Medicaid Expansions

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.

In 2008, Oregon initiated a limited expansion of its Medicaid program for low-income adults through a lottery drawing of approximately 30,000 names from a waiting list of almost 90,000 persons. Selected adults won the opportunity to apply for Medicaid and to enroll if they met eligibility requirements. The researchers used the random assignment embedded in the Oregon Medicaid lottery to examine the effects of insurance coverage on health care use and health outcomes after approximately 2 years. They found that insurance led to increased access to and utilization of health care, substantial improvements in mental health, and reductions in financial strain.

In this 2-page FAQ, CMCS reviews the premium assistance option under Medicaid. It also provides further detail for states interested in submitting demonstration proposals for providing premium assistance in the individual market.

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.