Answering The Question – Who Can Afford Their Health Services?

Executive Briefing | June 24, 2017
Monica E. Oss Can Americans afford the health care services they need? That question is a big part of the current debate – from premium rates under the Patient Protection & Affordable Care Act (PPACA) to the proposed provisions in the recently released health care bill from the U.S. Senate. The answer depends on who you are talking about and how you frame the question. But I want to share some statistics that can help us to think about the question. In the U.S., the broad population is generally covered by two systems – one for non-disabled people under 65 and the other people who are 65+. Today, I want to focus on the over-65 population. For that population, according to a recent report from the United...

The Medicaid Health Plan Secondary Carve-Out Market Landscape: The OPEN MINDS 2017 Annual Update

Market Intell Report | April 18 2017
In a primary behavioral health carve-out, a state Medicaid program delegates some or all behavioral health benefits to a separate management entity. In a secondary carve-out, Medicaid contracts with a health plan to manage all benefits, including behavioral health. The health plan then sub-contracts with another organization (a behavioral health care management organization) to manage behavioral health services. Management...

California Medicaid Health Homes Program Launching In July 2018

News Report | June 25 2017
On May 4, 2017, the California Department of Health Care Services (DHCS) announced that the state would implement the Medi-Cal (California Medicaid) Health Homes Program (HHP) beginning on July 1, 2018. Following a three-phase launch schedule, a total of 29 counties will implement the HHP to serve beneficiaries with chronic conditions, including substance use disorder (SUD) and serious mental illness...

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