Examines two generations of Social HMOs (S/HMO I and S/HMO II), models of managed care that incorporate additional long-term care benefits and care coordination services for Medicare beneficiaries. Finds that one of the three S/HMO I plans examined has implemented innovative geriatric...

Congress mandated in the Balanced Budget Refinement Act of 1999 (BBRA) that the Secretary of the U.S. Department of Health and Human Services conduct an independent comprehensive study of the State Children’s Health Insurance Program (SCHIP). The evaluation was funded through the $10...

Identifies promising practices and lessons learned from grantees operating with limited financial resources.

Health insurance coverage in New Jersey is threatened on all sides: private insurance coverage is eroding; the number of uninsured individuals is growing; and state budget pressure, combined with federal policy pressure, could lead to public insurance coverage cutbacks. This issue brief presents...

The issue of risk selection is especially important for states that enroll blind and disabled beneficiaries of Supplemental Security Income (SSI) in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and...

Reviews Tennessee's experience setting, monitoring, and updating capitation rates for Medicaid managed behavioral health care and draws lessons for other states. Finds that the initial behavioral health rate was inadequate, primarily because of the way available information was used, rather than...

Looks at first-year experiences in HI, RI, and TN, finding quick design, limited opportunities for stakeholder input, and implementation problems, especially with enrollment. All three states were able to attract and retain managed care organizations in the first year.

This case study discusses trends in new Medicaid and SCHIP enrollment of children in New Jersey from 1999 through 2003. New Jersey’s ambitious effort to insure children eligible for Medicaid or NJ FamilyCare was slowed by administrative difficulties.