiable item with the manufacturers or with the health plans’ pharmacy benefits managers (PBMs). Instead, Medicaid health plans would receive the same level of rebate available to state Medicaid fee-for-service programs. The report describes the potential trade-offs of the proposal and looks at its potential financial impact.
Client Area: Associations
Expertise Area: Medicaid and CHIP
April 2003
Medi-Cal Policy Institute
The California Working Disabled Medi-Cal Buy-In Program was implemented in April 2000 to enable disabled individuals to participate in the workforce without the threat of losing their Medi-Cal coverage. Although a relatively new program, policymakers and advocates have already begun considering programmatic and policy changes that would build on the existing program, expand eligibility, and broaden access to certain services. This study was initiated to better understand the factors affecting enrollment in CWD and to estimate the enrollment and cost impacts of select programmatic changes. This report shares findings from an enrollee survey, interviews with county eligibility workers, and modeling of data from the Census Bureau and the California Department of Health Services.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
February 2003
Oregon Association of Hospitals and Health Systems
The Oregon Association of Hospitals and Health Systems asked The Lewin Group to focus on four areas related to the Oregon Health Plan (OHP) Medicaid program and provider reimbursement. The areas were:
An analysis of Medicaid provider payments compared to actual provider costs
Comparisons to other states' Medicaid programs and to Medicare
The impact of proposed budget reductions
The effect of Medicaid payment rates on access to care.
This report describes Oregon's Medicaid reimbursement system and analyzes Oregon and national health expenditure data related to reimbursement issues. It presents discussions of the various findings and conclusions.
Client Area: Associations
Expertise Area: Medicaid and CHIP
February 2003
University of Maryland, Baltimore County
The home and community-based Medicaid waiver that serves seniors in Maryland requires restructuring, in order to make services available to eligible seniors on a more expedited basis. In our report, we researched this waiver, known as the "Older Adults Waiver," and we made several recommendations to make the it more efficient. These recommendations include a sequence to develop a single point of entry, as well as tools to recruit, retain and pay providers, to ensure capacity in the community.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
February 2003
National Governors Association
Drawing upon our expertise in the effective management of Medicaid's prescription drug benefit, the Center for Best Practices at the National Governors Association commissioned an Issue Brief from The Lewin group entitled "Reducing Pharmacy Fraud, Abuse and Waste: Promising Practices of States." This Issue Brief identifies several tools states may utilize to prevent pharmacy fraud, abuse and waste. By utilizing these tools, states may save money without imposing reductions in the pharmacy benefit itself and without impairing access to prescription drugs by Medicaid beneficiaries.
Client Area: Associations
Expertise Area: Medicaid and CHIP
January 2003
Center for Health Care Strategies
Lewin contact: Joel Menges
Both state Medicaid fee-for-service programs and Medicaid managed care organizations (MCOs) are experiencing double-digit growth rates in their pharmaceutical budgets. As states grapple with both short-term and longer-term Medicaid budget issues, pharmacy spending is receiving substantial attention. The Omnibus Budget Reconciliation Act of 1990 gave states access to a generous rebate program, but limited states' ability to control drug expenditures in ways that other commercial payers can. Medicaid MCOs do not have access to the federal rebate, but may have more leeway in cost containment methodologies. No previous study, however, had quantified and described the differences in drug spending and utilization patterns between Medicaid FFS programs and Medicaid MCOs. This report, Comparison of Medicaid Pharmacy Costs and Usage between the Fee-for-Service and Capitated Setting, prepared by The Lewin Group and the Association for Health Center Affiliated Health Plans and funded by the Center for Health Care Strategies, brings data findings to bear on the many policy making efforts underway in the Medicaid pharmacy arena. The study's intent is to help both state Medicaid agencies and health plans assess how they are faring and what opportunities for cost savings might exist.
Expertise Area: Medicaid and CHIP
December 2002
Office of Vermont Health Access
Lewin contact: John Sheils
The Lewin Group analyzed an 1115 waiver concept that would provide vouchers for the purchase of health insurance to people who are currently eligible under the Vermont Health Access Plan (VHAP) and State Children's Health Insurance Program (SCHIP). In this analysis, Lewin estimates the number of persons who would be covered under the voucher program and the cost of providing the benefits called for under the proposal. The paper also provides estimates of the impact of the waiver on the number of persons in the state of Vermont who do not have health insurance.
Client Area: State and Local Governments
Expertise Area: Health Reform, Medicaid and CHIP
November 2002
Minnesota Department of Human Services
Lewin contact: Joel Menges
Minnesota’s Department of Human Services (DHS) engaged The Lewin Group to assist in the development of a performance payment system for the state’s prepaid medical assistance program (PMAP) and MinnesotaCare. This report describes the performance payment system that has been recommended to DHS, based on input from the health plans, from DHS staff, and from Lewin’s consulting team.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
October 2002
Washington State Legislature
Like Washington, almost all states are experiencing a fiscal crisis, and Medicaid is considered to be one of the largest causes of the budget problem. States have several policy tools to address these budget challenges. For varying reasons, all can be politically difficult, and all represent hard choices. Most states have begun implementing cost containment strategies but few have saved enough money to entirely solve their budget problems.
Through an innovative cost containment project for the State of Washington, whereby Lewin jointly was hired by the Governor's budget office and the Legislature's fiscal committees, Lewin measured the success of Washington's recent cost containment initiatives, including a series of pharmacy strategies commenced in 2002. Lewin also presented to Washington additional Medicaid cost containment options based on other states' approaches, and we modeled the potential savings to Washington of each "imported" option, utilizing data provided to us by Washington. This is the first of three reports prepared for this project. Report No. 1 inventories Washington's ongoing Medicaid cost containment activities.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
June 2002
Robert Wood Johnson Foundation
Following successful children's outreach efforts, and now facing rising unemployment and health care costs, the demands on state Medicaid budgets are increasing at the same time that states have less funds available for their share of Medicaid. Governors and state legislatures have identified Medicaid as their leading "budget buster," and are looking for any means possible to control costs. The Bush Administration is permitting benefit cutbacks, while many Governors and members of Congress are seeking to increase federal Medicaid funding in the midst of an already strained federal budget.
Are there effective methods to moderate the underlying health care costs for the Medicaid population? What policy tools are available to provide quality care to Medicaid beneficiaries at a price states and the federal government can afford?
These questions are addressed in the paper, Medicare Budget Options, which was presented at the Ninth Princeton Conference, Can Health Care Spending Be Contained?, June 6-8, 2002.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
April 2002
DHHS, Centers for Medicare and Medicaid Services
Lewin contact: Lisa Alecxih
As part of a CMS-funded study, case studies were conducted in Alabama, Indiana, Washington, Wisconsin, Maryland, Michigan, and Kentucky to assess the major features of the home and community-based services system for older people and younger adults with physical disabilities in each State. The case studies analyzed the financing of services; administrative systems; eligibility, assessment, and case management structures; the services provided, including consumer-directed home care and group residential care; cost-containment efforts; and quality assurance. The role that Medicaid plays in home and community-based services is a major focus of the study.
Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP
January 2002
Center for Health Care Strategies
Lewin contact: Lisa Chimento
This report, prepared by Mathematica Policy Research and The Lewin Group, is designed to help states focus their data collection and analysis and maximize the value of their investment in data. The report seeks to help states gain insight into what other states are doing, plan data collection and analysis efforts, and understand the strengths and drawbacks of specific data sources.
Expertise Area: Medicaid and CHIP
June 2001
Massachusetts Division of Medical Assistance
This study analyzes Medicaid payments made to acute care hospitals, non-acute hospitals, and community health centers licensed by the Massachusetts Department of Public Health. The study was commissioned through legislation that was passed in October 2000.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
June 2001
California HealthCare Foundation
Lewin contact: Lisa Chimento
The California HealthCare Foundation commissioned The Lewin Group to conduct a business case analysis of Health-e-App---an interactive, Web-based enrollment application designed to expedite and simplify the enrollment of children and pregnant women in California's Medi-Cal (Medicaid) and Healthy Families (SCHIP) programs.
Modeled on the state's four-page joint Medi-Cal and Healthy Families mail-in paper application, Health-e-App offers unique features like real-time preliminary program eligibility determination and application tracking that allows community-based enrollment workers to inform inquiring clients of the application's status at different points.
A pilot test of Health-e-App demonstrated that state-of-the-art technology can be applied to improve systems for enrolling low-income individuals in public health insurance programs and to enhance stakeholders' understanding of the entire application process.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
June 2001
California HealthCare Foundation
Lewin contact: Joel Menges
The study provides details on fee-for-service Medicaid payment rates for 50 common medical services, including office visits, surgeries, and tests. The report contains payment rates for all 50 states and the District of Columbia.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
May 2001
North Carolina General Assembly
In most states it is common to hear that the Medicaid program offers a "Cadillac" benefit package to its beneficiaries. In many ways this observation is true: Medicaid offers benefits unavailable in private insurance. But it is also true that the catchy use of the "Cadillac" comparison masks important points about Medicaid. For one, federal Medicaid law mandates that states offer certain services that exceed the benefits available through private health insurance plans. States must provide those federally mandated benefits. For another, the poverty and disability status of many Medicaid beneficiaries necessitates including services that are not needed by a generally healthier and wealthier population in a private insurance plan.
The North Carolina Medicaid Benefit Study was commissioned by the North Carolina Legislature to look in-depth at North Carolina's Medicaid benefit package. The Legislature wanted an independent expert review to know whether the process by which benefits are added to the Medicaid benefit package makes sense. It wanted to know how well these benefits are managed by the state's Medicaid agency. And the Legislature also wanted to know how North Carolina's benefit package and approach stack up against other state Medicaid programs, and to private insurers in North Carolina.
We found that the Medicaid program is managed by dedicated, skilled and professional public servants in both the Executive and Legislative branches of government. No matter how skilled the managers are, however, a state Medicaid benefit package inevitably looks "messier" than a private insurance product. For example, in North Carolina, as in other states, Medicaid benefits are added (and generally not actively managed) when the provider that is paid for the benefit is another public agency, such as a school (for special education services) or an Area Mental Health Authority (for behavioral health benefits). These decisions, which expand Medicaid far beyond commercial insurance, are typically motivated by a desire to access federal Medicaid funds to legitimately subsidize otherwise state-only funded health services. Over time the cumulative effect of these decisions can blur the line regarding whether the benefit package is designed to put a package of needed services around Medicaid beneficiaries or whether it is designed to support public providers with revenue.
In our review, we found features in North Carolina's Medicaid benefit process that could be improved, and that some changes could save over $130 million a year. The full report includes dozens of recommendations to improve the integrity of the program, its service to program beneficiaries, and its emphasis on cost containment.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
December 2000
DHHS, Centers for Medicare and Medicaid Services (CMS)
Lewin contact: Lisa Alecxih
The Centers for Medicare and Medicaid Services contracted with The Lewin Group, and its subcontractors, the Urban Institute, the University of Minnesota, Mathematica Policy Research, Inc., and the MEDSTAT Group, to design and implement a study of the impact of Medicaid home and community based services programs on quality of life, quality of care, utilization and cost. The research project is studying the financing and delivery of services to older and younger people with disabilities in seven states and the Medicaid financing and delivery of services for individuals with mental retardation and developmental disabilities (MR/DD) in six states.
Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP
November 2000
Idaho State Legislature Office of Performance Evaluations
This study assesses the management, oversight, and administration of the Idaho Medicaid program in key areas including utilization management, fiscal and budgetary control, veterans' homes, and Medicaid automated systems. The report identifies cost-savings opportunities for the state.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
November 2000
Center for Health Care Strategies
Lewin contact: Lisa Chimento
This analysis, commissioned by the Center for Health Care Strategies, estimates the quantitative and qualitative impacts of the proposed Medicaid BBA regulation on states and health plans. Key provisions addressed in the report include initial health assessments, complaints and grievances, and quality improvement studies.
Expertise Area: Medicaid and CHIP
June 2000
DHHS, Health Care Financing Administration (HCFA)
Lewin contact: Lisa Alecxih
This report reviews literature and provides a brief summary of current program statistics for the Medicaid 1915(c) Home and Community-Based Services (HCBS) Waiver program. The review is limited to literature specifically related to the 1915(c) waiver program and focuses on two categories of programs that constitute the majority of recipients and expenditures: programs serving aged individuals and individuals under age 65 with physical disabilities (A/D); and programs serving individuals with mental retardation or developmental disabilities (MR/DD).
The document addresses the following six areas:
History of the waiver program;
Current program characteristics;
The role of care management and consumer direction;
Issues related to quality of care and life in HCBS waivers;
Cost control mechanisms; and
Evaluations of cost savings associated with the waiver program.
Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP
May 2000
The Commonwealth Fund
This report explores six states' experiences with eligibility, outreach, and enrollment as they developed their State Child Health Insurance Program. It explores how the design and administration of state incremental insurance expansions affect access to health insurance coverage and, ultimately, access to all health care services. The study was intended to inform national policy discussion about these publicly financed expansions and to provide early feedback for states as they implement insurance programs for low-income families and individuals.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
April 2000
DHHS, Substance Abuse and Mental Health Services Administration (SAMHSA)
This report synthesizes the collective experiences of four managed behavioral health care organizations (MBHOs) that hold public sector managed care carve-out contracts. The views presented are those of representatives of the MBHOs who participated in a daylong focus group meeting.
Client Area: Federal Government
Expertise Area: Medicaid and CHIP, Mental Health and Substance Abuse
April 2000
DHHS, Center for Mental Health Services
This study sought to learn how schools and providers of school-based mental health services work with Medicaid managed care organizations. To that end, it observed the experiences of several States and local communities in providing for the inclusion of school-based mental health services in managed care contracts. The study also explored options and models for including school-based mental health services within managed care; examined financing and reimbursement issues that might affect the viability and expansion of such services; and assessed alternative ways to maintain and expand school-based mental health services within the managed care environment.
Client Area: Federal Government
Expertise Area: Medicaid and CHIP, Mental Health and Substance Abuse
March 2000
Medi-cal Policy Institute
Under the existing Medi-Cal managed care program, enrollees are free to disenroll from their existing health plan at any time – with the disenrollment becoming effective on the first of the upcoming or ensuing month. States have the option, under provisions of the Balanced Budget Act of 1997 (BBA), to restrict beneficiaries' latitude to voluntarily disenroll from their existing health plan. The Medi-Cal Policy Institute engaged The Lewin Group to evaluate the pros and cons of implementing this feature, known as "lock-in," in California.
The report contains an overview of the BBA provisions; an overview of state experiences and perspectives; data analysis of a lock-in policy for Medi-Cal; and pros and cons, and policy considerations of a lock-in policy for Medi-Cal.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
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