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Recommendations for Minnesota’s Personal Care Assistance Program: Final Report

July 2009

Minnesota Department of Human Services

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: Center on Aging and Disability, Medicaid and CHIP


Medicaid Non-Emergency Out-of-Network Payment Study

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


Comprehensive Application of Predictive Modeling to Reduce Overpayments in Medicare and Medicaid

June 2009

Lewin contact: Paul Hogan

Expertise Area: Medicaid and CHIP, Medicare


Recommendations for Minnesota’s Personal Care Assistance Program from PCA Provider Survey: Interim Report #3

June 2009

Minnesota Department of Human Services

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: Center on Aging and Disability, Medicaid and CHIP


Financial Impacts on Medicare Beneficiaries if Larger Part D Rebates Are Required for Medicare/Medicaid Dual Eligibles

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


Recommendations for Minnesota’s Personal Care Assistance Program From Focus Groups of PCA Consumers and PCAs: Interim Report #2

June 2009

Minnesota Department of Human Services

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: Center on Aging and Disability, Medicaid and CHIP


Recommendations from Evaluation of Current Service Authorization and Resource Allocation in Minnesota’s Personal Care Assistance Program: Interim Report #1

March 2009

Minnesota Department of Human Services

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: Center on Aging and Disability, Medicaid and CHIP


Medicaid Managed Care Cost Savings - A Synthesis of 24 Studies : Final Report

March 2009

America's Health Insurance Plans (AHIP)

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


Increasing Use of the Capitated Model for Dual Eligibles: Cost Savings Estimates and Public Policy Opportunities

November 2008

Association for Community Affiliated Plans; Medicaid Health Plans of America

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


Assessment of One-e-App: A Web-based Application and Enrollment Application for Public Health Insurance Programs

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

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