Senior and Persons with Disability Use of California's LTSS Programs
June 2016
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Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility
January 2016
Among individuals dually-enrolled in Medicaid and Medicare in California, researchers from UCSF found that total health care expenditures were substantially higher for those receiving long-term services and supports (LTSS) in a nursing home rather than through home and community based services. The difference in total costs was related to LTSS expenditures and not to differences in acute and post-acute care expenses. The paper describing the research and results is published in Medical Care.
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Service Use and Expenditures Before and After Entry into California’s LTSS Programs
April 2014
The final report in CaMRI’s series on the use of long-term support services (LTSS) in California examines the patterns of health care related events and expenditures that preceded and followed the initiation of LTSS, as well as the pattern of LTSS use following a hospitalization. Nearly 475,000 adults who were beneficiaries in both the Medicaid and Medicare program and who initiated at least some type of LTSS over a two-year period were included in the study. The report concludes with policy considerations for the CA Department of Health Care Services, the agency that administers the state’s Medicaid program.
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California County Profiles of Medi-Cal Beneficiaries Who Use Long-Term Services and Supports in 2008
February 2014
This publication follows on previous reports describing the population who uses Medi-Cal-funded long-term services and supports (LTSS). It describes key characteristics of the population using LTSS across each of the state’s 58 counties, including each county’s spending and service use patterns. County-specific data files that accompany this report can be found at: http://camri.ucsf.edu/sites/camri.ucsf.edu/files/HCBS-County-Tables.pdf.
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Extended Nursing Facility Stays Among California's Dual Eligible and Medi-Cal Only Beneficiaries, 2006-2008
September 2013
Adult Medi-Cal beneficiaries who are admitted to nursing facilities for extended stays are profiled in this report and examined to determine whether the high costs of Medi-Cal's nursing facility services are justified on the basis of health need. The study also evaluates the use of community-based services (HCBS) to support community living in this population and finds these services are underutilized.
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Smooth Transitions into Medi-Cal: Ensuring Continuity of Coverage for Low Income Health Program Enrollees
April 2013
This policy brief focuses on the transition of the 470,000 poorest enrollees in California’s Low-Income Health Program (LIHP) into a state-operated Medi-Cal program, as part of the Affordable Care Act’s implementation in 2014. One-third of those potentially eligible for the Medicaid expansion in California have already been enrolled in the LIHP. Key transition issues and challenges are outlined in the brief.
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Promoting Enrollment of Low Income Health Program Participants in Covered California
April 2013
The policy brief focuses on transition planning for the 27,000 higher income enrollees in California’s Low Income Health Program (LIHP) that will be eligible for sizeable federal subsidies in the state-based health insurance exchange, Covered California. Enrollees will be moving into a complex system of premium payment, plan choice, subsidies and cost-sharing -- and their engagement in the transition is necessary to result in enrollment in health plans by January 1, 2014. Recommendations to promote a successful transition are included in the brief.
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Medi-Cal Beneficiaries Who Use Long Term Services and Supports: Profiles of Utilization and Spending in Eight Dual Eligible Integration Counties, 2008
February 2013
This report provides detailed demographic and health care spending data among recipients of long term services and supports in each of the eight counties selected by California's Department of Health Care Services as demonstration sites for their Coordinated Care Initiative (CCI). The Initiative is intended to better integrate the financing and services of Medi-Cal and Medicare for those dually eligible for both Medicare and Medi-Cal programs. The analysis uses CAMRI's linked database of Medi-Cal and Medicare claims and assessment data for recipients of long-term services and support.
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California Hospitals 2010: EHR Adoption, Meaningful Use, and Health Information Exchange
February 2013
Findings from an analysis of California hospitals responding to the 2010 American Hospital Association annual survey on their adoption of an electronic health record (EHR) are reported here. Most California hospitals had made progress towards Stage I meaningful use objectives and would likely receive the corresponding incentive payments from Medicaid. However, hospitals that scored lower on a meaningful use index were those with larger Medicaid populations, small hospitals, and rural hospitals – and they will have a more difficult time meeting Stage II objectives for any further incentive payments.
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Use of Electronic Health Records by Nurse Practitioners and Nurse Midwives
February 2013
Nurse practitioners and certified nurse midwives qualify for Medicaid financial incentives for meaningful adoption of electronic health records (EHR) if they practice outside of hospitals and at least 30% of their patients are enrolled in Medicaid. A survey was conducted in 2011 to assess their use of EHRs prior to the incentive program. About 20% (an estimated 2,216) of these types of advanced practice nurses appear to be eligible for Medicaid incentive payments. The report details the variation in EHR meaningful use by practice type and setting.
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Medicaid and Medicare Spending on Acute, Post-Acute and Long-Term Services and Supports in California
December 2012
As part of a partnership between the University of California and the California Department of Health Care Services (DHCS), the CAMRI developed an integrated and longitudinal database containing Medi-Cal and Medicare claims and assessment data of LTSS recipients in California in 2008. CAMRI's integrated database provides opportunities to look at program spending across the entire care continuum of beneficiaries with LTSS needs within Medi-Cal and, for MMEs, across Medicare and Medi-Cal. To assist policymakers in targeting programmatic interventions and better identifying opportunities for cost containment, this report describes the categories of services with high and low relative costs.
FactSheet (pdf)
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Successful Strategies for Increasing Enrollment in California's Low Income Health Program (LIHP)
September 2012
More than 400,000 Californians had ever enrolled in California's Low Income Health Program (LIHP) as of March 2012. These LIHP enrollees, who would otherwise be underinsured or uninsured, now have access to services through their county's safety net facilities and contracted providers. This policy note highlights innovative and successful strategies for outreach, enrollment, and redetermination and retention, as well as the challenges faced by LIHPs.
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Recipients of Home and Community-Based Services in California
June 2012
This report describes the demographic characteristic, home and community-based service (HCBS) use, functional level of care needs, and rates of nursing home admissions and mortality for HCBS recipients in California. Findings are based on CAMRIs integrated dataset of Medi-Cal, Medicare, and other state claims and assessment files describing LTSS recipients in Medi-Cal and those dually enrolled in Medicare.
FactSheet (pdf)
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On the Road to Meaningful Use of EHRs: A Survey of California Physicians
June 2012
The report provides findings from a survey of California physicians about their current use of EHRs and their eligibility for a federal incentive program to implement them.
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Studying Recipients of Long-Term Care Services and Supports: A Case Study in Assembling Medicaid and Medicare Claims and Assessment Data in California
November 2011
This report describes the process CAMRI underwent with its state and federal partners to assemble, link and clean Medicare, Medicaid, and other state data for the analysis of California's recipients of home and community-based services between calendar years (CYs) 2005-2008.
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Medi-Cal MDM Pilot Project: Cost Savings Assessment and Proposed Evaluation Design
September 2011
Findings in this report are based on an evidence-based literature review and a cost model with sensitivity analyses to assess potential savings to help inform decisions about proceeding with a proposed project to implement a HOme and Community-Based Medication Dispensing Machine (MDM).
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California's Medi-Cal Home & Community Based Services Waivers, Benefits & Eligibility Policies, 2005-2008
August 2011
This report provides information about Medi-Cal's home and community-based services waivers (HCBS) and state plan programs providing long term services and supports. It describes the benefits and eligibility criteria for each of California's HCBS Medicaid waiver programs operating during 2005-2008.
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The Rapid Evaluation of Performance System
August 2011
Final Report to the Department of Health Care Services on the implementation of, successes, and barriers faced with the Rapid Evaluation Performance System.
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Differences In The Volume Of Services And In Prices Drive Big Variations In Medicaid Spending Among US States And Regions
July 2011
Description and source analysis of interstate variation in Medicaid spending over several years.