Medicaid Expansions

The final rule reducing Medicaid disproportionate share hospital (DSH) payments had few changes from the proposed rule. It cuts $500 million in fiscal 2014 and $600 million in fiscal 2015 allotments. The rule also defines the five factors that will be considered to generate a state-specific reduction allotment amount and establishes additional reporting requirements for the new DSH methodology.

Between 2010 and 2012, nearly one-third (32 percent) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. Yet, fewer than half the states are currently planning to expand their Medicaid programs. In those states that have not yet decided to expand, as many as two of five (42 percent) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law.

A key method of stabilizing Medicaid coverage is to provide beneficiaries with twelve months of continuous eligibility. Following the passage of the Children’s Health Insurance Program Reauthorization Act in 2009, seven states adopted the continuous-eligibility option for children. That policy change led to a 1.8-percentage-point increase in the average length of child enrollment during fiscal year 2010 and increased annual costs for children by about 2.2 percent. The Medicaid and CHIP Payment and Access Commission has recommended offering states the option of giving adults twelve-month continuous eligibility for Medicaid. This study’s findings suggest that continuous eligibility could promote more stable coverage for adults enrolled in Medicaid at a modest cost.

This brief lays out the major factors that states have considered in estimating the cost of a potential Medicaid expansion, provides examples of state fiscal impact analyses, and highlights the tools created through the State Health Reform Assistance Network that additional states can use to inform their fiscal analyses as they consider the Medicaid expansion decision.

This brief examines the role of Medicaid in providing health coverage to the 9.6 million Medicare beneficiaries who are also eligible for Medicaid. The brief explains the role Medicaid plays in providing supplemental coverage to fill in the gaps in Medicare’s coverage for these dual-eligible beneficiaries. It explains how Medicare beneficiaries become eligible for Medicaid, provides national and state-by-state data on enrollment, and examines national and state-specific data on Medicaid spending for dual-eligible beneficiaries by service and eligibility group.