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HMA Insights puts the vast depth of HMA’s expertise at your fingertips, helping you stay informed about the latest healthcare trends and topics. Below, you can easily search based on your topic of interest to find useful information from our blogs, webinars, case studies, reports and more.

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111 Results found.

Brief & Report

Report Evaluates Uncompensated Care and Medicaid Payments in Texas Hospitals

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HMA was engaged by the Texas Health and Human Services Commission to perform an independent evaluation of Texas’ Uncompensated Care Pool, as required under the Special Terms and Conditions (STCs) of the State’s Section 1115 waiver, to submit to the Centers for Medicare and Medicaid Services (CMS). The report was submitted to CMS on August 31st.

Consistent with the approach it has taken in other states that operate uncompensated care pools, CMS required Texas to commission a detailed analysis of the state’s uncompensated care costs, payments and the impact of environmental factors and potential policy changes. Pursuant to the waiver Special Terms and Conditions (STCs), the report includes the following:

  1. A detailed description of the composition of current Medicaid hospital payments.
  2. Analysis of Medicaid financing and how the non-federal match is funded.
  3. Estimated cost incurred by hospitals to provide services to Medicaid beneficiaries compared to the cost to the corresponding payments received.
  4. Estimated cost of uncompensated care provided by hospitals and the portion of uncompensated care attributed to charity care.
  5. Analysis of the adequacy of Medicaid payments in relation to cost incurred by hospitals.
  6. Analysis of Texas Medicaid payment adequacy relative to other states.[1]
  7. Assessment of recent economic and environmental trends within Texas that may impact future reimbursement levels and the cost of caring for low-income populations.
  8. Estimated financial impact of: 1) implementing a Medicaid expansion for low-income adults; 2) Medicaid DSH reductions required by the Affordable Care Act (ACA); 3) reestablishing supplemental upper payment limit (UPL) payments; and 4) fully funding Medicaid hospital costs through payment rates.

[1] Note that this portion of the analysis and report were completed by Deloitte Consulting.

Brief & Report

Initiative to Decriminalize Mental Illness: Recommendations for a Treatment Center and Continuum of Care

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The Baton Rouge Area Foundation (BRAF) tapped HMA to assess and recommend a comprehensive model of care for individuals in East Baton Rouge (EBR) Parish with behavioral health and substance use needs who, under the current system in place in EBR, may otherwise end up behind bars. HMA also took into account a model proposed by the Clinical Design Committee, which the BRAF convened.

The report, recently presented to BRAF, provides the following recommendations:

  • Embrace a model of care that promotes a continuum-of-care strategy across the community and that focuses on targeted population health interventions—the provision of services that focus on outcomes for specific groups of people.
  • Plan and implement a set of priority diversion processes and services, modeled after the diversion programs located in Bexar County, Texas, and tailored to meet the needs of the EBR community.
  • Work toward a system of care that over time includes expansion of services anticipated to leverage the results of implementing the recommendations.

The report also lays out business plan and implementation components for the proposed crisis care and diversion center currently being called “the BRidge Center,” that are designed to address the challenges EBR is currently facing, with the goal of stopping the cycle of criminalization of people with behavioral health issues.

The report’s recommendations are based on an analysis of the current East Baton Rouge system of care that is available to support people with behavioral health issues, recommendations offered by over 35 EBR behavioral health and criminal justice leaders, and a review of national best practices and literature.

Brief & Report

HMA Releases Medicaid Managed Care White Paper

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Medicaid Managed Care is the subject of a recently released HMA white paper.

In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

  • Planning and implementation
  • Stakeholder engagement
  • Procurement approaches
  • Outreach and enrollment
  • Contract management and monitoring
Brief & Report

The Value of Medicaid Managed Care

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In “The Value of Medicaid Managed Care,” HMA authors Lisa Shugarman, Jaimie Bern and Jessica Foster review the literature describing the evolving Medicaid delivery system, focusing specifically on the growth of Medicaid managed care in the form of comprehensive risk-based managed care (RBMC) organizations. The paper, prepared for United HealthCare, also explores the role of Medicaid RBMC relative to the fee for service (FFS) delivery system and draws comparisons of the experience of these delivery systems from the perspective of the Medicaid beneficiary, the provider, and the state.

The paper concludes by sharing lessons learned from the last decade of Medicaid managed care expansion, including:

  • Planning and implementation
  • Stakeholder engagement
  • Procurement approaches
  • Outreach and enrollment
  • Contract management and monitoring
Brief & Report

HMA’s Smith Part of NAMD Panel Reviewing Medicaid at 50

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HMA Managing Principal Vern Smith was one of four experts who took part in the plenary panel discussion “Medicaid at 50: Past, Present and Future” at the National Association of Medicaid Directors (NAMD) fall conference Tuesday. He was joined by:

  • Thomas Betlach, NAMD President, Arizona Medicaid Director, AHCCCS
  • Deborah Bachrach, Partner, Manatt, Phelps & Phillips LLP
  • Charles Milligan, Jr., CEO, UnitedHealthcare Community & State – New Mexico

The tenures of these Medicaid agency leaders have spanned the history of Medicaid. They discussed how Medicaid has fundamentally transformed from its origins in 1965, and what the future of the program holds. Judith Moore, co-author of Medicaid Politics and Policy, and a health policy consultant, moderated the panel which followed the keynote address of Secretary Sylvia Mathews Burwell of the U.S. Department of Health and Human Services.

Click here to see the discussion as it appears in the video archive of C-Span3.

Brief & Report

Report Examines Provider Network Monitoring Practices

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HMA released findings from a qualitative study this week in the report, “Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans.”

The study examined the standards and practices that state agencies and health plans use to ensure access to care in the period following implementation of the Affordable Care Act (ACA). The report was prepared by HMA’s Karen Brodsky, Diana Rodin, and Barbara Smith with support from the State Health Reform Assistance Network, a Robert Wood Johnson Foundation program.

Based on evidence gathered through surveys of and interviews with key informants in state agencies and plans, the study explores the standards applied by commercial insurance regulators and Medicaid agencies and the practices actually employed by Medicaid managed care organizations (MMCOs) and Qualified Health Plans (QHPs) in Marketplaces to form provider networks and monitor performance.

While the response sample is small, the information provided paints a picture of the range of standards and practices used and the challenges faced, which provides a basis for identifying gaps in current understanding and strategies and opportunities for developing best practices. Among the report’s key findings:

  • Network standards differ significantly between state insurance regulators and Medicaid agencies
  • Health plans report they are exceeding states’ network standards
  • Few states track provider network overlap across plans.
Brief & Report

Making Affordable Care Act Coverage a Reality: A National Examination of Provider Network Monitoring Practices by States and Health Plans

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This qualitative study examines the standards and practices that state agencies and health plans use to ensure access to care in the period following the implementation of the Affordable Care Act (ACA). Based on evidence gathered through surveys of and interviews with key informants in state agencies and plans, the study explores the standards applied by commercial insurance regulators and Medicaid agencies and the practices actually employed by Medicaid managed care organizations (MMCOs) and Qualified Health Plans (QHPs) in Marketplaces to form provider networks and monitor performance. While the response sample is small, the information provided paints a picture of the range of standards and practices used and the challenges faced, which provides a basis for identifying gaps in current understanding and strategies and opportunities for developing best practices.

Brief & Report

A Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs

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HMA Senior Consultant Ellen Breslin prepared this recently released primer for the Massachusetts Medicaid Policy Institute. It includes:

  • An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
  • The overall process for setting Medicaid managed care capitation rates; and
  • The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.
Brief & Report

HMA’s Breslin Authors Primer on Medicaid Managed Care Capitation Rates

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HMA Senior Consultant Ellen Breslin prepared the recently released “Primer on Medicaid Managed Care Capitation Rates: Understanding How MassHealth Pays MCOs” for the Massachusetts Medicaid Policy Institute. It includes:

  • An explanation of how state Medicaid programs generally pay their managed care organizations (MCOs)
  • The overall process for setting Medicaid managed care capitation rates; and
  • The various tools states use to mitigate the risks that MCOs face when they assume financial responsibility for Medicaid members.
Brief & Report

Medicaid Enrollment & Spending Growth: FY 2015 & 2016

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This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Vernon K. Smith and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation authored this brief.

Executive Summary

Beginning in Fiscal Year (FY) 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state FY 2015 and state FY 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described in this report.

Brief & Report

Medicaid Enrollment & Spending Growth: FY 2015 & 2016

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This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

HMA Managing Principal Vernon K. Smith and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation authored this brief.

Executive Summary

Beginning in Fiscal Year (FY) 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state FY 2015 and state FY 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described in this report.

Brief & Report

Annual Survey Finds ACA Drove Record Annual Increases in Enrollment, Total Medicaid Spending

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The Affordable Care Act’s Medicaid expansion resulted in record increases in Medicaid enrollment and spending nationally in fiscal year 2015, with both rising an average of nearly 14 percent. This is just one finding in the 15th annual 50-state Medicaid budget survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

Released Oct. 15, this report provides an in-depth examination of the changes taking place in state Medicaid programs across the country. Health Management Associates conducted the survey of Medicaid directors across the country. The survey shows big differences across states driven largely by the states’ decisions on the Medicaid expansion and also provides an examination of state Medicaid policy and program changes across the country. 

HMA Managing Principals Vernon K. Smith, Kathleen Gifford and Eileen Ellis authored the report along with Robin Rudowitz, Laura Snyder and Elizabeth Hinton of the Kaiser Family Foundation.

Two additional issue briefs were developed as well:

Medicaid Enrollment & Spending Growth: FY 2015 & 2016, which provides an analysis of national trends in Medicaid enrollment and spending.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Three States in FY 2015 and 2016, a collection of three case studies of Medicaid programs in Alaska, California and Tennessee.