Publications

Initial Results and Evaluation Design for the SSA Medicare Part B Buy-in Demonstration

June 2000

SSA was mandated to conduct a demonstration to test outreach and application methods for enrollment in Medicare Part B Buy-in programs in which state Medicaid programs pay for Medicare Part B premiums and possibly Medicare copayments and deductibles for low income beneficiaries. The demonstration included mailing letters to all potentially eligible individuals in eleven sites in six states informing them of the benefits and asking them to contact SSA. Of the nearly 240,000 letters mailed, approximately six percent responded and 61 percent appeared to meet the required income and asset limits. Depending upon the site, one of the three models for application referral and intake were employed: 1) Screening Only, where potential eligibles were made an appointment with the local Medicaid or welfare office; 2) Co-location, where a state Medicaid or welfare worker was onsite at the SSA office; and 3) Application, where SSA staff filled out state application forms and forwarded them to the state for processing. This report describes the demonstration, documents its implementation, presents descriptive analyses of individuals targeted for the program, and discusses our plans for assessing the effectiveness of the models. The key process lessons include the need for clear communication among all parties involved in the demonstration; a well-defined liaison role to resolve implementation problems efficiently; accountability on the part of the central office and the field offices participating in the demonstration; adequate training; local flexibility in implementation strategy; and commitment from major players.

Client Area: Federal Government
Expertise Area: Medicare

Review of the Medicaid 1915(c) Home and Community Based Services Waiver Program Literature and Program Data

June 2000

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

A Survey of Employers Offering Group Long-Term Care Insurance to Their Employees

June 2000

This report presents findings from a survey of employers offering long term care (LTC) insurance to their employees. The survey found that the employer LTC insurance market provides greater access to coverage than the individual LTC insurance market by providing opportunities to avoid extensive medical underwriting. Employers identified simplicity of plan design (most importantly, limiting the number of choices employees face) and employee education as factors critical to the success of a LTC insurance offering.

Client Area: Federal Government
Expertise Area: Aging and Disability

The Economic Cost of Mental Illness, 1992

May 2000

The aim of this study is to identify and quantify the adverse impacts of mental illness and sum together the magnitude of these consequences using economic values—in dollars. This report estimates the direct economic impact of mental illness for 1992 and for 1995.

Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness, Mental Health and Substance Abuse

Evaluating Community Collaborations: A Research Synthesis

April 2000

An interagency federal working group is planning a demonstration to address the intersection of domestic violence and child abuse. The demonstration, to be implemented in five communities, will involve the active collaboration between three service systems: the child protection system, the network of domestic violence providers, and the court system. The Lewin Group was hired to prepare a synthesis of issues pertaining to the evaluation of community collaborations. This research synthesis draws on the evaluation literature to identify the major challenges of evaluating collaborations, discuss approaches for addressing them, and suggest implications for the planned evaluation.

Client Area: Federal Government
Expertise Area: Children, Youth, and Family Policy

The Potential of the Child Support Enforcement Program to Avoid Costs to Public Programs: A Review and Synthesis of the Literature

April 2000

The U.S. Department of Health and Human Services contracted with The Lewin Group and Johns Hopkins University to synthesize the literature on child support cost avoidance and to identify areas where additional research is required. The major components of this report are a synthesis of the literature on cost avoidance and an annotated bibliography of cost avoidance studies and related studies that contribute to the methodology of measuring cost avoidance -- e.g., studies on compliance, child support review and adjustment efforts, the behavioral implications of child support policies, microsimulation models and their current and future capacity to estimate cost avoidance, and the use of administrative data to measure cost avoidance. The report also contains a summary of additional research that is needed and recommendations about the most promising strategies for expanding our knowledge about cost avoidance.

Client Area: Federal Government
Expertise Area: Income Security

Contracting for Public Mental Health Services: Opinions of Managed Behavioral Health Care Organizations

April 2000

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

School-Based Mental Health Services under Medicaid Managed Care

April 2000

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

Success in the New Welfare Environment: An Assessment of Approaches in HUD's Employment and Training Initiatives

March 2000

Interest in work and self-sufficiency among welfare recipients was heightened among government officials, social service providers, academics, and the general public when Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act (PWRORA), which changed the focus of the welfare system from income support to work. One agency affected by welfare reform is the U.S. Department of Housing and Urban Development (HUD). The transformation of the welfare system presented HUD with an important opportunity to conduct a preliminary assessment of its programs. As a result, HUD contracted with ICF Consulting and the Lewin Group to review the employment and training components of 13 HUD programs. This study assessed HUD's efforts to help residents transition from welfare to work. The study focuses on the following questions: What are the specific service components of HUD employment and training programs? To what extent are the practices consistent with the research on the effectiveness of those service approaches? What is the nature of the linkages between the HUD programs and the programs being provided through the larger human services and employment and training systems in the community?

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Using Case Mix Adjustment Methods to Measure the Effectiveness of Substance Abuse Treatment: Three Examples Using Client Employment Outcomes

March 2000

The increasing emphasis on fiscal responsibility and accountability has led the Federal government, States, and managed care entities to increase efforts to identify cost-effective health care providers. This report addresses some of the potential challenges of measuring the effectiveness of substance abuse treatment across providers and highlights the importance of controlling for differences in the characteristics of clients treated by each provider (i.e., provider case mix).

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse