Edward Alan Miller

Medicaid is the largest grant-in-aid program in the United States. Reform in this area, therefore, provides a unique opportunity to study the intersection between federal and state policy making in an area recently characterized by substantial uncertainty deriving from the lingering effects of the Great Recession, ongoing debate over the federal budget, and implementation of the Patient Protection and Affordable Care Act. Invariably states reform the way health care is delivered, regulated, and financed within broader parameters established by federal statutes and regulations. It is critical therefore that effective strategies be put into place if both current and future health and long-term care reform efforts are to have their greatest chances at success. Rhode Island is the first state to receive permission to operate its entire Medicaid program under a global cap. As a consequence, it has entered the national consciousness as a key data point potentially supporting the block grant approach to Medicaid reform.In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.

Medicaid is the largest grant-in-aid program in the United States. Reform in this area, therefore, provides a unique opportunity to study the intersection between federal and state policy making in an area recently characterized by substantial uncertainty deriving from the lingering effects of the Great Recession, ongoing debate over the federal budget, and implementation of the Patient Protection and Affordable Care Act. Invariably states reform the way health care is delivered, regulated, and financed within broader parameters established by federal statutes and regulations. It is critical therefore that effective strategies be put into place if both current and future health and long-term care reform efforts are to have their greatest chances at success. Rhode Island is the first state to receive permission to operate its entire Medicaid program under a global cap. As a consequence, it has entered the national consciousness as a key data point potentially supporting the block grant approach to Medicaid reform.In this book, Edward Alan Miller identifies factors that either facilitated or impeded the design and implementation of Rhode Island’s Global Consumer Choice Compact Medicaid Waiver in order to draw broader lessons for the Medicaid block grant debate and health and long-term care reform more generally. Evidence gathered from archival sources and in-depth interviews with key stakeholders exposes the role that provider capacity has played in the implementation process, including adult day care, assisted living, home maker, and other home- and community-based services. The impact of the Global Waiver on the nursing home sector is examined as well, in addition to new authority to obtain federal matching dollars for previously state-only funded programs. By providing a sophisticated understanding of factors enhancing or impeding state health reform, this book will contribute to improvements in the development and administration of policy development at both the state- and federal-levels.

Information technology has dramatically changed our lives in areas ranging from commerce and entertainment to voting. Now, policy advocates and government officials hope to bring the benefits of enhanced information technology to health care. Already, consumers can access a tremendous amount of medical information online. Some physicians encourage patients to use email or web messaging to manage simple medical issues. Increasingly, health care products can be purchased electronically.Yet the promise of e-health remains largely unfulfilled. Digital Medicine investigates the factors limiting digital technology's ability to remake health care. It explores the political, social, and ethical challenges presented by online health care, as well as the impact that racial, ethnic, and other disparities are having on the e-health revolution. It examines the accessibility of health-related websites for different populations and asks how we can close access gaps and ensure the reliability and trustworthiness of the information presented online.Darrell West and Edward Miller use multiple sources, including original survey research and website analysis, to study the content, sponsorship status, and public usage of health care-related websites, as well as the relationship between e-health utilization and attitudes about health care in the United States. They also explore the use of health information technology in other countries. The result is an important contribution to our understanding of health information innovation in America and around the world.

In exploring integration of acute and long-tern care, this book begins by characterising the dually eligible population, and describing problems associated with meeting their health and social service needs in an uncoordinated system. It continues by analysing the advantages of using capitation and care management as a vehicle for integrating those services, and by discussing concerns about care integration strategies. It concludes by profiling nine federal and state programs that to varying degrees, integrate the acute and long-term care services that people who are dually eligible for Medicare-Medicaid, often require. They are: Federal initiatives such as the Program for All-inclusive Care of the Elderly (PACE), which capitates both Medicare and Medicaid acute and long-term care services for those who are dually eligible, and the Social/Health Maintenance Organization (S/HMO) and EverCare demonstrations, which capitate Medicare benefits only; Comprehensive state demonstrations such as Minnesota Senior Health Options, the Wisconsin Partnership Program, and the Continuing Care Network Demonstration of Monroe County, New York, which, like PACE, capitates both Medicare and Medicaid benefits; and Capitated state Medicaid demonstrations such as the Arizona Long-Term Care System, Oregon Health Plan, and Florida's Community-Based Diversion Pilot Project, which capitate Medicaid only, but actively pursue various Medicare co-ordination strategies. Proposals that explore using care management techniques to integrate Medicare and Medicaid services delivery, without capitation, are also discussed briefly. The book concludes with the observation that although federal and state initiatives to integrate acute and long-term care for those who are dually eligible, only serve a relatively small percentage of this population, they provide a set of options which Congress may want to examine when formulating long-term care policy in the future.

Shortly after the beginning of the 20th century, the federal government entered a new phase -- the rise of the administrative state. Among the forces propelling this development was the Progressive Movement, which sought greater government engagement with and regulation of various sectors of American society. An autonomous Department of Labor, with Cabinet status, was established in 1913, along with the Federal Reserve. The Federal Trade Commission was created the following year. With the entry of the United States into World War I, regulatory activities further expanded, and the number of administrative agencies and federal employees increased. With the post-war era, the expansion of the federal government momentarily slowed, but began again with the onset of the Great Depression and the launching of the New Deal. The colossus that was constructed to combat the national economic emergency was soon refashioned and augmented to enable the United States to victoriously end a world war. With the return to peace in 1945, the federal government stood as a giant complex organisation, with over 3.8 million employees. During the next 45 years, it would continue to expand in terms of both its principal units and resources. In the immediate past few years, however, some downsizing has occurred. This book reviews trends regarding various aspects of the operations of the federal government during the past 50 years, as evidenced by personnel, budget, and other data. It also identifies and discusses, in cameo form, various developments during the period that are considered significant for federal operations during the next century. Some of these are crafted innovations, such as mission performance planning and measurement; some are imposed restraints, such as the Supreme Court's Chadha decision rendering so-called congressional or legislative vetoes unconstitutional. Some developments are still evolving, such as the electronic government phenomenon, and await conclusive assessment.