Overview

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Medicaid is a government program that pays for the healthcare of low-income Americans. In this course, we discuss how the federal government, individual states, and private systems interact to fund, regulate, and deliver healthcare under this system. We establish a basic history and structure under the law, and give a general overview of funding, trends, similarities and differences between states, and some states' attempts to integrate social determinants of health into healthcare. It ends with a more detailed look at the Arizona Healthcare Cost Containment System as an example of one state Medicaid program. We start at the most basic level, but build upon it to provide a solid overview of the most important aspects of Medicaid policy. This course should be accessible and relevant to anyone new to Medicaid, regardless of whether you have no prior exposure to policy or are a lawyer or seasoned policy analyst. Our target audience includes: policy advisors, lawyers, advocates, legislators, employees of Medicaid agencies, employees of nonprofits and MCOs, and students.

Syllabus

Medicaid and the Government

This first module focuses on how Medicaid fits into government systems, a basic overview of Medicaid, and the historical context. We start with some basics you may already be familiar with, but quickly build upon them as a foundation for understanding where policy decisions are made.

Delivery Systems & Managed Care

Kirin and Asha discuss healthcare delivery systems, focusing on managed care – a delivery system in which third party managed care organizations (MCOs) coordinate care for members and the state Medicaid agency pays MCOs rather than paying providers directly.

State Plans

Kirin and Asha discuss state plans, which are the blueprints for establishing all important details about how a state structures and administers its Medicaid program. We also talk about how state plans can be amended and circumstances under which a state can request permission to "break the rules" using a waiver.

Social Determinants of Health (SDoH)

Kirin and Asha talk about how state Medicaid programs are increasingly going beyond providing traditional healthcare services and adding programs and services that improve member health through things like healthy housing, reliable transportation, and nutritious food.

Medicaid Finance

In this module, Kirin and Asha discuss how the federal contribution to Medicaid funding is calculated, how state budgets work, and what policy arguments are made with regard to Medicaid spending and structure.

Medicaid in Arizona (optional)

Kirin and Asha visit a single state in more depth. Part I gives an overview of the Arizona Healthcare Cost Containment System (AHCCCS), including: the history, structure of the agency, its influence on national trends, the benefits provided, costs, and the dual eligible population. In part II, special guest Markay Adams explains how the tribal healthcare system intersects with Medicaid in Arizona.