Medicaid Expansions

This survey offers a window into the nation’s Medicaid programs at the 50th anniversary of the program. The survey results demonstrate the variety and coherence among the 56 Medicaid programs, and exemplify the changing job of “Medicaid Director” in the 50 states, the District of Colombia, and the 5 territories. The survey provides unique insight into how Medicaid Directors are managing increasingly sophisticated programs and driving system reform amid funding and staff constraints, and how they navigate the myriad stakeholders to build consensus and drive improvement.

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings in this report are drawn from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report highlights policy changes implemented in state Medicaid programs in FY 2015 and those planned for implementation in FY 2016 based on information provided by the nation’s state Medicaid directors. Policy changes and initiatives described in this report include those in eligibility and enrollment, managed care, delivery and payment system reforms, provider payment rates, and covered benefits. The report also looks at the key issues and challenges now facing Medicaid programs.

Access to oral health care for low-income adults is a persistent challenge in the U.S. Poor oral health can elevate risks for chronic conditions such as diabetes and heart disease, and can lead to lost workdays, reduced employability, and the preventable use of costly acute care. As many states expand Medicaid coverage for adults through the ACA, there are new opportunities to expand much-needed dental coverage and avoid the dangerous and costly consequences of untreated dental disease. This fact sheet identifies key challenges related to oral health care access and utilization for low-income adults, and outlines states’ current coverage of dental benefits for adults in Medicaid. It also suggests opportunities for states to increase oral health care coverage and access for this population.

The ACA required Medicaid to cover all children with incomes up to 138 percent of the federal poverty level (FPL) as of January 2014. Whereas all states were previously required to cover children under age 6 in families with incomes up to 138 percent of FPL and children ages 6 to 18 up to 100 percent of FPL through Medicaid, children ages 6 to 18 with family incomes between 100 and 138 percent of FPL were permitted to be covered through separate CHIP. At the time the ACA was enacted, 21 states covered these so-called “stairstep” children through separate CHIP and thus needed to transition them to Medicaid in order to comply with the ACA requirement. Such a transition raises concerns about continuity of coverage and access for children transitioning, along with concerns about potential confusion for parents and providers. This report describes 10 states’ approaches to the transition, identifying common challenges and lessons learned that could support future transitions between health coverage programs.
 

Similar to other reports recently released, new data examining hospital discharges in 16 states show increases in Medicaid discharges and declines in uninsured or self-pay discharges in states that implemented the Medicaid expansion. These trends hold true for all hospital discharges as well as for specific services such as mental health or asthma. This information adds to a growing body of evidence demonstrating how coverage expansions are affecting providers and may lead to decreases in uncompensated care for the uninsured.