Medicaid, SCHIP, and Medicare
The Center conducts analyses of developments in Medicaid, SCHIP, and Medicare policies and their impact on health care access, quality, and financing, including tracking and analyzing developments in Federal law and regulations, policy analysis, evaluation of implementation efforts, and identifying areas for future policy changes.
Related Publications
Publications Available Online
Rosenbaum, S. The CMS Medicaid Targeted Case Management Rule: Implications for Special Needs Service Providers and Programs. Center for Health Care Strategies, Inc. April 2008
Rosenbaum, S. CMS' Medicaid Regulations: Implications for Children With Special Health Care Needs. March 2008.
Vernon, J.A., Trujillo, A., Rosenbaum, S., and DeBuono, B. Low Health Literacy: Implications for National Health Policy. October 2007.
Biles, B., and Adrion, E. Payments to Medicare Advantage Plans Exceed Fee-for-Service Costs: Options for Medicare Savings from 2008 Through 2012. The Commonwealth Fund. June 2007.
Rosenbaum, S., Shin, P., DeBuono, B. Achieving Family Health Literacy: The Case for Insuring Children. Department of Health Policy; Pfizer, Inc. June 2007.
Rosenbaum, S., Whittington, R. Parental Health Insurance Coverage as Child Health Policy: Evidence from the Literature. June 2007.
Biles, B., Nicholas, L.H., Cooper, B., Adrion, E., and Guterman, S. The Cost of Privatization: Extra Payments to Medicare Advantage Plans—Updated and Revised. The Commonwealth Fund. November 2006.
Biles, B. and Adrion, E. The Cost of Privatization: Extra Payments to Medicare Advantage Plans; Updated Tables for 2007; February 2007 MA Plan Enrollment, 2007 MA and FFS Payment Rates. Supplemental to Biles, et. al., The Cost of Privatization: Extra Payments to Medicare Advantage Plans—Updated and Revised. The Commonwealth Fund. May 2007.
Shin, P. Finnegan, B., Hughes, L., and Rosenbaum, S. The Medicaid Documentation Requirements: An Initial Assessment of Medicaid Documentation Requirements on Health Centers and Their Patients. With Support from the RCHN Community Health Foundation. May 2007.
Wilensky, S., Whittington, R., and Rosenbaum, S. Strategies for Improving Access to Comprehensive Obesity Prevention and Treatment Services for Medicaid-Enrolled Children. (2006) Supported with a grant from the Robert Wood Johnson Foundation. April 2007.
Rosenbaum, S, Wilensky, S., Cox, M., and Wright, B.D. Reducing Obesity Risks During Childhood: The Role of Public and Private Health Insurance. (2005). April 2007.
Shin, Reilly, and Schwartz. Update on the Status of the Medicaid Prospective Payment System in the States. National Association of Community Health Centers, September 2006
Biles, B., and Adrion, E. Payments to Medicare Advantage Exceed Fee-for-Service Costs: Options for Medicare Savings from 2007 through 2011. Commonwealth Fund. September 2006.
Rosenbaum, S. Defined-Contribution Plans and Limtied-Benefit Arrangments: Implications for Medicaid Beneficiaries. America's Health Insurance Plans (AHIP). September 2006.
Rosenbaum, S., Wilensky, S., Shin, P., and Whittington, R. Managed Care and Medi-Cal Beneficiaries with Disabilities: Assessing Current State Practice in a Changing Federal Policy Environment. The California Endowment. July 2006.
Rosenbaum, S., Shin, P., and Whittington, R.P.T. Laying the Foundation: Health System Reform in New York State and the Primary Care Imperative. June 2006.
Rosenbaum, S. and Shin, P. Health Centers Reauthorization: An Overview of Achievements and Challenges. Kaiser Commission on Medicaid and the Uninsured. March 2006.
Markus, A., Rosenbaum, S., Stein, R.E.K., and Joseph, J. Policy Brief #6: From SCHIP Benefit Design to Individual Coverage Decisions. January 2006.
Shin, P., Rosenbaum, S., and Mauery, D.R. Medicaid's Role in Treating Children in Military Families. The Robert Wood Johnson Foundation. October 2005.
Rosenbaum, S., Wilensky, S., and Shin, P. Achieving "Readiness" in Medi-Cal's Managed Care Expansion for Persons with Disabilities: Issues and Process. The California Endowment. August 2005.
Markus, A., Rosenbaum, S., Stewart, A., and Cox, M. How Medical Claims Simplification Can Impede Delivery of Child Developmental Services. The Commonwealth Fund, August 2005.
Howard, E., Biles, B., Burke, R., Ston, R., Wing, P., McCloskey, K., Henderson, T., Salsberg, E., Nicholas, L.H. Act Now For Your Tomorrow: Final Report of the National Commission on Nursing Workforce for Long-Term Care. April 2005.
Rosenbaum, S., Shin, P. Migrant and Seasonal Farmworkers: Health Insurance Coverage and Access to Care. GW Department of Health Policy, Center for Health Services Research and Policy, Kaiser Commission on Medicaid and the Uninsured. May 2005.
Rosenbaum, S., Mauery, D.R., Shin, P., and Hidalgo, J. National Security and U.S. Child Health Policy: The Origins and Continuing Role of Medicaid and EPSDT. GW Department of Health Policy; The Robert Wood Johnson Foundation. April 2005.
Rosenbaum, S., Markus, A., and Sonosky, C. Public Health Insurance Design for Children: The Evolution from Medicaid to SCHIP. The Journal of Health and Biomedical Law. March 2005. Executive Summary. The Journal of Health & Biomedical Law (JHBL) is published by the Health and Biomedical Law Society of Suffolk University Law School and serves as a national forum for academic discourse regarding the legal and social implications of the dramatic changes in health care and biomedicine.
Kenney, K., Blake, Sarah C., Maloy, K., Ranji, Usha R., Salganicoff, A. Hearing Their Voices: Lessons from the Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA). Kaiser Family Foundation. November 2004.
Rosenbaum, S., Shin, P., and Darnell, J. Economic Stress and the Safety Net: A Health Center Update. Kaiser Commission on Medicaid and the Uninsured, June 2004.
Rosenbaum, S., and Rousseau, D. Teaching Medicaid: A Tool for Health Law Teachers (2004 Update). Kaiser Commission on Medicaid and the Uninsured. May 2004.
Nicholas, L.H., Dallek, G., and Biles, B. Medicare + Choice in Palm Beach: Watching and Waiting? May 2004.
Nicholas, L.H., Dallek, G., and Biles, B. Medicare + Choice in Phoenix, Arizona: So Far So Good? May 2004.
Markus, A., Rosenbaum, S., and Cyprien, S. SCHIP-Enrolled Children with Special Health Care Needs: An Assessment of Coordination Efforts Between State SCHIP and Title V Programs. Kaiser Commission on Medicaid and the Uninsured. March 2004.
Mauery, R.D., Kamoie, B., Blake, S.C., and Levi, J. Public Health Communicable Disease Reporting Laws: Managed Care Organizations' Laboratory Contracting Practices and Their Implications for State Surveillance and Reporting Statutes. Centers for Disease Control and Prevention. October 2003 (Posted February 2004).
Rosenbaum, S., Markus, A., Sonosky, C., Repasch, L., Mauery, D.R, and Schneider, A. Accountability in Medicaid Managed Care: Implications for Pediatric Health Care Quality. December 2003.
Rosenbaum, S., Stewart, A., Cox, M., and Lee, A. The Epidemiology of U.S. Immunization Law: A National Study for The National Immunizations Prgram, Centers for Disease Control and Prevention, Medicaid Coverage of Immunizations for Non-Institutionalized Adults. November 2003.
Shin, P., Jones, K., and Rosenbaum, S. Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-Income Communities. Prepared under a grant from the National Association of Community Health Centers. September 2003.
Lambrew, J., and Briesacher, B. Medicare Prescription Drug Legislation: What It Means for Rural Beneficiaries. Center for American Progress. September 2003.
Rosenbaum, S., Stewart, A., Cox, M., and Mitchell, S. The Epidemiology of U.S. Immunization Law: Mandated Coverage of Immunizations Under State Health Insurance Laws. Download the Executive Summary. Download Coverage Maps. July 2003.
Mauery, R., Collins, J., McCarthy, J., McCullough, C., and Pires, S. Contracting for Coordination of Behavioral Health Services in Privatized Child Welfare and Medicaid Managed Care. Center for Health Care Strategies, Inc. June 2003.
Dallek, G., Biles, B. and Nicholas, L. Policy Brief: Lessons from Medicare+Choice for Medicare Reform, The Commonwealth Fund. June 2003.
Rosenbaum, S., and Shin, P. Health Centers as Safety Net Providers: An Overview and Assessment of Medicaid's Role. Kaiser Family Foundation. May 2003.
Wilensky, S. and Schipani, B. State of the State Addresses: Governors’ Discussions of Budget and Health Care Issues, March 13, 2003
Side-by-Side Analysis of State HIFA
Waivers, Updated as of January 31,
2003
Nolan, L., Kamoie, B., Harvey, J., Vaquerano, L., Blake, S., Chawla, S., Levi, J., and Rosenbaum, S. The Effects of State Dental Practice Laws Allowing Alternative Models of Preventive Oral Health Care Delivery to Low-Income Children. Download the Executive Summary. January 2003.
Rosenbaum, S, and Sonosky, C. Prepaid Ambulatory Health Plans (PAHPs): Implications for Safety Net Providers. December 2002.
Pediatric Managed Care Training Module. Center for Health Services Research and Policy. December 2002.
Maloy, K., Kenney, K., Blake, S., and Proser, M. State Implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000. Centers for Disease Control and Prevention presentation. October 2002.
Rosenbaum, S., Markus, A. Policy Brief #4: State Eligibility Rules under Separate State SCHIP Programs—Implications for Children's Access to Health Care. September 2002.
Rosenbaum, S., Sonosky, C., Shaw, K., and Mauery, D.R. Policy Brief #5: Behavioral Health and Managed Care Contracting Under SCHIP. September 2002.
Harvey, J., Vaquerano, L., Nolan, L., and Sonosky, C. School-Based
Health Centers and Managed Care Arrangements: A Review of State Models
and Implementation Issues. July 2002.
Nolan, L., Harvey, J., Jones, K., Vaquerano, L., and Zuvekas, A. The Impact of the State Children's Health Insurance Program (SCHIP) on Community Health Centers. June, 2002.
Rosenbaum, S., Stewart, A., and Sonosky, C. Negotiating the New Health System: Findings from A Nationwide Study of Medicaid Primary Care Case Management Contracts. Center for Health Care Strategies, Inc. June 2002.
Jensen, A., Silverstein, R., Folkemer, D., and Straw, T. Policy Frameworks for Designing Medicaid Buy-In Programs and Related State Work Incentive Initiatives. View Executive Summary. May 2002.
Jensen, A., Silverstein, R., and Folkemer, D. A Summary Description of the Federal Income Maintenance and Health Care Programs for Disabled Persons Who Are Working or Want to Work. Spring 2002.
Folkemer, D., Jensen, A., Silverstein, R., Straw, T. The Medicaid Buy-In Program: Lessons Learned from Nine 'Early Implementer' States. View Executive Summary. May 2002.
Folkemer, D., Jensen, A., Silverstein, R., Straw, T. Medicaid Buy-In Programs: Case Studies of Early Implementer States. May 2002.
Maloy, K.A., Kenney, K.A., Darnell, J., and Cyprien, S. Can Medicaid Work for Low-Income Families? Kaiser Commission on Medicaid and the Uninsured. April 2002.
Testimony, Lambrew, J., "Issues with a State-Based Low-Income Prescription Drug Benefit for Medicare Beneficiaries," for the Hearing on "Creating a Medicare Prescription Drug Benefit: Assessing Efforts to Help Low-Income Seniors," Committee on Energy and Commerce, U.S. House of Representatives (April 17, 2002) (Download PDF file now)
Daw, C., Dennington, A., Biles, B., and Dallek, G. Medicare+Choice After Five Years: Harris County, TX Site Visit Report. March 2002.(Download PDF file now)
Rosenbaum, S. Health Policy Report: Medicaid, New England Journal of Medicine. Vol. 346, No. 8. February 12, 2002. (Download PDF file now)
Dallek, G., and Dennington, A. Physician Withdrawals: A Major Source of Instability in Medicare+Choice. The Commonwealth Fund. January 2002.
Stuber, J., Dallek, G., Edwards, C., Maloy, K., and Biles, B. Instability and Inequity in Medicare+Choice: The Impact for Medicare Beneficiaries. The Commonwealth Fund, January 2002.
Rosenbaum, S. and Sonosky, C. Caselaw Developments in the Aftermath of Westside Mothers v. Haveman: Emerging Trends. January 2002. (Download PDF file now)
Rosenbaum, S., Shaw, K., and Sonosky, C. SCHIP Policy Brief #3: Managed Care Purchasing Under SCHIP: A Nationwide Analysis of Freestanding SCHIP Contracts. December 2001. (Download PDF file now)
Dallek, G., Biles, B., and Dennington, A. The 2002 Medicare+Choice Plan Lock-In: Should It Be Delayed? New York: The Commonwealth Fund, November 2001. (Download PDF now)
Zuvekas, A. Community Health Center Affiliated Health Plans: A Viable Alternative for Medicaid Managed Care?. Association for Health Center Affiliated Health Plans. November 2001.
Dallek, G., Biles, B., and Dennington, A. Restoring Choice to Medicare+Choice: The Importance of Standardizing Health Plan Benefit Packages. The Commonwealth Fund, October 2001.(Download PDF now)
Stuber, J., Dallek, G., and Biles, B. National and Local Factors Driving Health Plan Withdrawals from Medicare+Choice: Analyses of Seven Medicare+Choice Markets. The Commonwealth Fund, October 2001.(Download PDF now)
Rosenbaum, S., and Sonosky, C. An Analysis of the Bush Administration’s Proposed Medicaid Managed Care Regulations. September 2001. (Download PDF now)
Rosenbaum, S., and Sonosky, C. An Analysis of the Bush Administration’s Proposed Medicaid Managed Care Regulations: A Comparison of Selected Provisions of the January 19, 2001, Medicaid Managed Care Rule and the August 20, 2001, Notice of Proposed Rulemaking (NPRM). September 2001. (Download PDF now)
Sonosky, C. Early Child Development and EPSDT: Opportunities for States, Presentation at the 14th Annual State Health Policy Conference, National Academy for State Health Policy August 13, 2001 (Download pdf file now)
Lambrew, J. Section 1115 Waivers in Medicaid and the State Children's Health Insurance Program: An Overview. Kaiser Commission on Medicaid and the Uninsured. July 2001.
Rosenbaum, S., Proser, M., and Sonosky, C. Health Policy and Early Childhood Development: An Overview. The Commonwealth Fund, July 2001.
Rosenbaum, S., Proser,M., Schneider, A., and Sonosky, C. Room to Grow: Promoting Child Development Through Medicaid and CHIP. The Commonwealth Fund, July 2001.
Rosenbaum, S., and Sonosky, C. Issue Brief: Medicaid Case Management Services and Child Development June 2001. Funded by The Commonwealth Fund. (Available for purchase from National Academy for State Health Policy)
Rosenbaum, S., and Smith, B. SCHIP Policy Brief #1: State SCHIP Design and the Right to Coverage. March 2001. (Download PDF now)
Rosenbaum, S., Markus, A., Sonosky, C., and Repasch, L. SCHIP Policy Brief #2: State Benefit Design Choices under SCHIP. May 2001. (Download PDF now)
Stuber, J., Maloy, K., Edwards, C., and Biles B. Monitoring the Implementationof Medicare+Choice: Hennepin and Ramsey Counties, MN. Site Visit Report. May 2001(Download PDF file now)
Dallek, G., Stuber, J., and Edwards, C. Monitoring the Implementation of Medicare+Choice: Pima County, AZ Site Visit Report. May 2001. (Download PDF file now)
Stuber, J., Maloy, K., Edwards, C., and Biles, B. Monitoring the Implementation of Medicare+Choice: Harris County, TX Site Visit Report. May 2001. (Download PDF file now)
Rosenbaum, S., Borzi, P.C., and Smith, V. Allowing Small Businesses and the Self-Employed to Buy Health Care Coverage Through Public Programs. The Commonwealth Fund. December 2000.
Rosenbaum, S. and Sonosky, C. Federal EPSDT Coverage Policy: An Analysis of State Medicaid Plans and State Medicaid Managed Care Contracts. December 2000.
Rosenbaum, S., Smith, B.M. Behavioral Health Issue Brief 10: Medicare, Managed Care, and Behavioral Health Care. November 2000. 20 pages. 721K
Johnson, K. and Rosenbaum, S. Making Medicaid and SCHIP Work for Working Families. Carnegie Corporation (September 2000). (Click here to order from the Carnegie Corporation)
Stuber, J., Maloy, K.A., Rosenbaum, S., and Jones, K. Beyond Stigma: What Barriers Actually Affect the Decisions of Low-Income Families to Enroll in Medicaid? June 2000. (Download PDF now)
Maloy, K.A., Darnell, J., Nolan, L., Kenney, K.A., and Cyprien, S. Effects of the 1996 Welfare and Immigration Reform Laws on the Ability and Willingness of Immigrants to Access Medicaid and Health Care Services. May 2000.
Rosenbaum S. Olmstead v L.C. Analysis and Implications for Medicaid Policy. Center for Health Care Strategies. May 2000.
Rosenbaum, S. The Olmstead Decision: Implications for Medicaid. Henry J. Kaiser Family Foundation. March 2000.
Wehr, E. Issue Brief: Basic Elements of Care Coordination for Persons with Special Health Care Needs in Medicaid Managed Care. Center for Health Care Strategies, Inc. February 2000.
Kenney, K.A., Maloy, K.A., and Kreling, B.A. Experiences of HIV-Infected Beneficiaries in the Move to Mandatory Medicaid Managed Care in Three States. March 1999.
Maloy, K.A., Rosenbaum, S., Darnell, J,. Silver, K., Kreling, B.A., and Kenney, K.A. Results Of A Multi-Site Study Of Mandatory Medicaid Managed Care Enrollment Systems: Implications For Policy And Practice. March 1999.
Maloy, K.A., Pavetti, Darnell, J., and Shin, P. Diversion as a Work-Oriented Welfare Reform Strategy and Its Effect On Access To Medicaid: An Examination Of The Experiences of Five Local Communities. March 1999. (Download PDF now)
Rosenbaum, S., Markus, A., and Roby, D. An Analysis of Implementation Issues Relating to CHIP Cost-Sharing Provisions for Certain Targeted Low Income Children. Health Resources and Services Administration and the Health Care Financing Administration, Department of Health and Human Services. 1999. (Download PDF now)
Rosenbaum, S., et. al., Section 1115 Medicaid Managed Care Demonstrations: Findings and Implications for Federal Policy, Access to Health Care, Washington, DC: Kaiser Commission on the Future of Medicaid. 1999.
Rosenbaum, S., and Darnell, J. Medicaid Managed Care: An Analysis of the Health Care Financing Administration's Notice of Proposed Rulemaking. Kaiser Commission on Medicaid and the Uninsured. November 1998.
Rosenbaum, S., Teitelbaum, J., and Kirby C. Behavioral Health Issue Brief 2. An Overview of Medicaid Managed Care Litigation. October 1998. 9 pages. 387K
Markus, A., Rosenbaum, S., and Roby, D. CHIP, Health Insurance Premiums and Cost-Sharing: Lessons from the Literature. Prepared for the Health Resources and Services Administration. October 1998. (Download PDF now)
Maloy, K.A., Pavetti, Shin, P., and Darnell, J. A Description and Assessment of State Approaches to Diversion Programs and Activities Under Welfare Reform. August 1998.
Rosenbaum S., and Teitelbaum, J. Coverage Decision-Making in Medicaid Managed Care. The Managed Behavioral Health Care Issue Brief Series #1. May 1998.
Rosenbaum, S., Maloy, K.A., Stuber, J., and Darnell, J. Initial Findings from a Nationwide Study of Outstationed Medicaid Enrollment Programs at Federally Qualified Health Centers. February 1998.
Maloy, K.A., Rosenbaum, S., DeGraw, C., Sonosky, C., and Teitelbaum, J. A Preliminary Study: The Role of Autoenrollment in Mandatory Medicaid Managed Care. Center for Health Care Strategies. 1997.
Rosenbaum, S., and Darnell, J. A Comparison of the Medicaid Provisions in the Balanced Budget Act of 1997 (P.L. 105-33) with Prior Law. Kaiser Commission on Medicaid and the Uninsured. October 1997.
Johnson, K., DeGraw, C., Sonosky, C., Markus, A., and Rosenbaum, S. State Children's Health Insurance Program: 1997 Budget Agreement Provisions. October 1997. (Download PDF now)
Johnson, K., DeGraw, C., Sonosky, C., Markus, A., and Rosenbaum, S. Children's Health Insurance: 1997 Budget Reconciliation Provisions. July 1997. (Download PDF now)
Johnson, K., DeGraw, C., Sonosky, C., Markus, A., and Rosenbaum, S. Children's Health Insurance: A Comparison of Major Federal Legislation. May 1997.(Download PDF now)
Rosenbaum, S., and Darnell, J. Statewide Medicaid Managed Care Demonstrations Under Section 1115 of the Social Security Act: A Review of the Waiver Applications, Letters of Approval, and Special Terms and Conditions. May 1997.
Articles Published in Professional Literature
Markus, A.R., Rosenbaum, S., Sonosky, C., Repasch, L., Mauery, D.R. (2005) State Purchasing and Enforcement of Quality Care for Children in Medicaid and SCHIP Managed Care. Managed Care Interface Vol. 18: No. 6, pp. 24-30.
Nolan, L., Zuvekas, A., Harvey, J., Jones, K., Vaquerano, L., and Regan, J. "Enrolling Uninsured Children in SCHIP: Lessons Learned from Community Health Centers". The Journal of Ambulatory Care Management, Vol. 26, No. 1, January-March 2003, pgs. 51-61.
Rosenbaum, S., and Sonosky, C. Medicaid Reforms and SCHIP: Health Care Coverage and the Changing Policy Environment in Who Speaks for America’s Children: The Role of Child Advocates in Public Policy. DeVita, C, and Mosher-Williams, R, editors. The Urban Institute. 2001. (Link to order online)
Rosenbaum, S., and Rousseau, D. Medicaid at Thirty-Five. Saint Louis University Law Journal, Vol. 45, No. 1, Winter 2001.
Rosenbaum, S. Legal Report: "The Olmstead Decision: Implications for State Health Policy," Health Affairs. September/October 2000.
Rosenbaum, S., Smith, B., Sonosky, C., Repasch, L., and Markus, A. Devolution of Authority and Public Health Insurance Design: National SCHIP Study Reveals An Impact on Low-Income Children. Houston Journal of Health Law and Policy, Vol. 1, No. 1, Symposium 2001.
Smith, B.S., and Rosenbaum, S. Potential Effects of the 'Premium Support' Proposal on the Security of Medicare, JAMA 282:18 (Nov. 10, 1999) pp. 1760-1763.
Rosenbaum, S., and Maloy, K.A. "The Law of Unintended Consequences: The 1996 Personal Responsibility and Work Opportunity Act and Its on Medicaid for Families with Children," Ohio State University Law Review, Vol. 60 No. 4 (1999).
Rosenbaum, S., Johnson, K., Sonosky, C., Markus, A., and DeGraw, C. "The Children's Hour: The State Children's Health Insurance Program," Health Affairs. 1:75-89 January/February, 1998.
Smith, B.M., Trends in Health Care Coverage and Financing and Their Implications for Policy, New England Journal of Medicine (October 2, 1997).
Rosenbaum, S., Shin, P., Mauskopf, A., Funk, K., Stern, G., and Zuvekas, A. Beyond the Freedom to Choose: Medicaid Managed Care and Family Planning. Western Journal of Medicine 1995; 103 [suppl]: 33-38.
Other Publications
Maloy, K.A., and Aguirre-Happoldt, I. How Can Medi-Cal Enrollment be Preserved and Promoted Under CalWORKs? Oakland, CA:The Medi-Cal Policy Institute. June 2000.
