Medicaid Expansions

This letter to state health officials and Medicaid directors clarifies and expands upon the opportunities for facilitating Medicaid and the Children’s Health Insurance Program (CHIP) enrollment. In particular, it is offering states a new opportunity under Medicaid state plan authority to use Supplemental Nutrition Assistance Program (SNAP) gross income to support Medicaid income eligibility determinations at both initial application and renewals for certain populations.

Since the June 2012 Supreme Court decision effectively made Medicaid expansion under the ACA optional for states, the effects of the Medicaid expansion on state budgets and economies have been key issues for policymakers. This brief provides some insight into the underlying economic and fiscal conditions in expansion and non-expansion states leading up to 2014. The brief will provide a framework against which to measure the impact of expansion decisions going forward.

Through the Medicaid Accountable Care Organization Learning Collaborative, the Center for Health Care Strategies has developed a library of practical resources for states considering and implementing accountable care organizations (ACOs) for Medicaid populations. These resources are designed to help states and provider organizations develop and launch Medicaid ACOs.

A health insurance marketplace renewal process that accounts for both enrollee convenience and the changing value of financial assistance from year to year will likely play an important role in maintaining overall enrollment and long-term sustainability for state-based marketplaces. Through marketplace enrollment data and interviews with marketplace officials, insurer representatives and navigators, this paper examines how six state-based marketplaces experienced the first year of renewals. It finds that while the marketplaces approached renewals differently, they faced similar challenges, but were successful overall in retaining a substantial proportion of their 2014 enrollees.

As millions of Americans gain Medicaid coverage under the ACA, attention has focused on the access to care, quality of care, and financial protection that coverage provides. This analysis explores these questions by comparing the experiences of working-age adults with private insurance, Medicaid beneficiaries, and those who are uninsured. The survey findings suggest that Medicaid coverage provides access to care that in most aspects is comparable to private insurance. Adults with Medicaid coverage reported better care experiences on most measures than those who had been uninsured during the year. Medicaid beneficiaries also seem better protected from the cost of illness than are uninsured adults, as well as those with private coverage.