Medicaid Expansions

This brief provides an overview of the health and mental health needs of girls and boys in the juvenile justice system and the role of Medicaid in addressing those needs. It focuses on the circumstances of those girls and boys who are placed in juvenile justice residential facilities, the discontinuity of Medicaid coverage for those youth, and the options for improving coverage, continuity of care and access to needed services post-discharge, including new opportunities provided by the Affordable Care Act.
 

This set of FAQs released by CMS provides information regarding eligibility, benefits and cost-sharing for Basic Health Program (BHP) enrollees, and additional details about BHP administration, contracting, and financing by state governments. CMS is currently developing a BHP Blueprint template, and will be making it available to states shortly.
 

This paper provides an overview of states’ efforts to finance, through Medicaid, the services that supportive housing residents need to achieve both housing and health stability. As evidence continues to establish supportive housing as an intervention that stabilizes people with chronic illnesses and/or behavioral health conditions and reduces health system costs, states are exploring ways to better utilize health care financing for the services that supportive housing residents need. This paper summarizes how Illinois, Louisiana, Massachusetts, Minnesota, New York, the City of Philadelphia, Rhode Island, Texas and Washington are exploring ways to add housing services as Medicaid reimbursable services for supportive housing populations.
 

New data released by the Centers for Medicare and Medicaid Services (CMS) shows that as of the end of March 2014, Medicaid and CHIP enrollment had increased by over 4.8 million people since open enrollment began for the new Health Insurance Marketplaces in October 2013. These data help provide insight into how the ACA is impacting Medicaid enrollment, which has been a keen focus and subject of debate. However, understanding the ACA’s impact on Medicaid enrollment remains complex given that the ACA promotes increased Medicaid enrollment in varied ways, including changes in eligibility, modernization and simplification of enrollment processes, and increased outreach and enrollment efforts. This brief discusses the data and its interpretation to assess the influence of the ACA on Medicaid enrollment.
 

This report is the fifth in a series of monthly reports on state Medicaid and Children’s Health Insurance Program (CHIP) data, and represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of February 2014, which coincides with the fifth month of the initial open enrollment period for the Health Insurance Marketplace. This report includes state data and analysis regarding applications to Medicaid and CHIP agencies and the State Based Marketplaces (SBMs) and eligibility determinations made by the Medicaid and CHIP agencies. New for this month, this report also includes state data on total enrollment in the Medicaid and CHIP programs.

This brief reviews the literature on the impact of premiums and cost sharing on enrollment, service utilization, and health status. It focuses particularly on how the research consensus fits with the flexibility Medicaid law gives states to establish premiums and cost sharing. It also highlights changes brought about by new cost sharing regulations and discusses the legal and policy ramifications of proposals by some states to charge Medicaid beneficiaries even higher cost sharing and premiums.
 

This study is the first to offer a detailed look at medical spending burden levels, defined as total family medical out-of-pocket spending as a proportion of income, for each state. It further investigates which states have greater shares of individuals with high burden levels and no Medicaid coverage, but would be Medicaid eligible under the 2014 rules of the Affordable Care Act should their state choose to participate in the expansion. This work suggests which states have the largest populations likely to benefit, in terms of lowering medical spending burden, from participating in the 2014 adult Medicaid expansions.
 

The ACA has dramatically increased the number of low-income nonelderly adults eligible for Medicaid. Starting in 2014, states can elect to cover individuals and families with modified adjusted gross incomes below a threshold of 133 percent of federal poverty guidelines, with a 5 percent income disregard. This study uses simulation methods and data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA’s Medicaid expansion and thus newly eligible for coverage. Although differences in health across the groups were not large, both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees.
 

Effective outreach, enrollment, and retention efforts are essential for ensuring that these new coverage opportunities under the ACA translate into increased coverage. One potential avenue for targeted outreach is through text messaging and other mobile technology, which has become an increasingly common source of communication, particularly among low-income adults targeted by the coverage expansions. To provide greater insight into the potential role of text messaging as an outreach vehicle, this brief focuses on the use of standard cell phones and smartphones for text messages and internet access and illustrates how one text messaging initiative, Text4baby, a free, personalized maternal child health education text messaging service for pregnant women and new mothers, is helping eligible pregnant women and their families connect to health coverage.
 

Under the ACA, changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults. This report provides state-by-state estimates of potential eligibility changes (“churning”) if all states expanded Medicaid under health reform, and identifies predictors of rates of churning within states. The authors found that, even in states with the least churning, more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months. Policy options for states to reduce the frequency and impact of coverage changes include adopting twelve-month continuous eligibility for adults in Medicaid, creating a Basic Health Program, using Medicaid funds to subsidize Marketplace coverage for low-income adults, and encouraging the same health insurers to offer plans in Medicaid and the Marketplaces.