Medicaid Expansions

The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes.

One of the significant changes brought about by the Affordable Care Act (ACA) is the introduction of a new methodology to evaluate eligibility for Insurance Affordability Programs (IAPs): Modified Adjusted Gross Income (MAGI). MAGI will be used to evaluate available income for most Medicaid and Children’s Health Insurance Program (CHIP) applicants and enrollees beginning in 2014. MAGI will also be used to determine eligibility for Advance Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs) through the health insurance Marketplaces.  This Advocate’s Guide explains how MAGI works, and sets forth the guidelines that CMS has developed to implement and govern this new methodology.

At the National Academy for State Health Policy’s Annual Conference in October 2013, Dr. Leininger presented on one potential method that Medicaid agencies can use to prepare for the the health needs of its new enrollment population under the ACA. This presentation reviews Dr. Leininger's findings on the feasability of embedding a health needs assessment into Medicaid applications to predict this population's future health needs.

Between 2010 and 2012, nearly one-third (32 percent) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. Yet, fewer than half the states are currently planning to expand their Medicaid programs. In those states that have not yet decided to expand, as many as two of five (42 percent) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law.

A key method of stabilizing Medicaid coverage is to provide beneficiaries with twelve months of continuous eligibility. Following the passage of the Children’s Health Insurance Program Reauthorization Act in 2009, seven states adopted the continuous-eligibility option for children. That policy change led to a 1.8-percentage-point increase in the average length of child enrollment during fiscal year 2010 and increased annual costs for children by about 2.2 percent. The Medicaid and CHIP Payment and Access Commission has recommended offering states the option of giving adults twelve-month continuous eligibility for Medicaid. This study’s findings suggest that continuous eligibility could promote more stable coverage for adults enrolled in Medicaid at a modest cost.