January 2013
New Hampshire Department of Health & Human Services (DHSS)
Lewin contact: Randy Haught
As a result of the June 2012 Supreme Court ruling that the federal government cannot require individual states to expand their Medicaid programs for adults under the Affordable Care Act (ACA), The Lewin Group is working with the New Hampshire Department of Health and Human Services (DHHS) to explore the potential financial impacts of expanding or not expanding the state’s Medicaid program.
Phase I of the study, released in November 2012, analyzes Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period.
This report represents Phase II of the study, where we estimate the secondary effects of expanding versus not expanding Medicaid in the state. We estimate the impact of Medicaid expansion versus no expansion on other state programs, the uninsured, various provider groups, the state economy, and the commercial market. Here, we find that deciding to expand or not expand Medicaid in New Hampshire will have impacts beyond the state’s Medicaid program itself. If expanding Medicaid under a fee-for-service program, the state will see offsets (savings) to other state programs totaling $67.1 million from 2014 to 2020, reducing the total cost of expanding Medicaid to $18.4 million over this period. If expanding Medicaid under a managed care program, the state would save $47.1 million from 2014 to 2020, compared to projected costs without the ACA.
Phase II findings also indicate that the ACA will have a measurable, positive impact on the state economy at large, and expanding Medicaid will maximize this impact. The impact on the uninsured, on providers, and on the commercial market should also be considered, as the decision to expand Medicaid affects these stakeholders and subgroups in different ways.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
November 2012
Health Strategies of New Hampshire
Lewin contact: Randy Haught
As a result of the June 2012 Supreme Court ruling that the federal government cannot require individual states to expand their Medicaid programs for adults, as under the Affordable Care Act (ACA), The Lewin Group is working with the New Hampshire Department of Health and Human Services (DHHS) to explore the potential financial impacts of expanding or not expanding the state’s Medicaid program. This report provides estimates on Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period.
In Phase II of the study, to be released in December 2012, Lewin will estimate the secondary effects of expanding versus not expanding Medicaid in the state. This will include the impact of additional federal revenues on the state economy if the state expands Medicaid, the impact on spending for other state programs, the impact on Medicaid Disproportionate Hospital Share (DSH) payments and provider uncompensated care, the financial impact on health care providers, and the potential impact on cost shifting and its effect on commercial premiums.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP, Health Reform
June 2010
City and County of San Francisco
The purpose of this study was to estimate a portion of the health-related economic costs of the measureable, direct effects of alcohol consumption to the City and County of San Francisco. These estimates will be used by the City to assess the public health impact of alcohol and inform policy surrounding an alcohol mitigation fee. There are two major components of this study:
- Cost Analysis: Using data collected from City, State and national data sources, we compute the costs of alcohol use to the City, including costs of City-funded alcohol treatment facilities, direct medical costs at City-operated health care facilities, and City paid fire and ambulance response to alcohol-related medical emergencies.
- Fee Calculation: Using alcohol consumption data from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and population estimates from the U.S. Census Bureau, we estimate the aggregate number of alcoholic drinks consumed in the City. We use this estimate to calculate a maximum fee per alcoholic drink (and an equivalent fee per fluid ounce of alcohol) which recovers a portion of the City’s total alcohol attributable costs.
Analyses are supported by a literature review and environmental scan.
Client Area: State and Local Governments
Expertise Area: Chronic Disease / Cost of Illness
June 2010
Missouri Department of Social Services
This report, prepared under contract to the Missoui Department of Social Services, MO HealthNet Division, focuses on organizational recommendations, as well as recommendations to improve MO HealthNet Program Integrity operations related to cost avoidance and recoveries. The report also provides recommendations to continue developing a collaborative relationship with Medicaid Fraud Control Unit (MFCU), best practices from other states, and Lewin's perspective on creating a new Office of Medicaid Program Integrity.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP, Program Integrity
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
April 2010
Missouri Department of Social Services
For the Missouri Department of Social Services, The Lewin Group examined high-cost individuals in the MO HealthNet program. For the analysis, Lewin evaluated high-cost individuals from two different perspectives: individuals whose claims history demonstrated unusually high use of certain services, specifically pharmacy, inpatient hospital and emergency room (ER) and individuals whose overall claims history demonstrated unusually high overall spending levels.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
April 2010
Missouri Department of Social Services
MO HealthNet retained The Lewin Group to conduct a comprehensive review of Missouri’s Medicaid program. The review included numerous interviews with Missouri officials, documentation review, and intensive data analysis. Specific areas of analysis included the pharmacy program, clinical services, long-term care, high volume providers, high cost participants, and non-emergency medical transport. The report includes a “big-picture” assessment of the Missouri Medicaid program and potential opportunities for organizational improvement.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
February 2010
Missouri Department of Social Services
For the Missouri Department of Social Services, The Lewin Group conducted a high-level review of MO HealthNet’s Non-Emergency Medical Transportion (NEMT) program. The review focused on the following questions: Should MO HealthNet continue to use actuarially-sound rates? What alternative reimbursement approaches might Missouri consider? What best practices have states implemented to oversee brokers and assure quality in their NEMT programs? What service or contract modifications Missouri might consider incorporating into its NEMT broker program?
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
January 2010
Missouri Department of Social Services
Under contract to the Missouri Department of Social Services, The Lewin Group conducted a review of selected areas of the MO HealthNet Clinical Services Program for potential short and longer-term cost-savings and areas in which operational effectiveness and efficiency could potentially be improved. The report focuses on the following areas: Inpatient Hospital, Outpatient Hospital, Chronic Care Improvement Program, Durable Medical Equipment, and Hospice.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
January 2010
Missouri Department of Social Services
The purpose of this report, prepared under contract to the Missouri Department of Social Services, is to present strategies for containing costs for Medicaid services in Missouri's Medicaid program, MO HealthNet. It includes short-term cost containment opportunities, as well as opportunities for operational improvement.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
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