News Briefs

Kaiser Commission update on state Medicaid budgets: Midway through the 2012 fiscal year (FY), the Kaiser Commission on Medicaid and the Uninsured held structured discussions with leading Medicaid directors and sent e-mail surveys to the remaining states. For most states, the growth in Medicaid spending and enrollment is equal to or below original projections for FY 2012, the commission found, and most states do not anticipate significant midyear cuts. However ten states—California, Colorado, Louisiana, Maine, Maryland, North Carolina, Pennsylvania, Tennessee, Washington and West Virginia—are trying to close 2012 budget gaps by making midyear revisions, including restricting additional benefits and provider payment rates. Looking ahead to FY 2013, many states are planning to take advantage of new opportunities available under the Affordable Care Act (ACA) to integrate care for persons dually eligible for Medicare and Medicaid. Many states are also preparing to implement the ACA Medicaid coverage expansion in 2014, and several states are moving forward with creating insurance exchanges. States will continue to face the dual challenges of implementing health care reform and coping with another year of budget shortfalls heading into FY 2013. The eight-page report is available on the Kaiser Commission Web site at www.kff.org/medicaid/upload/8277.pdf.

Key issues in Medicaid managed care for people with disabilities: As many states expand use of managed care in Medicaid, more beneficiaries with disabilities are being enrolled in risk-based managed care arrangements for at least some of their care. Further growth in managed care is expected in 2014, when the ACA expands Medicaid eligibility to many uninsured low-income adults. A 17-page brief released by the Kaiser Commission examines issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities. Drawing on existing research, the brief highlights policy considerations related to setting plan payment rates, developing adequate provider networks and delivery systems, and ensuring sufficient beneficiary protections and plan oversight. The brief considers the wide range of intensive and specialized medical and long-term care needs facing Medicaid beneficiaries with disabilities that may include traumatic brain injuries, autism, Alzheimer's disease, and severe mental illness and the challenges that states face in designing effective managed care programs that successfully meet those needs. The issue brief is available on the Kaiser Commission site at www.kff.org/medicaid/upload/8278.pdf.

AHRQ resources on the patient-centered medical home: Two new resources—a “decision-maker brief” and a white paper—from the Agency for Healthcare Research and Quality (AHRQ) discuss how to improve the quality of the evidence and evaluations for the patient-centered medical home (PCMH) to ensure optimal policy decisions. The brief describes why effective evaluations of medical home demonstrations are needed and how best to commission them. It provides insights into the choice of appropriate outcomes to assess and the need to include control practices and account for clustering in evaluations. The white paper provides information about how to determine the effect sizes a given study can expect to detect, identifies the number of patients and practices required to detect achievable effects, and demonstrates how evaluators can select the outcomes and types of patients included in analyses to improve a study's ability to detect true effects. The 53-page white paper and the four-page issue brief are available from the AHRQ's PCMH Resource Center at pcmh.ahrq.gov.

MHA Web site on shared decision making: Mental Health America (MHA) has launched a new Web site, “You're on the Team,” designed to promote shared decision making in mental health treatment. The site is designed to separately educate consumers and providers on how the process works, how it can help them, and how to handle difficult issues. At the heart of the site are videos introducing shared decision making in mental health treatment and demonstrating how it works. MHA president and CEO David Shern, Ph.D., and Allen Dyer, M.D., a psychiatrist, explain the concept. During an office visit, Randy lays out his concerns to Dr. Dyer about new side effects that undermine his performance at work. Randy shares a checklist that he completed at the suggestion of Cicely, a peer specialist. He and Dr. Dyer discuss possible solutions and find one that Randy is willing to try. The site (www.mentalhealthamerica.net/go/youreontheteam) also features an extensive list of links to helpful external resources on shared decision making.

Federal blueprint to provide integrated care to Asian Americans: As part of its ongoing commitment to eliminate disparities in behavioral health for racial and ethnic minority populations, the Office of Minority Health of the U.S. Department of Health and Human Services partnered with the National Asian American Pacific Islander Mental Health Association to convene a summit meeting in August 2011 of more than 40 key stakeholders committed to improving the quality of life for Asian American, Native Hawaiian, and Pacific Islander communities. The stakeholders' goal was to develop a national agenda to address the health and behavioral health needs of these populations through integrated care. Recommendations to promote integrated care in four areas are presented, including strategies to eliminate disparities, workforce development and training, community-based participatory research and evaluation, and health information technology. The 43-page document, Integrated Care for Asian Americans, Native Hawaiians, and Pacific Islanders Communities: A Blueprint for Action, is available at www.integration.samhsa.gov.

CDC report documents high cost of child abuse. A new report from the Centers for Disease Control and Prevention found that the negative effects of child maltreatment over a survivor's lifetime generate many costs that have impacts on the U.S. health care, education, criminal justice, and welfare systems. The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse, and neglect) is approximately $124 billion, according to the report. The study looked at confirmed child maltreatment cases in the United States for a 12-month period (1,740 fatal and 579,000 nonfatal cases); the costs estimated were for childhood and adult medical care, child welfare, criminal justice, special education, and productivity losses. The lifetime cost for each victim who lived was comparable to other costly health conditions, such as stroke or type 2 diabetes. The article, “The Economic Burden of Child Maltreatment in the United States and Implications for Prevention,” appears in the journal Child Abuse and Neglect and is available at www.sciencedirect.com/science/journal/aip/01452134.