Medicaid: Issues and Challenges

Research Issues: Dually Eligible Medicare and Medicaid Beneficiaries, Challenges and Opportunities

This overview describes the Medicare and Medicaid dually eligible beneficiaries, and it summarizes challenges in obtaining information and designing health care and supportive systems across the continuum of their needs. Some of the challenges include: the complexities of Medicaid eligibility, key structural differences between Medicare and Medicaid, long-standing data limitations, and determin...

Medicaid: Issues and Challenges for Health Coverage of the Low-Income Population

Coverage decision-making in Medicaid managed care: key issues in developing managed care contracts.

Coverage provisions are the most complex part of any managed care contract. This is particularly true for Medicaid agencies, because of important differences between Medicaid and insurance. This Issue Brief identifies general issues that should be addressed by States as managed care contracts are developed and drafted, and it specifically explores the challenges faced by public purchasers when ...

Reconciling Practice and Theory: Challenges in Monitoring Medicaid Managed-Care Quality

The massive shift to managed care in many State Medicaid programs heightens the importance of identifying effective approaches to promote and oversee quality in plans serving Medicaid enrollees. This article reviews operational issues and lessons from the ongoing evaluation of a three-State demonstration of the Health Care Financing Administration's (HCFA) Quality Assurance Reform Initiative (Q...

Studying prescription drug use and outcomes with medicaid claims data: strengths, limitations, and strategies.

Medicaid claims and eligibility data, particularly when linked to other sources of patient-level and contextual information, represent a powerful and under-used resource for health services research on the use and outcomes of prescription drugs. However, their effective use poses many methodological and inferential challenges. This article reviews strengths, limitations, challenges, and recomme...