Reports & Publications

August 2017
Pi-Ju Liu, Carrie Graham, Mel Neri, Austin Marshall, Winston Tseng, and Brooke Hollister
An image of the Cal MediConnect logo

The second in a series of research briefs by the UCSF Community Living Policy Center and the UC Berkeley Health Research for Action Center, this latest research brief examines the efforts of CMC health plans to coordinate behavioral health services for their beneficiaries. The brief describes the progress CMC plans have made toward better coordination of behavioral health services, including new integrated models of care, successful strategies, and ongoing challenges.

July 2017
Mary Lou Breslin
A map of the U.S. showing states with managed LTSS programs in blue and the other states in gray.

We reviewed managed long-term services and supports (LTSS) contracts for nine states in order to understand the extent to which they promote physical and programmatic accessibility for enrollees with disabilities. Medicare/Medicaid duals demonstration contracts for Virginia, Illinois, Massachusetts, Michigan, New York, and South Carolina contain provisions that represent a ground shift in federal expectations and requirements for physical and programmatic accessibility of managed care organizations (MCOs) and the providers with whom they contract.

July 2017
Carrie Graham, Holly Stewart, Elaine Kurtovich, and Pi-Ju Liu
The Disability and Health Journal logo
Background

In 2014 California implemented a federal dual alignment demonstration that used a capitated managed healthcare model called Cal MediConnect (CMC) to integrate medical care and long-term services and supports (LTSS) for beneficiaries with both Medicare and Medicaid. These beneficiaries often have complex care needs, including multiple chronic conditions and disabilities. By 2016, 120,000 eligible beneficiaries were enrolled in the program.

July 2017
H. Stephen Kaye
A line graph titled, "Figure 1. Average annual HCBS spending per non-I/DD enrollee, 2001–13, actual and reduced as if BCRA caps had been in place."  A blue line shows the average national per-enrollee HCBS spending for programs targeted to people without I/DD. Beginning in 2005, a green and a red line diverge from the blue line, showing the impact that per capita caps might have had.  By 2013, the green line is 23% lower and the red line 30% lower than the blue line.

The Better Care Reconciliation Act (BCRA) proposes to cap Federal Medicaid reimbursements to the states on a per-enrollee basis, effectively limiting growth to a rate at first only modestly exceeding the rate of inflation in healthcare costs and then falling below inflation. If the BCRA were to be enacted, it is reasonable to assume that most states would limit home and community-based services (HCBS) spending to the per-enrollee cap amount; otherwise, any excess comes entirely out of the state budget.

June 2017
H. Stephen Kaye
A line graph showing the divergence between actual average HCBS spending in 2001-13 with the amounts calculated if AHCA-like caps had been in place.

AN UPDATED VERSION OF THIS REPORT, BASED ON THE SENATE'S DRAFT BETTER CARE RECONCILIATION ACT, IS NOW AVAILABLE.

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