May 2010
Prepared for the Congress of California Seniors
Lewin Contact: Lisa Alecxih
This study estimates the potential State revenue impacts associated with the proposed elimination of the Medi-Cal ADHC program. While the proposed elimination of the Medi-Cal ADHC program would save direct expenses on the program, policymakers should also consider the potential negative impacts of the elimination on cost-shifting to other more expensive care settings, loss of jobs among ADHC employees, reductions in family caregivers’ ability to work, loss of State tax revenue, forfeiting $164 million annually in federal Medicaid matching funds and economic impact on local businesses and other entities that would lose revenue from the elimination of adult day health care providers.
Client Area: Foundations, State and Local Governments
Expertise Area: Aging and Disability
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
October 2009
Colorado Department of Human Services
Lewin Contact: Sam Elkin
This annual report presents the findings from the Colorado Works Evaluation from activities conducted during State Fiscal Year 2009. In 2005, the Colorado Department of Human Services contracted with The Lewin Group and its partners, the University of Colorado’s Health Sciences Center, the Johns Hopkins University’s Institute for Policy Studies, and Capital Research Corporation, to perform an in-depth study of the state’s Temporary Assistance for Needy Families program. This report examines caseload trends, work participation, employment outcomes of program participants and leavers, and service delivery variation across Colorado counties. It reviews TANF trends and outcomes in light of the recession.
Client Area: State and Local Governments
Expertise Area: Income Security
July 2009
Colorado Department of Human Services
Lewin contact: Sam Elkin
This report explores why former welfare recipients in Colorado left the Colorado Works program and how they fare after exiting. It is part of a multi-year, in-depth study The Lewin Group conducted for the Colorado Department of Human Services (CDHS). The analysis in this report relies primarily on data from a survey of 494 individuals who had been on single-parent Colorado Works cases and left the program during the first three months of 2007. Survey Research Management conducted the survey for Lewin. The survey occurred in August through November of 2008, which was between 17 and 23 months after the individuals surveyed had left Colorado Works. The paper covers characteristics of this sample of welfare leavers; their reasons for leaving the program; the extent to which they have returned to TANF in Colorado or elsewhere; employment outcomes of the group; characteristics of the jobs held by those who are working; sources of income, including earnings of spouses, partners, or other household members, and benefits from other government programs; and indicators of well being, such as food security, mental health, and health insurance coverage. The paper gives particular attention to the outcomes of Colorado Works leavers who were neither working nor receiving TANF benefits at the time of the survey.
Client Area: State and Local Governments
Expertise Area: Income Security
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
Colorado Department of Human Services
Colorado counties have used the TANF block grant in a number of ways to reach a population beyond those served by basic cash assistance This issue brief outlines ways in which counties may use their TANF funds to assist needy families in their communities and highlights promising practices and strategies from across the state.
The brief is a part of a five-year evaluation of Colorado Works, the state's TANF program, that The Lewin Group and its partners, University of Colorado's Health Sciences Center, The Johns Hopkins University's Institute for Policy Studies, and Capital Research Corporation, are conducting for the Colorado Department of Human Services.
Client Area: State and Local Governments
Expertise Area: Income Security
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
April 2009
Colorado Department of Human Services
This issue brief provides analysis of employment and earnings outcomes of individuals who received welfare in Colorado since 2005, based on wage records from Colorado’s Unemployment Insurance Program. The brief is a part of a five-year evaluation of Colorado Works, the state's TANF program, that The Lewin Group and its partners, University of Colorado's Health Sciences Center, The Johns Hopkins University's Institute for Policy Studies, and Capital Research Corporation, are conducting for the Colorado Department of Human Services. The brief shows that between 2005 and 2008, about a third of Colorado Works participants worked while on welfare, and had relatively low earnings during that period. Those who left welfare worked at higher rates, but the consistency of their employment varied. Earnings increased overall in the two years following exit, though remained low. About 10 percent earned $20,000 or more in the first and second years after leaving Colorado Works. Among certain subgroups, including those with fewer months of welfare and those with older children, larger shares of individuals earned $20,000 or more.
Client Area: State and Local Governments
Expertise Area: Income Security
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
December 2008
Colorado Department of Human Services
This report summarizes the findings from the past year’s work on the Colorado Works Program Evaluation. It presents and updates analysis of longitudinal data on TANF caseload trends, work activity participation rates, and employment and earnings outcomes of welfare participants; presents findings on county policies, strategies, and activities from a survey of county TANF directors; and analyzes client interactions with other social service agencies including the Child Support Enforcement Division and Child Welfare.
Client Area: State and Local Governments
Expertise Area: Income Security
December 2008
Colorado Department of Human Services
This report summarizes statistical models The Lewin Group developed to explain the determinants of caseload trends in the Colorado Works program from July 1998 through December 2007. Using regression analysis, equations were developed to estimate the size of the Colorado Works monthly caseload based on the Colorado economy, Colorado Works program characteristics, and other factors. Separate models of caseload size were developed for one-parent families, two-parent families, and child-only cases. In addition, models were also developed of monthly entries and exits for one-parent cases, and county-level models of the one-parent caseload for the five largest counties. Models were estimated using data from July 1999 through December 2007. Among the findings: Unemployment rate is the key factor affecting the size of the one-parent and two-parent caseloads. The caseload in a month is affected by the unemployment rate up to 24 months earlier. Several Colorado Works and federal policy variables also had a statistically significant effect on the size of the caseload.
Client Area: State and Local Governments
Expertise Area: Income Security
May 2008
California Division of Workers' Compensation
Lewin contact: Pete Welch
The Lewin Group was commissioned by the California Division of Workers' Compensation to evaluate the impact of switching from the current physician fee schedule to a physician fee schedule based on the Resource-Based Relative Value Scale (RBRVS) system. The current physician fee schedule requires physicians and selected health care providers to use codes and descriptors of the 1997 edition of the American Medical Association's Current Procedural Terminology to bill for their services while the RBRVS-based system bases payments for medical treatment on the resources used to provide services. The Lewin Group study reports on the impact of changing to an RBRVS-based fee schedule by estimating payments under both the current physician fee schedule and an RBRVS-based system for the same set of services.
Client Area: State and Local Governments
April 2008
Colorado Department of Human Services
The enactment of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) provided states with considerable flexibility to design their own welfare programs. The result was an increase in the variation between states’ welfare programs. In an effort to understand how Colorado’s TANF program compares to other programs across the country, the Colorado Department of Human Services (CDHS) commissioned The Lewin Group and its partners—the University of Colorado’s Health Sciences Center (UCHSC), the Johns Hopkins University’s Institute for Policy Studies (JHU), and Capital Research Corporation (CRC)—to perform an in-depth study of Colorado’s TANF program (Colorado Works) on a variety of different dimensions. This report examines how Colorado compares with other states on dimensions such as caseload changes, program expenditures, eligibility requirements and benefits, work requirements, financial incentives to work, sanctions, work participation rates, employment outcomes, and diversion policies.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security
December 2007
Colorado Blue Ribbon Commission for Health Care Reform
Lewin contact: John Sheils
The Lewin Group was engaged by the Colorado Blue Ribbon Commission for Health Reform to assist in developing and analyzing alternative proposals to expand health insurance coverage and reform the Colorado health care system. Lewin first developed a “baseline” projection of what health care coverage and costs would be in Colorado in 2008 under current law for major stakeholder groups, including governments, providers, employers and families. Lewin then estimated the cost and coverage effects of several proposals to expand insurance coverage for major stakeholder groups in Colorado.
Client Area: State and Local Governments
Expertise Area: Health Reform
December 2007
Colorado Department of Human Services
Federal TANF funds can be used for a range of cash and non-cash services to needy low-income families with children, including cash benefits, employment services, child care, and other support services, and services intended to prevent families from requiring monthly cash benefits. In Colorado, the federal TANF block grant and the related supplemental funds are used, along with state and county funds, to operate the Colorado Works program. This report describes the general trends in Colorado Works spending between 2000 and 2006 as well as county expenditures of Colorado Works funds, including basic cash assistance, non-cash assistance, and reserve amounts.
Client Area: State and Local Governments
Expertise Area: Income Security
December 2007
San Francisco Department of Public Health
The Lewin Group recently performed strategic planning for San Francisco's Department of Public Health and Office of the Controller in preparation for implementation of the City's Healthy San Francisco initiative, a program to insure all San Francisco adult uninsured. Key areas of The Lewin Group’s work performed for the City were: projecting demand for health services under Healthy San Francisco, analyzing the Department of Public Health’s capacity to take new patients and meet the service demands, modeling the impact of changes in fees for the safety-net population, and analyzing a ‘one-stop’ web-based eligibility and enrollment system called One-e-App, which is used by other California counties for health and welfare client program management. The Lewin Group’s analyses and recommendations were also presented at the San Francisco Health Commission.
Client Area: State and Local Governments
Expertise Area: Community Health Needs Assessment
December 2007
Colorado Department of Human Services
The Deficit Reduction Act of 2005 (DRA) reauthorized the TANF program and made policy changes that increased the effective work participation rates that states must meet to avoid a financial penalty. In Colorado, counties have been reassessing strategies to meet federal requirements while still providing services and benefits to clients that best help them to meet their immediate needs and overcome barriers to longer-term self-sufficiency. This report examines three related topics affecting participation and engagement in Colorado’s TANF program. They are: (1) Work participation activities and strategies; (2) Diversion policies among Colorado’s counties; and (3) Sanctioning practices in Colorado.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security
December 2007
San Francisco Department of Public Health
The Office of the Controller of the City and County of San Francisco, and the San Francisco Department of Public Health commissioned The Lewin Group to conduct a local market assessment and benchmarking analysis. The market assessment analyzes the current health care environment in the city, makes projections of demand for healthcare services, and examines the role of the Department of Public Health, in providing direct healthcare to San Franciscans. The benchmarking analysis compares San Francisco General Hospital with comparable Bay Area, California and national public healthcare delivery systems across measures designed to assess efficiency and effectiveness. The benchmarking analysis also identifies best practices contributing to the success of the benchmark safety net systems.
Client Area: State and Local Governments
Expertise Area: Community Health Needs Assessment
October 2007
Colorado Department of Human Services
This report summarizes the findings from the past year’s work on the Colorado Works Program Evaluation. It presents and updates longitudinal data analysis of the TANF receipt and employment outcomes among welfare recipients. It also analyzes client interactions with other social service agencies including child support services and child care services. It also summarizes special topic reports examining program participation and fiscal trends, which were conducted throughout the year.
Client Area: State and Local Governments
Expertise Area: Income Security
September 2007
Colorado Department of Human Services
This report presents findings from focus groups that were conducted with 78 current and past TANF recipients in four Colorado counties. The focus groups provide the clients’ perspective about their experiences on welfare and how participation in various services may have contributed to their long-term self-sufficiency. The report focuses on seven key topic areas: (1) Reasons for TANF application, (2) Application and eligibility determination process, (3) Views on diversion, (4) Views on services provided by staff, (5) Views on services received through TANF offices and Workforce Centers, (6) Work participation requirements and time limits, and (7) Long-term self-sufficiency.
Client Area: State and Local Governments
Expertise Area: Income Security
August 2007
Colorado Department of Human Services
The purpose of this study is to examine Colorado employers’ experiences with welfare recipients they have hired for low-skill, entry-level jobs. The research gathers information on the characteristics of employers and the low-skill workforce, employer hiring practices, staffing needs, overall employer satisfaction, and employer feedback on county Colorado Works offices and workforce centers operated under local Workforce Investment Boards. The survey provides information about the extent to which the Colorado Works program and the clients are able to meet employer needs.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security
May 2007
Hawaii Department of Human Services
Lewin contact: Karen Gardiner
The Hawaii Department of Human services (DHS) currently uses the Temporary Assistance for Needy Families block grant to fund a diverse set of positive youth development programs to prevent teenage pregnancy and other behaviors that can negatively affect a successful transition to adulthood. DHS contracted with The Lewin Group to develop objective criteria for measuring the effectiveness of these programs. The key project tasks were a literature review, field research, and development of performance measures.
Client Area: State and Local Governments
Expertise Area: Children, Youth, and Family Policy
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
District of Columbia Child Support Services Division
In 2004, the District of Columbia’s Child Support Services Division (CSSD) launched a demonstration to improve collaboration between the child support agency and the Temporary Assistance for Needy Families (TANF) agency and reduce the number of TANF clients who failed to attend scheduled child support intake appointments, the first step to establishing a child support order. To accomplish this goal, child support intake workers were co-located at the TANF office in the Anacostia neighborhood. CSSD contracted with The Lewin Group to develop the demonstration and conduct the evaluation. To measure the effect of the intervention, individuals applying for TANF or visiting the office for recertification were randomly assigned to a treatment or control group. Treatment group members received child support services at the TANF office, while control group members followed the standard procedure for child support intake, which involved an in-person interview at the CSSD headquarters. The impact study found that the demonstration produced a significant increase in paternities and orders established; impacts on child support payments began to emerge after 12 months.
Client Area: State and Local Governments
Expertise Area: Income Security
September 2006
Colorado Department of Human Services
his report summarizes the findings from the past year’s work on the Colorado Works Program Evaluation. It provides policy analysis of the Colorado Works program as well as descriptions of the local socioeconomic trends. It presents longitudinal data analysis of the TANF receipt and interactions among welfare recipients. It also summarizes special topic reports examining service delivery strategies and practices, which were conducted throughout the year. These include program coordination and collaboration, employment services and employer interactions, preventative services, and serving the hard-to-employ.
Client Area: State and Local Governments
Expertise Area: Income Security
September 2006
Marin County
Lewin contact: Lisa Chimento
This report was commissioned by Marin County to analyze the services provided at Marin General Hospital and the extent to which County residents and County government rely on the hospital to meet health care needs. The report's recommendations are designed to help assure that health services in Marin are accessible and effective for all consumers.
Client Area: State and Local Governments
August 2006
Rhode Island Office of the Health Insurance Commissioner
The Office of the Health Insurance Commissioner (OHIC) commissioned The Lewin Group to assess the surplus levels of Rhode Island’s three health plans, Blue Cross Blue Shield of Rhode Island, United HealthCare of New England and Neighborhood Health Plan of Rhode Island, pursuant to requirements of the Rhode Island Health Care Reform Act of 2004. The legislature asked OHIC to provide recommendations for what appropriate insurance surplus reserve levels might be for health insurers in Rhode Island. Lewin conducted this study to assess whether Rhode Island's three health plans have surplus levels within appropriate ranges, given the special circumstances of the individual plans and the Rhode Island market. To assess the sufficiency of surplus of health plans in the state, Lewin conducted a series of analyses in which we applied existing models for assessing health plan solvency. We also performed a detailed analysis of the financial experience of the three key insurers in Rhode Island. Lewin drafted and presented oral testimony for use at public forums convened by the Rhode Island Insurance Commissioner. Finally, Lewin drafted a final report that summarized key findings, addresses substantive issues raised during the forums, and made recommendations for action related to health plan surplus. Please click on the links for the Reserves Report Preliminary Findings, and the individual reports for Blue Cross Blue Shield of Rhode Island, United HealthCare of New England and Neighborhood Health Plan of Rhode Island.
Client Area: State and Local Governments
June 2006
Colorado Department of Human Services
This report describes employment services in local Colorado Works programs, particularly strategies that involve interaction with employers and industries, highlighting promising practices for other programs. It finds that the most common employment-specific activities in Colorado counties are (1) job readiness workshops that generally include some guided job search activity, and (2) work experience activities. It also finds that counties generally tailor their employment services to local labor market trends, working with both public and nonprofit agencies as well as private sector business when possible. Finally, several county programs are found to have developed large and formal networks of employers for such employment activities which may serve as a model for other counties.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security
June 2006
Colorado Department of Human Services
In Colorado, county human service and social service departments provide a range of programs for adults, youth and relative caretakers to help stabilize families, increase self-sufficiency, and prevent the intergenerational transmission of welfare dependency. This report provides an overview of services offered in Colorado. The report also highlights three broad areas of innovative family-related and prevention services, including collaborations with child welfare and other efforts to prevent out-of-home placements, programs designed to increase child well-being through parental involvement and access to quality child care, and a broad array of youth programs including non-marital pregnancy prevention programs, summer employment and training initiatives, and in-school services for high-risk youth.
Client Area: State and Local Governments
Expertise Area: Children, Youth, and Family Policy, Income Security
June 2006
Colorado Department of Human Services
This report examines the variety of cross-agency collaboration and coordination strategies used by county Colorado Works/TANF programs across the state. Based primarily upon information collected during site visits to 18 Colorado Works county programs, this report focuses on collaborative arrangements in two major areas: (1) partnerships with local Workforce Centers and other community organizations to obtain employment, education, and training services; and (2) collaboration with other public agencies and private organizations to obtain a wide array of support services. The report finds that program coordination is extensive and that there is wide variation in the network of collaboration across Colorado counties.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security
June 2006
Colorado Department of Human Services
This report examines strategies Colorado counties were using to serve the hard-to-employ TANF population in 2005, highlighting promising approaches that counties might choose to adopt and providing the state with useful information that can help guide future policy choices. While there are a wide range of issues that affect welfare recipients’ ability to succeed in the job market, this report focuses on seven barriers: 1) Physical disabilities; 2) Limited education and learning disabilities; 3) Mental health; 4) Substance abuse; 5) Domestic violence; 6) Limited English skills; and 7) Homelessness.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security
June 2006
Mississippi Office of the Governor, Division of Medicaid
Lewin contact: John Sheils
The Lewin Group developed an analysis of options to expand coverage to the uninsured in the state of Mississippi and estimated their impact on government spending, employers and households. The policy options included in the analysis were selected to cover the range of policy recommendations developed under the Mississippi State Planning Grant project. These policy options include expanding coverage under public programs, expanding private insurance coverage and universal coverage options.
Client Area: State and Local Governments
Expertise Area: Health Reform
April 2006
North Carolina Department of Health and Human Services
Lewin contact: Lisa Alecxih
North Carolina offers an array of long term care (LTC) services for Medicaid beneficiaries. In 2004, House Bill 1414 directed the state’s Depart.ment of Health and Human Services to commission a study of whether an institutional bias exists in Medicaid-financed LTC services. In 2001, North Carolina’s Institute of Medicine presented a General Assembly-commissioned report entitled “A Long Term Care Plan for North Carolina.” The report outlined barriers in state LTC policy and practices and offered recommendations to the State on how to improve the LTC delivery system. This study builds on those findings and recommendations and offers an updated look at North Carolina’s Medicaid LTC system
Client Area: State and Local Governments
Expertise Area: Aging and Disability
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
October 2005
Colorado Department of Human Services
The State of Colorado’s Department of Human Services funded The Lewin Group to perform an in-depth study of Colorado’s TANF program, Colorado Works. The objective is to provide administrators with information about program strategies and approaches being used in various counties that others might find useful for improving program implementation, performance, and outcomes. This report summarizes findings from a survey of county Colorado Works directors conducted in 2005. It documents the diversity of the policies, organization and staffing approaches, and activities and services found across the state.
Client Area: State and Local Governments
Expertise Area: Income Security
July 2005
Marin Healthcare District
Lewin contact: Lisa Chimento
For the Marin Healthcare District, The Lewin Group conducted a strategic assessment of options for the future of Marin General Hospital. This report describes the assessment methodology and presents the Lewin Team's findings and conclusions.
Client Area: State and Local Governments
June 2005
Pennsylvania Legislative Budget and Finance Committee
Lewin contact: Lisa Chimento
In the last few years, the public's focus on the financial activities of Blue Cross and Blue Shield plans has intensified. First, the Blues nationwide started seeing large increases in their earnings. Second, the economy softened at the same time that health care costs swelled. In Pennsylvania, as in other states nationwide, this increased the numbers of uninsured and made it harder for those having insurance to afford it. Some stakeholders argued that the Blues should give up portions of their surpluses to help make health coverage more affordable.
The Pennsylvania Legislative Budget and Finance Committee commissioned The Lewin Group, pursuant to House Resolution No. 865, to conduct a study of the regulation and disposition of reserves and surpluses of health insurers in Pennsylvania—specifically the four Blue Cross and Blue Shield plans in the state. The report is divided according to the two central topics: the issue of the Blues' reserves and surpluses, (including an analysis of measures already taken to regulate the Pennsylvania Blues' reserves and surpluses, and other states' laws and practices) and an assessment of the Blues' community benefit spending and activities, along similar dimensions.
Client Area: State and Local Governments
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
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
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
June 2004
Save Our ERs Coalition
Lewin contact: Terry West
In recent years, Harris County's emergency care system has become increasingly overburdened by growing emergancy department volume. The Lewin Group was commissioned by the Save Our ERs coalition to assist them in creating a framework for revisioning the organization and delivery of health care services in Harris County be developing and examining three conceptually distinct and credible options for reconfiguring care to safety net populations in Harris County, arrayed by degree of system reorganization and resources required.
Client Area: State and Local Governments
Expertise Area: Health Reform
March 2004
Maryland Health Care Commission
Over the past few years, the Maryland Health Care Commission (MHCC) has undertaken several public reporting initiatives to assist the general public in making informed health care decisions. The Maryland General Assembly authorized the MHCC to produce several state sponsored online health care reports, including the Maryland Hospital and Nursing Home Performance Evaluation Guides, in January 2002 and August 2001, respectively.
Since the Guides were released, feedback has been primarily anecdotal. In its
Client Area: State and Local Governments
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
December 2003
New York State Insurance Department
The State of New York launched the Healthy New York program in January 2001 to give working families access to affordable health insurance coverage. The Lewin Study examines the impact of Healthy NY and analyzes the enrollment, premium costs, cost experience by the HMOs, surveys the enrollees and gathers input from participating employers and participating health plans.
Client Area: State and Local Governments
Expertise Area: Health Reform
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
Washington State Employment Security Department
Washington State implemented its WorkFirst Post-Employment Labor Exchange (WPLEX) in 1998 to provide post-employment services through a centralized call center. Staff contact individuals to provide them with guidance on career advancement, tips on specific job opportunities in the customer's labor market, vouchers for certain support services, and referral to social services and education providers. Washington's Employment Security Department hired The Lewin Group and its subcontractor, Cornell University, to conduct an evaluation of WPLEX. This report presents an overview of the program, an in-depth examination of the program's implementation and costs, and analysis of the effectiveness of WPLEX in moving individuals from welfare to work.
Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development
March 2003
Office of the California Attorney General
This report, prepared for the Office of the California Attorney General, assesses the potential effects of the acquisition of the University of Southern California – Kenneth Norris Jr. Cancer Hospital, a California nonprofit public benefit corporation, by Tenet Healthcare Corporation on the availability and accessibility of health care services.
Client Area: State and Local Governments
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
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
November 2002
Wisconsin Legislative Audit Bureau
Lewin contact: Lisa Alecxih
This third implementation report for the Wisconsin Legislative Audit Bureau regarding the Family Care program serves as an update to The Lewin Group's August 2001 report. It notes the progress made in implementing the Family Care model in the pilot counties, as well as issues the State and the counties will need to address as program expansion is considered.
Client Area: State and Local Governments
Expertise Area: Aging and Disability
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
April 2002
California Health and Human Services Agency
Lewin contact: John Sheils
The California Health and Human Services Agency engaged The Lewin Group to analyze the cost and coverage impacts of nine proposals to expand health insurance coverage in the state. The analysis included estimating the portion of the 6.6 million uninsured persons in California who would become insured under each proposal.
Client Area: State and Local Governments
Expertise Area: Health Reform
March 2002
South Dakota Department of Health
Lewin contact: John Sheils
In 2001 South Dakota was one of nine states awarded one-year grants from the federal Health Resources and Services Administration (HRSA) to conduct a survey and study of the state's uninsured population. The state contracted with The Lewin Group to conduct the survey which included statewide telephone surveys of more than 20,000 households and also of 401 South Dakota employers. Eight focus group interviews were also conducted with selected high-risk populations such as farmers and ranchers, Native Americans and low-income households.
Client Area: State and Local Governments
Expertise Area: Health Reform
November 2001
California Office of the Attorney General
This report, prepared for the Office of the California Attorney General assesses the potential effects of the acquisition of Daniel Freeman Hospitals, Inc., owner of Daniel Freeman Memorial Hospital (Inglewood, CA) and Daniel Freeman Marina Hospital (Marina del Rey, CA) by Tenet Healthcare Corporation on the availability and accessibility of health care services.
Client Area: State and Local Governments
October 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
The Lewin Group assisted the state of Vermont in developing options to expand insurance coverage in the state under the recent State Planning Grant program funded through the Health Resources and Services Administration (HRSA). This report describes the activities conducted to research the characteristics of uninsured Vermonters and the current state of the insurance, employer, and health care provider marketplaces. Additionally, this report contains the findings of the research as well as a summary of the various options developed under the HRSA grant.
Client Area: State and Local Governments
Expertise Area: Health Reform
September 2001
New York State Department of Civil Service
In January 1998, the New York Department of Civil Service implemented an integrated workers' compensation/health plan prescription benefit called "ONECARD Rx," which allows New York State employees to pay for WC prescription drug needs. The Lewin Group performed an evaluation of the benefit to measure cost effectiveness, quality of care received under benefit, and the feasibility of transferring the benefit concept to other WC health benefits and other employers. The evaluation found that the benefit can reduce health plan costs, and that workers and employers would likely gain from widespread adoption of the benefit.
Client Area: State and Local Governments
August 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
For the state of Vermont, The Lewin Group explored the expected costs and impacts of a single-payer program in which all state residents are covered under a single public program funded primarily with an employer payroll tax.
This report presents The Lewin Group's analysis of the financial impact of a single-payer program on various payers for health care including state, local, and federal governments. It includes estimates of the financial impact of the proposal on employers by industry and firm size, and of the impact of the plan on household health spending by age, income level, and other characteristics.
Client Area: State and Local Governments
Expertise Area: Health Reform
August 2001
Wisconsin Legislative Audit Bureau
Lewin contact: Lisa Alecxih
In its second report for the Wisconsin Legislative Audit Bureau regarding the Family Care program, the Lewin Group notes that since its first report in November 2000, the Department of Health and Family Services and the pilot counties made considerable progress in implementing Family Care. Based on information through June 2001, the pilot counties demonstrated different stages of program processes, capacity, and enrollment. In January 2002, the counties will implement a final program element, an independent enrollment broker, as proposed by the Department and approved by the federal government. The report points out a number of areas that need to be addressed as the pilots continue, including outreach, provider relations, care management, quality assurance, and cost.
Client Area: State and Local Governments
Expertise Area: Aging and Disability
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
May 2001
California Office of the Attorney General
This report, prepared for the California Office of the Attorney General, assesses the potential effects of the proposed transfer of control of St. Luke’s Hospital to Sutter Health on the availability and the accessibility of health care services.
Client Area: State and Local Governments
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
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
Wisconsin Legislative Audit Bureau
Family Care is an innovative, system redesign experiment designed to improve Wisconsin?s long-term care (LTC) system. Family Care creates two new community organizations, a Resource Center (RC) to provide one-stop shopping for information and assistance in obtaining services, and a Care Management Organization (CMO) to help arrange and manage services. The program also introduces managed care principles to control escalating costs. If the program achieves its goals, the new long-term care system will provide elderly and adult individuals with physical or developmental disabilities with greater access to flexible services that promote independence and facilitate a higher quality of life.
The Wisconsin Legislative Audit Bureau contracted with The Lewin Group to evaluate the Family Care pilot program. This report completes the first stage of the project, which was a process evaluation. The second stage will be the development of an impact evaluation, which will assess the extent to which the pilot projects are meeting the stated goals of Family Care. The final stage of the evaluation will assess the benefits and costs of the program This report contains background information on the Family Care program as a whole, as well as evaluative information on the development of each pilot project. The report also contains a glossary of terms and a research methodology section that demonstrates the contacts made in the five pilot counties?Fond du Lac, La Crosse, Milwaukee, Portage and Richland?in order to assess the current status of the Family Care program.
Client Area: State and Local Governments
Expertise Area: Aging and Disability
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