Brief Description of Medicaid

1
Brief Description of Medicaid
Division of Health Policy and Finance
Andy Allison, Ph.D.

• Deputy Director

Kansas Health Policy Authority
March 21, 2006
Slide 1
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What is Medicaid?
Division of Health Policy and Finance

• In a twelve-month period, Medicaid and SCHIP will
  pay for health services or provide health
  insurance coverage for about 400,000 Kansans
• but this is more a statement of what Medicaid
  does than what it is.

Slide 2
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A Working Definition of Medicaid
Division of Health Policy and Finance

• Medicaid is an optional source of matching funds
  for states wishing to purchase healthcare for
  selected populations
• It is both a payment source and an insurance
  product
• Run by states, governed jointly
• Opting out is hard to do
• Strings are attached.lots of them

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What are the Federal rules?
Division of Health Policy and Finance

• Minimum eligibility requirements
• SSI and TAF recipients
• Children living in poverty
• Minimum requirements for benefits
• Comprehensive package
• All medically necessary care for children
• Rules of equity or health care policy
• statewideness
• freedom of choice

Slide 4
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What flexibility do States have?
Division of Health Policy and Finance

• Optional eligibility requirements
• Parents above 34 of poverty
• Children above poverty line (roughly)
• Individuals with specific health care needs
• Optional benefits
• Dental services for adults
• Service delivery mechanisms
• Managed care
• Consumer-driven approach

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How do States Make Medicaid Policy?
Division of Health Policy and Finance
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Division of Health Policy and Finance
Federal Laws
Medicaid Manual
Informal Guidance
Waivers
Regulations
CMS
Single State Agency Kansas Health Policy
Authority
Provider manuals Eligibility manuals MMIS payment
system
State Plan
State Laws
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How is Medicaid policy made in Kansas?
Division of Health Policy and Finance
Slide 8
9
Division of Health Policy and Finance
Slide 9
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Questions and Discussion
Division of Health Policy and Finance
Slide 10