Medicaid Expansions

The Medicaid primary care rate increase, a provision of the Affordable Care Act, requires Medicaid programs to reimburse primary care providers at Medicare levels for two years. The increase was intended to ensure sufficient provider participation as the Medicaid population expands. As the temporary provision enters its final months, a number of state and federal policymakers are considering extending the rate increase into 2015 and beyond. This new brief draws from interviews with policy experts and stakeholders across the country to assesses the policy's successes and failures. The brief examines the rate increase through the provider's lens, reviews its impact in meeting access and quality goals, and outlines considerations for states interested in extending and strengthening the provision to better meet its goals.

States across the country are embracing integrated care delivery models as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with both physical and behavioral health needs. The Medicaid expansion authorized by the ACA brings greater import to these efforts, as millions of previously uninsured low-income adults—many at increased risk of having behavioral health conditions—gain coverage. Drawing on a review of the literature and interviews with consumers, providers, payers, and policymakers, this report explores strategies states are deploying to promote integrated care for this medically complex and high-cost Medicaid population.
 

This report series explains how expanding Medicaid would give uninsured Americans access to affordable health insurance, create a healthier workforce, and strengthen state economies. The series focuses on 10 states: Alabama, Florida, Indiana, Missouri, North Carolina, Pennsylvania, Tennessee, Texas, Utah, and Virginia. These reports show that, in these states, more than half of the residents who could benefit from Medicaid expansion are working adults, and that they work in occupations that make up the foundation of the state’s economy.
 

Twenty-six states and the District of Columbia are now implementing health reform’s Medicaid expansion. Arkansas, Iowa, and Michigan have expanded through federally approved Medicaid demonstration projects, or “waivers.” This brief considers the guardrails the federal government has established so far around what is and is not permissible in a Medicaid expansion waiver, and provides useful lessons for policymakers in states considering whether to expand Medicaid.
 

Reducing readmissions is a national priority for payers, providers, and policymakers seeking to improve health care and lower costs, and readmissions are a significant issue among patients with Medicaid. This guide from AHRQ is designed to help acute care facilities adapt or expand existing Medicaid readmission reduction efforts; develop Medicaid readmission reduction strategies using the guide’s roadmap featuring 13 customizable online tools; comply with the Centers for Medicare and Medicaid Services’ Conditions of Participation requirements for standard, improved and transitional care for all patients; and develop partnerships across other settings. The guide is the only federal tool available that is tailored to the adult Medicaid population.