Document Type

Report

Publication Date

9-13-2006

Publisher

George Washington University, School of Public Health and Health Services, Department of Health Policy, Geiger Gibson Program in Community Health Policy

Keywords

Medical Necessity

Abstract

This Policy Brief explores the implications of state Medicaid reforms – whether implemented either as §1115 demonstrations or as part of state plan flexibility measures under the Deficit Reduction Act of 2005 (P.L. 109-171) – that limit benefits, coverage, and payments for medically necessary health care. Following a background and overview, the Policy Brief identifies a series of considerations that come into play when states approach the issue of benefit re-design, particularly in the context of developing coverage innovations that utilize "consumerdriven" and "defined-contribution" arrangements. As used in this Policy Brief, the term "defined-contribution" means the payment of a flat, per-capita amount toward the cost of health plan enrollment, regardless of benefit design or actual health care utilization and cost. The term "limited-benefit" plan means a health plan whose benefit and coverage design is narrower and more restricted than that utilized under "traditional" Medicaid benefit design. The use of more limited "alternative benefit" arrangements is now permitted for certain beneficiary groups under the DRA.

Comments

Funder: Supported by a gift to the Geiger Gibson Program in Community Health Policy by America's Health Insurance Plans (AHIP).

Open Access

1

Included in

Health Policy Commons

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.