Medicaid Expansions

This analysis uses evidence from the economics and health policy literatures to quantify several important consequences of States’ decisions not to expand Medicaid. That evidence, which is based primarily on careful analysis of the effects of past policy decisions, is necessarily an imperfect guide to the future, and the actual effects of Medicaid expansion under the ACA could be larger or smaller than the estimates presented below. However, this evidence is clear that the consequences of States’ decisions are far‐reaching, with implications for the health and well‐being of their citizens, their economies, and the economy of the Nation as a whole.

This brief describes global and episodic bundling and outlines considerations for state Medicaid agencies when evaluating potential implementation, including the relevance of these strategies for Medicaid agencies employing managed care strategies.

The Centers for Medicare and Medicaid Services preliminary spending and enrollment data from the Medicaid Budget and Expenditure System (MBES) that covers the period from January 2014 through December 2014, during which 27 states including D.C., had implemented Medicaid expansion. This brief examines the MBES data to examine the effect the Medicaid expansion on spending and enrollment.

This study examines the experiences of low-income adults during the first year of the ACA Medicaid expansion in three states that adopted different strategies: Kentucky, which expanded traditional Medicaid coverage; Arkansas, which used the private option; and Texas, which did not expand Medicaid. It found that low-income adults in Kentucky and Arkansas were more likely to be insured and less likely to have problems paying medical bills or affording prescriptions than low-income adults in Texas.

This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements—eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.

\

Many individuals involved in the criminal justice system are now eligible for Medicaid in states that expanded Medicaid under the ACA. Health coverage can provide individuals who are leaving incarceration with access to physical and behavioral health services critical to their successful reentry into the community. This new toolkit highlights the efforts of select states to enroll individuals involved with the criminal justice system. The toolkit is designed to provide state officials with actionable information about policies and practices available to connect justice-involved individuals to health care coverage through Medicaid.

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.

To date, nine states have launched Accountable Care Organization (ACO) programs for all or part of their Medicaid population, and 10 more are actively pursuing ACOs. While state ACO models differ widely, all share the following core components: payment model, quality measurement approach, and data strategy. This brief summarizes these core ACO characteristics and profiles how nine states – CO, IL, IA, ME, MN, NJ, OR, UT, and VT – have incorporated these elements into their Medicaid ACOs. For each state, it outlines key ACO infrastructure; details unique payment, quality, and data approaches; and spotlights one of the state’s Medicaid ACOs.

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.

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.