The FY 2017 National Defense Authorization Act required DOD to develop and use value-based initiatives in its TRICARE health care program. Value-based healthcare pays providers based on improved health outcomes, enhanced care for patients, and reduced health care costs over time (instead of the volume of services provided). DOD identified 20 potential initiatives and: Has implemented 5, including...

Medicaid is administered at the state level and overseen at the federal level. State Medicaid officials identified some federal policies that pose challenges for effective program administration. For example: Residents of certain mental health institutions are generally excluded from Medicaid coverage. This can make it harder to offer a full range of services to people with complex or changing m...

Eligible for both Medicare and Medicaid? In certain states you can get coverage from both programs through “aligned plans,” that is, private plans provided by the same or related companies. This arrangement is intended to better coordinate benefits and care delivery. Some states support the automatic assignment of “dual-eligible” beneficiaries to aligned plans. Finding out more about thes...

More than 9 million active-duty military servicemembers and their families rely on TRICARE health plans. In January 2018, the Department of Defense offered a new plan—TRICARE Select—for beneficiaries who primarily get care from civilian doctors. We looked at beneficiary surveys from before and after the new plan. These survey results were similar after the switch to TRICARE Select. However, m...

The Defense Department’s TRICARE program pays for health care services for more than 9 million beneficiaries. Congress in 2016 required DOD, among other things, to come up with a strategy to improve TRICARE that addressed 13 specific elements related to health care delivery—including provider networks, telehealth services, and referrals, among others. DOD has partially implemented 6 of these...

Medicaid is the largest source of federal funding for services that treat drug and alcohol addictions. We looked at state Medicaid programs’ changes to what they pay for these services from 2014–2019. Most state Medicaid programs increased payment rates for at least one addiction treatment service (e.g., counseling); rate decreases were less common. Higher rate increases can encourage more a...

If drug manufacturers want certain drugs covered by Medicaid, they must participate in both “340B” and Medicaid Drug Rebate programs. The 340B program allows certain hospitals and clinics to buy discounted drugs. The rebate program allows state Medicaid programs to request manufacturer rebates on certain drugs dispensed to their beneficiaries. Drugs that hospitals and clinics buy through 340B...

DOD offers health care through contractors with TRICARE, its regional health care program. In July 2016, DOD awarded its fourth generation of TRICARE contracts, which consolidated two regions. DOD provided a transition period for its incoming and outgoing contractors, after which the incoming contractors assumed responsibility for delivering health care. The incoming contractors had trouble meeti...

States must screen and enroll health care providers in Medicaid according to federal and state rules. These rules are designed to exclude providers who don’t meet minimum standards, which can help prevent fraud, waste, and abuse. Congress established new federal rules in 2010 and 2016, yet officials we spoke with in 5 of 7 states said they haven’t implemented all of them. The Centers for Medi...

For the first time, some states are requiring Medicaid beneficiaries to report work or other activities like training in order to keep their Medicaid coverage. As of July, the Centers for Medicare & Medicaid Services (CMS) had approved 9 states’ requests to test these requirements. We found that costs to administer work requirements may range from millions to hundreds of millions of dollars per...