Medicaid Expansions

States expanding Medicaid eligibility under the ACA can substantially expedite Medicaid enrollment and retention for SNAP participants, 97 percent of whom will qualify for Medicaid, according to this study. Even in states where SNAP provides broad-based categorical eligibility that extends SNAP’s gross income limits to at least 185 percent of the federal poverty level, 94 percent of SNAP recipients will qualify for Medicaid. Data showing SNAP receipt can thus verify Medicaid applicants’ financial eligibility, allow administrative renewal for Medicaid beneficiaries, and facilitate Medicaid enrollment for numerous eligible consumers when expanded coverage begins in early 2014.

This brief examines the cost and use of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance coverage or were uninsured. The analysis controls for a wide array of factors that also influence utilization and spending in an effort to isolate the specific effects of Medicaid coverage. Consistent with previous research, the analysis underscores how Medicaid facilitates access to care for program beneficiaries.

Accountable care organizations (ACOs) are gaining momentum in Medicaid as an innovative model to improve health care quality and reduce costs. As states design ACO programs for Medicaid populations, they must identify a robust set of quality measures that align with state and national goals and include a diverse array of measures to accurately evaluate the program's success. This technical assistance tool was developed to help states select quality measures for Medicaid ACO programs. It can be used to facilitate quality strategy discussions with the Centers for Medicare & Medicaid Services to achieve regulatory approval.

This chart, prepared by Manatt Health Solutions, allows states to explore different mechanisms to address the cost-sharing cliff in the Exchange and also to promote continuity of coverage and care as consumers transition across Insurance Affordability Programs. The chart provides a side-by-side analysis of coverage alternatives under state and federal consideration including: the Basic Health Program (BHP); the Bridge Plan; Qualified Health Plan (QHP) Premium and Cost-Sharing Support; maintaining existing Medicaid expansions above 133 percent FPL; and Premium Assistance. These options are compared against subsidized QHP coverage available under the ACA.

Medicaid cost $432 billion in 2011, and Medicaid spending is expected to grow to $795 billion by 2021. Concerns over Medicaid’s contribution to fiscal pressures at both the federal and state levels have led some policy makers to urge reforms. One such proposed reform would be to impose a cap on the amount of federal spending per Medicaid beneficiary, or what’s called a “per capita cap,” so that any program spending growth would be linked to enrollment, not rising per beneficiary spending. This policy brief examines the issues surrounding per capita caps in Medicaid and explores other policy options for states and the federal government.