Medicaid Expansions

Opponents of Medicaid expansion claim that states need flexibility to promote personal responsibility, ensure appropriate use of health care services, and require work. These critics seek to impose premiums, cost-sharing charges, and work requirements that go well beyond what the Medicaid statute allows. States can, however, use Medicaid to employ a number of strategies to promote personal responsibility and work and ensure appropriate use of health care, which would also help lower Medicaid spending and improve beneficiary health outcomes. These alternatives focus on improving the delivery of care instead of imposing harsh requirements that prevent people from getting care in the first place. Many states have already taken advantage of Medicaid’s existing flexibility to move in this direction.

This proposed rule would extend enhanced funding for Medicaid eligibility systems as part of a state’s mechanized claims processing system, and would update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes would allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems.

In the states that have chosen not to expand their Medicaid program, there are hundreds of thousands of uninsured, low-income Hispanics who are lagging behind on key measures of access to health care. Whether individuals are insured or uninsured greatly affects their ability to obtain regular health care. And in communities of color, where rates of uninsurance and poor health outcomes are higher than in white communities, the differences between those who have insurance and those who lack it are stark. This series of state-by-state reports illustrates the positive effects (in terms of access to care and certain preventive services) of having insurance for low-income Hispanics in states that have not expanded Medicaid.

In this brief, researchers from the Maine Rural Health Research Center present findings from a SHARE-funded evaluation of the rural implications of Medicaid expansion under the ACA. The authors examine the following issues: the extent to which prior public health insurance expansions have covered rural populations; whether rural residents who are expected to be newly eligible for Medicaid in 2014 differ from their urban counterparts; the extent to which rural individuals might differentially benefit from the ACA Medicaid expansion in light of the expansion becoming optional; and whether rural enrollees are likely to have adequate access to primary care.