State Children’s Health Insurance Program – The Children’s Health Insurance Program (CHIP) is a partnership between the federal and state governments that provides health coverage to uninsured children whose families earn too much to qualify for Medicaid, but too little to afford private health coverage.
Further reading
Qualified Medicare Beneficiaries – There are several programs to help people pay their Medicare expenses: The Qualified Medicare Beneficiary or QMB program; the Specified Low-income Medicare Beneficiary or SLMB program; and the Qualifying Individual or QI program.
Further reading
The Office of Management and Budget (OMB) is the largest office within the Executive Office of the President of the United States (EOP). OMB’s most prominent function is to produce the President’s Budget,[2] but OMB also measures the quality of agency programs, policies, and procedures to see if they comply with the president’s policies and coordinates inter-agency policy initiatives.
The current OMB Director is Mick Mulvaney. The OMB Director reports to the President, Vice President and the White House Chief of Staff.
Further reading
The Office of the Actuary conducts and directs the actuarial program for CMS and directs the development of and methodologies for macroeconomic analysis of health care financing issues.
Performs actuarial, economic and demographic studies to estimate CMS program expenditures under current law and under proposed modifications to current law.
Provides program estimates for use in the President’s budget and for reports required by Congress.
Studies questions concerned with financing present and future health programs, evaluates operations of the Federal Hospital Insurance Trust Fund and Supplementary Medical Insurance Trust Fund and performs microanalyses for the purpose of assessing the impact of various health care financing factors upon the costs of Federal programs.
Estimates the financial effects of proposals to create national health insurance systems or other national or incremental health insurance reform.
Develops and conducts studies to estimate and project national and area health expenditures.
Develops, maintains, and updates provider market basket input price indexes and the Medicare Economic Index.
Analyzes data on physicians’ costs and charges to develop payment indices and monitors expansion of service and inflation of costs in the health care sector.
Performs actuarial reviews and audits of employee benefit expenses charged to Medicare by fiscal intermediaries and carriers.
Publishes cost projections and economic analyses, and provides actuarial, technical advice and consultation to CMS components, governmental components, Congress, and outside organizations.
Further reading
https://www.cms.gov/About-CMS/Agency-Information/CMSLeadership/Office_OACT.html
Medicaid Statistical Information System – The 25 MSIS statistical tables contain national state-by-state data. These tables contain high-level aggregated statistics relating to Medicaid eligibility and claims data.
Further reading
Jim Milanowski is the conference chairperson for the upcoming Health Plan Innovations for Care Coordination Conference in Scottsdale, AZ on September 13th – 14th. Use code MM300 for $300 off your registration HERE!
Medicaid Who’s Who: Jim Milanowski – President and Chief Executive Officer of the Genesee Health Plan
1. What segment of the industry are you currently involved?
A: I run the Genesee Health Plan. We provide an outpatient health care coverage to those who do not qualify for the Medicaid Expansion or the ACA, or are waiting to enroll/become eligible for these coverages. Our staff are all trained to enroll people in the Medicaid Expansion or the ACA exchange. Finally, we do member onboarding and health risk assessments for Medicaid Expansion enrollees for two Medicaid Health Plans.
2. How many years have you been in the Medicaid industry?
A: I have been in the Medicaid industry for over 25 years, starting off as a Case Manager for mental health clients.
3. What is your focus/passion? (Industry related or not)
A: With understanding of health care coverage being so overwhelming to most people, making sure that the people we assist are educated on what coverage they qualify for and how to use their health benefit to becoming healthier.
4. What is the top item on your “bucket list?”
A: I am a big sports fan, so attending a Super Bowl would be right at the top, especially if the Detroit Lions would ever make it.
5. What do you enjoy doing most with your personal time?
A: Spending time with my two sons, who are 22 and 18. They still like hanging out with their father!
6. Who is your favorite historical figure and why?
A: Abraham Lincoln. During a stressful and chaotic time in our history, he stayed focus on the task at hand and found time to spend with his family.
7. What is your favorite junk food?
A: Pizza
8. Of what accomplishment are you most proud?
A: Our organization, Genesee Health Plan has provided hands on assistance to over 75,000 county residents in the last ten years.
9. For what one thing do you wish you could get a mulligan?
A: When the ACA came out in 2014, we spent that original open enrollment period getting as many people enrolled into coverage as quickly as possible, without spending an adequate time one on one educating them on options and benefits. We have slowed down our approach since that first year.
10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
A: 1. Deciding what happens with Medicaid funding at the national level.
2. To start developing a health care safety net if Medicaid Expansion goes away.
Jim Milanowski is the conference chairperson for the upcoming Health Plan Innovations for Care Coordination Conference in Scottsdale, AZ on September 13th – 14th. Use code MM300 for $300 off your registration HERE!
The Medicaid Analytic eXtract (MAX) data is a set of person-level data files on Medicaid eligibility, service utilization, and payments. The MAX data are created to support research and policy analysis. The MAX data are extracted from the Medicaid Statistical Information System (MSIS). The MAX development process combines MSIS initial claims, interim claims, voids, and adjustments for a given service into final action events.
Further reading
Department of Health and Human Services – HHS administers more than 100 programs across its operating divisions. HHS programs protect the health of all Americans and provide essential human services, especially for those who are least able to help themselves.
Further reading
Health Plan Employer Data and Information Set –
HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an “apples-to-apples” basis. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts.
HEDIS measures address a broad range of important health issues. Among them are the following:
Asthma Medication Use
Persistence of Beta-Blocker Treatment after a Heart Attack
Controlling High Blood Pressure
Comprehensive Diabetes Care
Breast Cancer Screening
Antidepressant Medication Management
Childhood and Adolescent Immunization Status
Childhood and Adult Weight/BMI Assessment
Further reading
http://www.ncqa.org/hedis-quality-measurement/what-is-hedis
A lot happens in Medicaid in 30 days. We covered it all in 60 minutes. Join Cathy Huff, Craigan Gray, Ray Hanley and Clay Farris for updates and insights into the Medicaid industry you won’t find anywhere else.
